10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

FORM 10-Q

☒ Quarterly Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

for the quarterly period ended June 30, 2019

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 HOLDINGS, INC.

(Exact name of registrant as specified in its charter)

Delaware	20-3341405
(State or Other Jurisdiction of Incorporation or Organization)	(I.R.S. Employer Identification No.)

31700 Research Park Drive

Madison Heights, Michigan 48071

(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 Class	Trading Symbol(s)	Name of Each Exchange on which Registered
Common Stock, par value $0.0001 per share	INFU	NYSE 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 during the past 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  ☒    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  ☒    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 filer ☐	Non-accelerated filer ☒	Smaller reporting company ☒
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 Securities Exchange Act).    Yes  ☐    No   ☒

As of August 9, 2019, 19,782,548 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
PART I -	FINANCIAL INFORMATION
Item 1.	Financial Statements		3
	-Unaudited Condensed Consolidated Balance Sheets as of June 30, 2019 and December 31, 2018
	-Unaudited Condensed Consolidated Statements of Operations for the three and six months ended June 30, 2019 and 2018
	-Unaudited Condensed Consolidated Statements of Stockholders’ Equity for the three and six months ended June 30, 2019 and 2018
	-Unaudited Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2019 and 2018
	-Notes to the Unaudited Condensed Consolidated Financial Statements
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations		15
Item 3.	Quantitative and Qualitative Disclosures About Market Risk		20
Item 4.	Controls and Procedures		20
PART II -	OTHER INFORMATION
Item 1.	Legal Proceedings		20
Item 1A.	Risk Factors		20
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds		21
Item 3.	Defaults Upon Senior Securities		21
Item 4.	Mine Safety Disclosures		21
Item 5.	Other Information		21
Item 6.	Exhibits		22
	Signatures		22

PART I—FINANCIAL INFORMATION  

Item 1. Financial Statements

INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(UNAUDITED)

	As of
	June 30,			December 31,
(in thousands, except share data)	2019			2018
ASSETS
Current assets:
Cash and cash equivalents	$	1,702		$	4,318
Accounts receivable, net		11,218			9,593
Inventories		2,742			2,254
Other current assets		1,368			1,372
Total current assets		17,030			17,537
Medical equipment for sale or rental		1,927			1,601
Medical equipment in rental service, net of accumulated depreciation		28,873			23,488
Property & equipment, net of accumulated depreciation		1,539			1,445
Intangible assets, net		17,616			19,865
Operating lease right of use assets		5,182			-
Other assets		194			137
Total assets	$	72,361		$	64,073
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable	$	10,206		$	7,091
Current portion of long-term debt		6,084			4,903
Other current liabilities		4,244			2,796
Total current liabilities		20,534			14,790
Long-term debt, net of current portion		27,478			28,842
Deferred income taxes		76			-
Operating lease liabilities, net of current portion		4,021			-
Total liabilities		52,109			43,632
Stockholders’ equity:
Preferred stock, $.0001 par value: authorized 1,000,000 shares; none issued		-			-
Common stock, $.0001 par value: authorized 200,000,000 shares; issued and outstanding 23,237,703 and 19,719,214, respectively, as of June 30, 2019 and 23,095,513 and 19,577,024, respectively, as of December 31, 2018		2			2
Additional paid-in capital		83,557			83,167
Retained deficit		(63,307	)		(62,728	)
Total stockholders’ equity		20,252			20,441
Total liabilities and stockholders’ equity	$	72,361		$	64,073

See accompanying notes to unaudited condensed consolidated financial statements.

3

INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS 

(UNAUDITED)

	Three Months Ended						Six Months Ended
(in thousands, except share and per share data)	June 30						June 30
	2019			2018			2019			2018
Net revenues	$	19,723		$	16,415		$	37,916		$	32,898
Cost of revenues		8,367			6,729			16,219			12,975
Gross profit		11,356			9,686			21,697			19,923
Selling, general and administrative expenses:
Amortization of intangibles		1,124			1,165			2,249			2,352
Selling and marketing		2,476			2,326			5,078			4,627
General and administrative		6,785			6,399			13,819			12,560
Total selling, general and administrative		10,385			9,890			21,146			19,539
Operating income (loss)		971			(204	)		551			384
Other expense:
Interest expense		(488	)		(296	)		(948	)		(611	)
Other (expense) income		(39	)		1			(60	)		(10	)
Income (loss) before income taxes		444			(499	)		(457	)		(237	)
Provision for income taxes		(63	)		(6	)		(122	)		(64	)
Net income (loss)	$	381		$	(505	)	$	(579	)	$	(301	)
Net income (loss) per share:
Basic	$	0.02		$	(0.02	)	$	(0.03	)	$	(0.01	)
Diluted		0.02			(0.02	)		(0.03	)		(0.01	)
Weighted average shares outstanding:
Basic		19,708,422			22,703,415			19,644,590			22,751,318
Diluted		20,583,434			22,703,415			19,644,590			22,751,318

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						Treasury Stock					Total
				Par Value		Paid in			Retained						Par Value		Stockholders’
(in thousands)	Shares			Amount		Capital			Deficit			Shares			Amount		Equity
Balances at March 31, 2018		23,003		$	2	$	92,659		$	(61,429	)		(230	)	$	-	$	31,232
Stock based shares issued upon vesting - gross		4			-		-			-			-			-		-
Stock-based compensation expense		-			-		114			-			-			-		114
Employee stock purchase plan		25			-		-			-			-			-		-
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		-			-		(5	)		-			-			-		(5	)
Common stock repurchased as part of Repurchase Program		-			-		(1,181	)		-			(348	)		-		(1,181	)
Net loss		-			-		-			(505	)		-			-		(505	)
Balances at June 30, 2018		23,032		$	2	$	91,587		$	(61,934	)		(578	)	$	-	$	29,655
Balances at March 31, 2019		23,221		$	2	$	83,429		$	(63,688	)		(3,518	)	$	-	$	19,743
Stock based shares issued upon vesting - gross		16			-		15			-			-			-		15
Stock-based compensation expense		-			-		284			-			-			-		284
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		-			-		(171	)		-			-			-		(171	)
Net income		-			-		-			381			-			-		381
Balances at June 30, 2019		23,237		$	2	$	83,557		$	(63,307	)		(3,518	)	$	-	$	20,252
Balances at December 31, 2017		22,978		$	2	$	92,584		$	(61,633	)		(198	)	$	-	$	30,953
Stock based shares issued upon vesting - gross		29			-		-			-			-			-		-
Stock-based compensation expense		-			-		226			-			-			-		226
Employee stock purchase plan		25					46											46
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		-			-		(5	)		-			-			-		(5	)
Common stock repurchased as part of Repurchase Program		-			-		(1,264	)		-			(380	)		-		(1,264	)
Net loss		-			-		-			(301	)		-			-		(301	)
Balances at June 30, 2018		23,032		$	2	$	91,587		$	(61,934	)		(578	)	$	-	$	29,655
Balances at December 31, 2018		23,096		$	2	$	83,167		$	(62,728	)		(3,518	)	$	-	$	20,441
Stock based shares issued upon vesting - gross		167			-		15			-			-			-		15
Stock-based compensation expense		-			-		530			-			-			-		530
Employee stock purchase plan		19					53											53
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(45	)		-		(208	)		-			-			-		(208	)
Net loss		-			-		-			(579	)		-			-		(579	)
Balances at June 30, 2019		23,237		$	2	$	83,557		$	(63,307	)		(3,518	)	$	-	$	20,252

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
	2019			2018
(in thousands)
NET CASH PROVIDED BY OPERATING ACTIVITIES	$	4,319		$	4,846
INVESTING ACTIVITIES
Purchase of medical equipment, property and equipment		(7,893	)		(2,743	)
Proceeds from sale of medical equipment, property and equipment		1,333			1,720
NET CASH USED IN INVESTING ACTIVITIES		(6,560	)		(1,023	)
FINANCING ACTIVITIES
Principal payments on term loans, capital lease obligations and other financing		(2,256	)		(3,708	)
Cash proceeds from other financing		2,024			-
Debt issuance costs		(3	)		-
Common stock repurchased to satisfy statutory withholding on employee stock based compensation plans		(208	)		(5	)
Common stock repurchased as part of Repurchase Program		-			(1,264	)
Cash proceeds from stock plans		68			46
NET CASH USED IN FINANCING ACTIVITIES		(375	)		(4,931	)
Net change in cash and cash equivalents		(2,616	)		(1,108	)
Cash and cash equivalents, beginning of period		4,318			3,469
Cash and cash equivalents, end of period	$	1,702		$	2,361

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. The Company provides products and services to hospitals, oncology practices and facilities and other alternative site healthcare providers. Headquartered in Madison Heights, Michigan, the Company delivers local, field-based customer support, and also operates pump repair Centers of Excellence in Michigan, Kansas, California, Massachusetts and Ontario, Canada.

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, 2018 as filed with the SEC.

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.

Certain prior period reclassifications were made to conform with the current period presentation. These reclassifications had no effect on reported income (loss), overall cash flows, total assets, total liabilities or stockholders’ equity as previously reported.

2. Recent Accounting Pronouncements and Developments

In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-13, “Financial Instruments (Topic 326) Credit Losses”. Topic 326 changes the impairment model for most financial assets and certain other instruments. Under the new standard, entities holding financial assets and net investment in leases that are not accounted for at fair value through net income are to be presented at the net amount expected to be collected. An allowance for credit losses will be a valuation account that will be deducted from the amortized cost basis of the financial asset to present the net carrying value at the amount expected to be collected on the financial asset. Topic 326 is effective as of January 1, 2020. Early adoption is permitted. The Company is currently evaluating the impact of Topic 326 on its consolidated balance sheets, statements of operations, statements of cash flows and related disclosures.

7

3. Revenue Recognition

          The following table presents disaggregated revenue by offering type:

	Three Months Ended						Six Months Ended
	June 30						June 30
	2019			2018			2019			2018
Third-Party Payor Rentals		49.4	%		47.5	%		48.8	%		48.0	%
Direct Payor Rentals		33.0	%		38.1	%		33.8	%		38.5	%
Product Sales		17.6	%		14.4	%		17.4	%		13.5	%
Total - Net revenues		100.0	%		100.0	%		100.0	%		100.0	%

4. Medical Equipment

Medical equipment consists of the following (in thousands):

	June 30,			December 31,
	2019			2018
Medical Equipment for sale or rental	$	1,927		$	1,601
Medical Equipment in rental service		68,721			61,429
Medical Equipment in rental service - pump reserve		(614	)		(530	)
Accumulated depreciation		(39,234	)		(37,411	)
Medical Equipment in rental service - net		28,873			23,488
Total	$	30,800		$	25,089

Depreciation expense for medical equipment for the three and six months ended June 30, 2019 was $1.8 million and $3.5 million, respectively, compared to $1.5 million and $3.0 million for the same prior year periods, respectively, which were recorded in “cost of revenues” for each period.

8

5. Property and Equipment

Property and equipment consists of the following (in thousands):

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Depreciation			Total		Gross Assets		Accumulated Depreciation			Total
Furniture, fixtures, and equipment	$	4,025	$	(3,385	)	$	640	$	3,717	$	(3,257	)	$	460
Automobiles		117		(84	)		33		118		(95	)		23
Leasehold improvements		2,002		(1,136	)		866		2,219		(1,257	)		962
Total	$	6,144	$	(4,605	)	$	1,539	$	6,054	$	(4,609	)	$	1,445

Depreciation expense for property and equipment for the three and six months ended June 30, 2019 was $0.1 million and $0.2 million, respectively, compared to $0.1 million and $0.2 million for the same prior year periods, respectively. This expense was recorded in general and administrative expenses.

6. Intangible Assets

The carrying amount and accumulated amortization of intangible assets is comprised of the following (in thousands):

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Amortization			Net		Gross Assets		Accumulated Amortization			Net
Nonamortizable intangible assets
Trade names	$	2,000	$	-		$	2,000	$	2,000	$	-		$	2,000
Amortizable intangible assets:
Trade names		23		(23	)		-		23		(23	)		-
Physician and customer relationships		36,534		(25,362	)		11,172		36,534		(24,175	)		12,359
Non-competition agreements		1,136		(1,136	)		-		1,136		(1,136	)		-
Software		11,230		(6,786	)		4,444		11,230		(5,724	)		5,506
Total nonamortizable and amortizable intangible assets	$	50,923	$	(33,307	)	$	17,616	$	50,923	$	(31,058	)	$	19,865

Amortization expense for the three and six months ended June 30, 2019 was $1.1 million and $2.2 million, respectively, compared to $1.2 million and $2.4 million for the same prior year periods, respectively. Expected annual amortization expense for intangible assets recorded as of June 30, 2019 is as follows (in thousands):

	7/1 -										2024 and
	12/31/2019		2020		2021		2022		2023		thereafter
Amortization expense	$	2,153	$	4,285	$	3,930	$	2,051	$	548	$	2,649

9

7. Debt

On April 15, 2019, the Company sold for $2.0 million and immediately leased back certain medical equipment in rental service to a third party specializing in such transactions. The leaseback term is 36 months. Because the arrangement contains a purchase option that the Company is reasonably certain to exercise, this transaction did not qualify for the sale-leaseback accounting under ASC 842. The medical equipment remains recorded on the accompanying condensed consolidated balance sheet and the proceeds received have been classified as an Other Financing liability, which is being paid off monthly over the term of the lease. The balance of Other Financing as of June 30, 2019 was $1.9 million.

On February 5, 2019, the Company and its primary lender entered into the fifth amendment (the “Fifth Amendment”) to its existing credit facility (the “Credit Agreement”). Among other things, the Fifth Amendment amended the Credit Agreement to (1) increase our borrowing capacity under our existing equipment line to $8.0 million, (2) revise the definition of earnings before interest, taxes, depreciation and amortization, a non-GAAP financial measure, to include additional add-back adjustments for the years ended or ending December 31, 2018 and 2019, (3) revise the definition of fixed charge coverage ratio for the year ending December 31, 2019 to include an unfinanced portion of capital expenditures of up to $7.0 million for the year ending December 31, 2019, (4) revise the Credit Agreement’s maximum permitted indebtedness to finance the acquisition, construction or improvement of any fixed or capital assets and (5) revise the maximum leverage ratio for each of the quarters during December 31, 2018 and December 31, 2019.

As of June 30, 2019, the Company’s term loans and equipment line under its credit facility had balances of $29.2 million and $2.6 million, respectively. The net availability under the revolving credit line under the credit facility is based upon our eligible accounts receivable and eligible inventory and is computed as follows (in thousands):

	June 30,			December 31,
	2019			2018
Revolver:
Gross availability	$	11,000		$	9,973
Outstanding draws		-			-
Letters of credit		(1,750	)		(750	)
Landlord reserves		(71	)		(70	)
Net availability	$	9,179		$	9,153

The Company had future maturities of loans and other financing as of June 30, 2019 as follows (in thousands):

	2019			2020			2021			2022		2023 and thereafter		Total
Term Loan A	$	1,792		$	3,584		$	16,143		$	-	$	-	$	21,519
Term Loan C		921			1,229			5,529			-		-		7,679
Equipment Line		128			512			512			512		898		2,562
Unamortized value of the debt issuance costs		(20	)		(39	)		(39	)		-		-		(98	)
Other financing		301			652			725			222		-		1,900
Total	$	3,122		$	5,938		$	22,870		$	734	$	898	$	33,562

The following is a breakdown of the Company’s current and long-term debt as follows (in thousands):

June 30, 2019										December 31, 2018
	Current Portion			Long-Term Portion			Total				Current Portion			Long-Term Portion			Total
Term Loan A	$	3,584		$	17,935		$	21,519		Term Loan A	$	3,584		$	19,727		$	23,311
Term Loan C		1,536			6,143			7,679		Term Loan C		1,229			6,757			7,986
Equipment Line		384			2,178			2,562		Equipment Line		128			2,434			2,562
Unamortized value of debt issuance costs		(39	)		(59	)		(98	)	Unamortized value of debt issuance costs		(38	)		(76	)		(114	)
Other financing		619			1,281			1,900		Other financing		-			-			-
Total	$	6,084		$	27,478		$	33,562		Total	$	4,903		$	28,842		$	33,745

10

As of June 30, 2019, interest on the credit facility is payable at our option as a (i) Eurodollar Loan, which bears interest at a per annum rate equal to the applicable 30-day London Interbank Offered Rate (“LIBOR”) plus an applicable margin ranging from 2.00% to 3.00% or (ii) CB Floating Rate (“CBFR”) Loan, which bears interest at a per annum rate equal to the greater of (a) the lender’s prime rate or (b) LIBOR plus 2.50%, in each case, plus a margin ranging from -1.00% to 0.25%. The actual rate at June 30, 2019 was 5.19% (LIBOR of 2.44% plus 2.75%). The actual CBFR Loan rate at June 30, 2019 was 5.50% (lender’s prime rate of 5.50%).

As of June 30, 2019, the Company was in compliance with all debt-related covenants under the Credit Agreement.

8. Income Taxes

During both the three and six months ended June 30, 2019, the Company recorded expense provision for income taxes of $0.1 million. The income tax provision relates principally to the Company’s state and local taxes and foreign operations in Canada. During the three and six months ended June 30, 2018, the Company recorded expense provision for income taxes of less than $0.1 million and $0.1 million, respectively.

 The Company’s realization of its deferred tax assets is dependent upon many factors, including, but not limited to, the Company’s ability to generate sufficient taxable income. Management assesses the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. The Company’s management has determined that it is not more likely than not that the Company will recognize the benefits of its federal and state deferred tax assets. Accordingly, the Company had a full valuation allowance for all deferred tax assets at June 30, 2019 and December 31, 2018.

9. Commitments, Contingencies and Litigation

From time to time in the ordinary course of its business, the Company may be involved in legal proceedings, the outcomes of which may not be determinable. The results of litigation 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 involved in any legal proceedings that the Company currently believes could have a material effect on the Company’s financial condition, results of operations or cash flows.

11

10. 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:	2019		2018			2019			2018
Net income (loss) (in thousands)	$	381	$	(505	)	$	(579	)	$	(301	)
Denominator:
Weighted average common shares outstanding:
Basic		19,708,422		22,703,415			19,644,590			22,751,318
Dilutive effect of non-vested awards		875,012		-			-			-
Diluted		20,583,434		22,703,415			19,644,590			22,751,318
Net income (loss) per share:
Basic	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)
Diluted	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)

For the three months ended June 30, 2019, less than 0.1 million of stock options with an exercise price above the current market value of the Company’s common stock were not included in the calculation because they would have an anti-dilutive effect. For the six months ended June 30, 2019 and the three and six months ended June 30, 2018, all options were anti-dilutive due to the Company’s net losses for those periods and therefore not included in the calculation.

11. Leases

On January 1, 2019 (the “Effective Date”), the Company adopted ASU 2016-02, Leases (Topic 842); ASU 2018-10, Codification Improvements to Topic 842, Leases; and ASU 2018-11, Targeted Improvements (collectively, “Topic 842”) using a modified retrospective transition approach, which requires Topic 842 to be applied to all leases existing at the date of initial application. Under Topic 842, lessees are required to recognize a lease liability and right-of-use asset (“ROU asset”) for all leases and to disclose key information about leasing arrangements. Additionally, leases will be classified as either financing or operating; the classification will determine the pattern of expense recognition and classification within the statement of operations. The Company has elected to apply its lease accounting policy only to leases with a term greater than twelve months.

The Effective Date is the Company’s date of initial application. Consequently, our financial information was not updated and the disclosures required under the new standard are not provided for dates and periods prior to January 1, 2019.

Topic 842 provides several optional practical expedients that can be adopted at transition. We have elected the “package of practical expedients”, which does not require us to reassess our prior conclusions regarding lease identification, lease classification and initial direct costs. We did not elect the practical expedient of hindsight to the evaluation of lease options (e.g. renewal).

The most significant effects related to this adoption relate to (i) the recognition of new ROU assets and lease liabilities on our balance sheet for our real estate and equipment operating leases; and (ii) significant new disclosures about our leasing activities. Upon adoption, we recognized approximately $3.1 million in additional operating lease liabilities with corresponding ROU assets of approximately the same amount.

Topic 842 also provides practical expedients for an entity’s ongoing accounting. We have elected the “combining lease and non-lease components” practical expedient and also elected to apply the short-term lease recognition exemption to certain leases; therefore, we did not recognize ROU assets and lease liabilities for these leases.

In adopting Topic 842, we have determined and will continue to determine whether an arrangement is a lease at inception. Our operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next ten years. Our leases do not contain any restrictive covenants. Our office leases generally contain renewal options for periods ranging from one to five years. Because we are 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. Our office leases do not contain any material residual value guarantees. Our equipment leases generally do not contain renewal options. We are not reasonably certain to exercise the renewal options for those equipment leases that do contain renewal options, thus, the options are not considered in determining the lease term and payments associated with the option years are excluded from lease payments.

For our equipment leases, we have used and will use the implicit rate in the lease as the discount rate, when available, otherwise, we use our incremental borrowing rate as the discount rate. For our office leases, the implicit rate is typically not available, so we have used and will use our incremental borrowing rate as the discount rate. Our lease agreements include both lease and non-lease components. We have elected the practical expedient that allows us to combine lease and non-lease components for all of our leases.

12

Payments due under our operating leases include fixed payments as well as variable payments. For our 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 our equipment leases, variable payments may consist of sales taxes, property taxes and other fees.

The components of lease costs for the three and six months ended June 30, 2019 are as follows (in thousands):

	Three Months Ended		Six Months Ended
	June 30, 2019		June 30, 2019
Operating lease cost	$	290	$	677
Variable lease cost		53		126
Total lease cost	$	343	$	803

Operating lease expense for the three and six months ended June 30, 2018 was $0.4 million and $0.7 million, respectively.

Amounts reported in the condensed consolidated balance sheet as of June 30, 2019 for our operating leases are as follows (in thousands):

	June 30, 2019
Operating lease ROU assets	$	5,182
Current operating lease liabilities (included in other current liabilities)	$	1,374
Operating lease liabilities, net of current portion		4,021
Total operating lease liabilities	$	5,395

Supplemental cash flow information and non-cash activity related to our leases are as follows (in thousands):

	Six Months Ended
	June 30, 2019
Cash paid for amounts included in the measurement of lease liabilities and ROU assets:
Operating cash flow from operating leases	$	771
ROU assets obtained in exchange for lease obligations:
Operating leases	$	3,015

13

Weighted average remaining lease terms and discount rates for our leases as of June 30, 2019 are as follows:

	Years
Weighted average remaining lease term:
Operating leases		7.3

	Rate
Weighted average discount rate:
Operating leases		7.5	%

Future maturities of lease liabilities as of June 30, 2019 are as follows (in thousands):

	Operating Leases (a)
2019	$	779
2020		1,262
2021		716
2022		655
2023		666
Thereafter		3,430
Total undiscounted lease payments		7,508
Less: Imputed interest		(2,113	)
Total lease liabilities	$	5,395

(a) Excludes $0.3 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of six years and is expected to commence later in 2019.

The Company disclosed in our 2018 Annual Report on Form 10-K maturities of lease liabilities as of December 31, 2018, in accordance with ASC 840. During the quarter ended March 31, 2019, the Company determined that it improperly included certain lease commitments in the maturities table as of December 31, 2018 in Note 10 of the 2018 Annual Report on Form 10-K. The table overstated our lease maturities as follows (in thousands): $121 in 2019, $370 in 2020, $381 in 2021, $392 in 2022, $404 in 2023 and $2,528 in the thereafter period.

The Company assessed the materiality of this error, considering both the qualitative and quantitative factors and determined that for the year ended December 31, 2018, the error was immaterial. The Company has decided to correct this immaterial error as a revision to our previously issued financial statements by adjusting the maturities of the lease liabilities as of December 31, 2018 for the overstated amounts as reflected in the table below (in thousands):

				Operating
	Capital Leases			Leases (As Revised)		Total (As Revised)
2019	$	33		$	1,745	$	1,778
2020		-			1,347		1,347
2021		-			726		726
2022		-			624		624
2023		-			636		636
Thereafter		-			3,071		3,071
Total require payments	$	33		$	8,149	$	8,182
Less amounts representing interest (3.5%)		-
Present value of minimum lease payments		33
Less current maturities		(33	)
Long-term capital lease liability	$	-

14

Item 2.     Management’s Discussion and Analysis of Financial Condition and Results of Operations

The terms “InfuSystem”, the “Company”, “we”, “our” and “us” used herein refer to InfuSystem Holdings, Inc. and its subsidiaries.

Cautionary Statement Regarding Forward-Looking Statements

Certain statements contained in this quarterly report on Form 10-Q are forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). The words “believe,” “may,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “should,” “plan,” “expect,” “strategy,” “future,” “likely,” variations of such words, and other similar expressions, as they relate to the Company, are intended to identify forward-looking statements. However, the absence of these words or similar expressions does not mean that a statement is not forward-looking. In connection with the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, the Company is identifying certain factors that could cause actual results to differ, perhaps materially, from those indicated by these forward-looking statements. Those factors, risks and uncertainties include, but are not limited to, potential changes in overall healthcare reimbursement, including the Centers for Medicare and Medicaid Services competitive bidding and fee schedule reductions, sequestration, concentration of customers, increased focus on early detection of cancer, competitive treatments, dependency on Medicare Supplier Number, availability of chemotherapy drugs, global financial conditions, changes and enforcement of state and federal laws, natural forces, competition, dependency on suppliers, risks in acquisitions & joint ventures, U.S. Healthcare Reform, relationships with healthcare professionals and organizations, technological changes related to infusion therapy, the Company’s ability to implement information technology improvements and to respond to technological changes, the ability of the Company to successfully integrate acquired businesses, dependency on key personnel, dependency on banking relations and the ability to comply with credit facility covenants, and other risks associated with our common stock, as well as any litigation to which the Company may be involved in from time to time; and other risk factors as discussed in the Company’s annual report on Form 10-K for the year ended December 31, 2018 and in other filings made by the Company from time to time with the Securities and Exchange Commission (“SEC”). Our annual report on Form 10-K is available on the SEC’s EDGAR website at www.sec.gov, and a copy may also be obtained by contacting the Company. All forward-looking statements made in this Form 10-Q speak only as of the date of this report. We do not intend, and do not undertake any obligation, to update any forward-looking statements to reflect future events or circumstances after the date of such statements, except as required by law.

15

Overview

We are 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 from five locations in the United States and Canada. Through our operating subsidiaries, including InfuSystem, Inc. (“ISI”) and First Biomedical, Inc. (“First Biomedical”), we provide our products and services to hospitals, oncology practices and facilities and other alternate site health care providers. Headquartered in Madison Heights, Michigan, we deliver local, field-based customer support and also operate pump service and repair Centers of Excellence in Michigan, Kansas, California, Massachusetts and Ontario, Canada. ISI is accredited by the Community Health Accreditation Program while First Biomedical is ISO certified.

Our core service is to supply electronic ambulatory infusion pumps and associated disposable supply kits to oncology clinics, infusion clinics and hospital outpatient chemotherapy clinics to be utilized in the treatment of a variety of cancers including colorectal cancer and other disease states. Colorectal cancer is the third most prevalent form of cancer in the United States, according to the American Cancer Society, and the standard of care for the treatment of colorectal cancer relies upon continuous chemotherapy infusions delivered via ambulatory infusion pumps.

In addition, we sell or rent new and pre-owned pole mounted and ambulatory infusion pumps to, and provide biomedical recertification, maintenance and repair services for, oncology practices as well as other alternate site settings including home care and home infusion providers, skilled nursing facilities, pain centers and others. We also provide these products and services to customers in the small-hospital market.

We purchase new and pre-owned pole mounted and ambulatory infusion pumps from a variety of sources on a non-exclusive basis. We repair, refurbish and provide biomedical certification for the devices as needed. The pumps are then available for sale, rental or to be used within our ambulatory infusion pump management service.

Our payor environment is in a constant state of change. Management is intent on extending its considerable breadth of payor contracts as patients move into different insurance coverages, including Medicaid and Insurance Marketplace products. In some cases, this may slightly reduce our aggregate billed revenues payment rate but result in an overall increase in collected revenues, effectively lessening bad debt expense on a micro level, but due to the mix of all payors may not have an impact on overall bad debt expense. Consequently, we are increasingly focused on net revenues, which include a reduction for bad debt.

In the midst of changes in the healthcare arena, we believe that we will support our overall business strategy discussed above by (i) focusing on supporting recurring revenues by increasing our pump fleet; (ii) improving liquidity and strengthening the balance sheet by keeping debt levels comparable to our operations; (iii) improving internal operational efficiencies; (iv) increasing our product and services offerings; (v) enhancing our technology offerings to the patients and providers of care; and (vi) investigating synergistic acquisitions.

Results of Operations for the Three Months Ended June 30, 2019 Compared to the Three Months Ended June 30, 2018

Net Revenues

Our net revenues for the quarter ended June 30, 2019 were $19.7 million, an increase of $3.3 million, or 20.2%, compared to $16.4 million for the quarter ended June 30, 2018. During this period, net revenues from rentals increased $2.2 million, or 15.6%, compared to the same prior year period. This increase was primarily attributable to growth in the Company’s customer base due to favorable changes in the competitive environment for oncology services and growth in its pain management business. Net revenues from product sales for the three months ended June 30, 2019 were $3.5 million, an increase of $1.1 million, or 47.2%, compared to the same period of 2018. This increase was primarily the result of an increase in equipment sales of $0.8 million and disposable sales of $0.3 million due to the timing of pump sales and the Company’s efforts to expand its product offering.

Gross Profit

Gross profit for the quarter ended June 30, 2019 was $11.4 million, an increase of $1.7 million, or 17.2%, compared to the quarter ended June 30, 2018. As a percentage of revenues, gross profit for the quarter ended June 30, 2019 was 57.6%, down from 59.0% for the same prior year period primarily due to growth in the Company’s lower margin products and increased supply costs in anticipation of future growth. The increase in gross profit for the period is mainly due to the increase in net revenues for the period, which was partially offset by an increase of $0.6 million in the costs of pumps and accessories sold, $0.4 million in the costs of supply and pump rentals, $0.3 million in the costs of disposables sold and $0.3 million in pump depreciation expense.

16

Amortization of Intangible Assets

Amortization of intangible assets for the quarter ended June 30, 2019 was $1.1 million, a decrease of less than $0.1 million compared to the same prior year period. This decrease is attributable to certain intangible assets becoming fully amortized, thus, the related amortization of those projects no longer existed in the second quarter of 2019.

Selling and Marketing Expenses

Selling and marketing expenses for the quarter ended June 30, 2019 were $2.5 million, an increase of $0.2 million, or 6.4%, compared to $2.3 million for the quarter ended June 30, 2018. This increase was largely attributable to an increase in commission expense of $0.1 million and travel and related costs of $0.1 million in support of revenue growth. Selling and marketing expenses during these periods consisted of sales personnel salaries, commissions and associated fringe benefits and payroll-related items, marketing, share-based compensation, travel and entertainment and other miscellaneous expenses.

General and Administrative Expenses

General and Administrative (“G&A”) expenses for the quarter ended June 30, 2019 were $6.8 million, an increase of $0.4 million, or 6.0%, from $6.4 million for the quarter ended June 30, 2018. The increase in G&A expenses versus the comparable prior year period was primarily due to increases in employee compensation related expenses of $0.5 million and outside services expense of $0.3 million, partially offset by a decrease in legal fees and strategic alternative costs of $0.2 million, travel and related expenses of $0.1 million and bank fees of $0.1 million. The increase in employee compensation expenses was primarily attributable to a $0.3 million increase in salaries and related expenses and a $0.2 million increase in stock compensation expense.

Other Income and Expenses

During the quarter ended June 30, 2019, we incurred interest expense of $0.5 million, an increase of $0.2 million, or 64.9%, compared to the comparable prior year period. This was a net result of the new term debt that was entered into during the second half of 2018 and first half of 2019, partially offset by payments of the previous term debt as well as higher interest rates in 2019 as compared to 2018.

Income Taxes

During both the three months ended June 30, 2019 and 2018, the Company recorded expense provision for income taxes of less than $0.1 million. The provision for income taxes relates principally to the Company’s state and local taxes and foreign operations in Canada.

The Company’s realization of its deferred tax assets is dependent upon many factors, including, but not limited to, the Company’s ability to generate sufficient taxable income. Management assesses the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. Accordingly, at both June 30, 2019 and December 31, 2018, the Company had a full valuation allowance for all deferred tax assets, as management determined that it is not more likely than not the Company will recognize the benefits of its federal and state deferred tax assets.

Results of Operations for the Six Months Ended June 30, 2019 Compared to the Six Months Ended June 30, 2018

Net Revenues

Our net revenues for the six months ended June 30, 2019 were $37.9 million, an increase of $5.0 million, or 15.3%, compared to $32.9 million for the six months ended June 30, 2018. During this period, net revenues from rentals increased $2.8 million, or 10.0%, compared to the same prior year period. This increase was primarily attributable to growth in the Company’s customer base due to favorable changes in the competitive environment for oncology services and growth in its pain management business, as well as decreased allowance for bad debt expense. Net revenues from product sales for the six months ended June 30, 2019 were $6.6 million, an increase of $2.2 million, or 49.2%, compared to the same period of 2018. This increase was primarily the result of an increase in equipment sales of $1.2 million and disposable sales of $1.0 million due to the timing of pump sales and the Company’s efforts to expand its product offering.

17

Gross Profit

Gross profit for the six months ended June 30, 2019 was $21.7 million, an increase of $1.8 million, or 8.9%, compared to the six months ended June 30, 2018. As a percentage of revenues, gross profit for the six months ended June 30, 2019 was 57.2%, down from 60.6% for the same prior year period primarily due to growth in the Company’s lower margin products and increased supply costs in anticipation of future growth. The increase in gross profit for the period is mainly due to the increase in net revenues for the period, which was partially offset by an increase of $1.0 million in the costs of pumps and accessories sold, $0.9 million in the costs of supply and pump rentals, $0.8 million in the costs of disposables sold and $0.4 million in pump depreciation expense.

Amortization of Intangible Assets

Amortization of intangible assets for the six months ended June 30, 2019 was $2.2 million, a decrease of $0.1 million compared to the same prior year period. This decrease is attributable to certain intangible assets becoming fully amortized, thus, the related amortization of those projects no longer existed in the six months ended June 30, 2019.

Selling and Marketing Expenses

Selling and marketing expenses for the six months ended June 30, 2019 were $5.1 million, an increase of $0.5 million, or 9.7%, compared to $4.6 million for the six months ended June 30, 2018. The increase was largely attributable to an increase in commission expense of $0.2 million, advertising costs of $0.1 million and travel and related expenses of $0.1 million in support of revenue growth. Selling and marketing expenses during these periods consisted of sales personnel salaries, commissions and associated fringe benefits and payroll-related items, marketing, share-based compensation, travel and entertainment and other miscellaneous expenses.

General and Administrative Expenses

G&A expenses for the six months ended June 30, 2019 were $13.8 million, an increase of $1.3 million, or 10.0%, from $12.6 million for the same prior year period. The increase in G&A expenses versus the comparable prior year period was primarily due to increases in employee compensation related expenses of $1.0 million, outside services of $0.3 million and accounting fees of $0.1 million, partially offset by a decrease in bank fees of $0.1 million. The increase in employee compensation related expenses was primarily attributable to a $0.6 million increase in salaries and related expenses, $0.3 million of stock compensation expense and $0.1 million net increase in the incentive bonus accrual.

Other Income and Expenses

During the six months ended June 30, 2019, we incurred interest expense of $0.9 million, an increase of $0.3 million, or 55.2%, compared to the comparable prior year period. This was a net result of the new term debt that was entered into during the second half of 2018 and first half of 2019, partially offset by payments of the previous term debt as well as higher interest rates in 2019 as compared to 2018.

Income Taxes

During the six months ended June 30, 2019, the Company recorded expense provision for income taxes of $0.1 million compared to expense provision for income taxes of less than $0.1 million for the same comparable prior year period. The provision for income taxes relates principally to the Company’s state and local taxes and foreign operations in Canada.

The Company’s realization of its deferred tax assets is dependent upon many factors, including, but not limited to, the Company’s ability to generate sufficient taxable income. Management assesses the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. Accordingly, at both June 30, 2019 and December 31, 2018, the Company had a full valuation allowance for all deferred tax assets, as management determined that it is not more likely than not the Company will recognize the benefits of its federal and state deferred tax assets.

Liquidity and Capital Resources

Overview:

We finance our operations and capital expenditures with internally-generated cash from operations and borrowings under our existing credit agreement (the “Credit Agreement”) or other financing arrangements. As of June 30, 2019, we had cash and cash equivalents of $1.7 million and $9.2 million of availability on our revolving credit facility under the Credit Agreement (the “Revolver”) compared to $4.3 million of cash and cash equivalents and $9.2 million of availability on our Revolver at December 31, 2018. Our liquidity and borrowing plans are established to align with our financial and strategic planning processes and ensure we have the necessary funding to meet our operating commitments, which primarily include the purchase of pumps, inventory, payroll and general expenses. We also take into consideration our overall capital allocation strategy which includes investment for future growth, share repurchases and potential acquisitions. We believe we have adequate sources of liquidity and funding available for at least the next year, however, there are a number of factors that may negatively impact our available sources of funds. The amount of cash generated from operations will be dependent upon factors such as the successful execution of our business plan and general economic conditions.

18

  Long-Term Debt Activities:

On April 15, 2019, the Company sold for $2.0 million and immediately leased back certain medical equipment in rental service to a third party specializing in such transactions. The leaseback term is 36 months. Because the arrangement contains a purchase option that the Company is reasonably certain to exercise, this transaction did not qualify for the sale-leaseback accounting under ASC 842. The medical equipment remains recorded on the accompanying condensed consolidated balance sheet and the proceeds received have been classified as an Other Financing liability, which is being paid off monthly over the term of the lease. The balance of Other Financing as of June 30, 2019 was $1.9 million.

On February 5, 2019, the Company and its primary lender entered into the fifth amendment (the “Fifth Amendment”) to the Credit Agreement. Among other things, the Fifth Amendment amended the Credit Agreement to (1) increase our borrowing capacity under our existing equipment line to $8.0 million, (2) revise the definition of earnings before interest, taxes, depreciation and amortization, a non-GAAP financial measure, to include additional add-back adjustments for the years ended or ending December 31, 2018 and 2019, (3) revise the definition of fixed charge coverage ratio for the year ending December 31, 2019 to include an unfinanced portion of capital expenditures of up to $7.0 million for the year ending December 31, 2019, (4) revise the Credit Agreement’s maximum permitted indebtedness to finance the acquisition, construction or improvement of any fixed or capital assets and (5) revise the maximum leverage ratio for each of the quarters during December 31, 2018 and December 31, 2019.

As of June 30, 2019, our term loans and equipment line under the Credit Agreement had balances of $29.2 million and $2.6 million, respectively. The net availability under the Revolver is based upon our eligible accounts receivable and eligible inventory and is computed as follows (in thousands):

	June 30,			December 31,
	2019			2018
Revolver:
Gross availability	$	11,000		$	9,973
Outstanding draws		-			-
Letters of credit		(1,750	)		(750	)
Landlord reserves		(71	)		(70	)
Net availability	$	9,179		$	9,153

As of June 30, 2019, interest on the credit facility is payable at our option as a (i) Eurodollar Loan, which bears interest at a per annum rate equal to the applicable 30-day London Interbank Offered Rate (“LIBOR”) plus an applicable margin ranging from 2.00% to 3.00% or (ii) CB Floating Rate (“CBFR”) Loan, which bears interest at a per annum rate equal to the greater of (a) the lender’s prime rate or (b) LIBOR plus 2.50%, in each case, plus a margin ranging from -1.00% to 0.25%. The actual Eurodollar Loan rate at June 30, 2019 was 5.19% (LIBOR of 2.44% plus 2.75%). The actual CBFR Loan rate at June 30, 2019 was 5.50% (lender’s prime rate of 5.50%).

As of June 30, 2019, the Company was in compliance with all debt-related covenants under the Credit Agreement.

 Cash Flows:

Operating Cash Flow.  Net cash provided by operating activities for the six months ended June 30, 2019 was $4.3 million compared to net cash provided by operating activities of $4.8 million for the six months ended June 30, 2018. This decrease was primarily attributable to the cash flow effect of increased accounts receivable which was partially offset by a net increase in accounts payable, as well as, the favorable change in net loss adjusted for non-cash items.

Investing Cash Flow.  Net cash used in investing activities was $6.6 million for the six months ended June 30, 2019 compared to cash used in investing activities of $1.0 million for the six months ended June 30, 2018. The increase in cash used was due to a $5.2 million increase in cash used to purchase medical equipment and other assets and a $0.4 million decrease in proceeds from the sales of medical equipment.

19

Financing Cash Flow.  Net cash used in financing activities for the six months ended June 30, 2019 was $0.4 million compared to net cash used in financing activities of $4.9 million for the six months ended June 30, 2018. The decrease in net cash used was primarily attributable to cash proceeds received as part of a new financing arrangement in 2019 and our decision to pay down our term loan debt and repurchase shares of common stock as part of a share repurchase program in the first half of 2018.

Critical Accounting Policies and Estimates

The unaudited condensed consolidated financial statements are prepared in conformity with U.S. GAAP, which require the use of estimates, judgments and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements, and the reported amounts of revenues and expenses in the periods presented. We believe that the accounting estimates employed are appropriate and resulting balances are reasonable; however, due to inherent uncertainties in making estimates, actual results could differ from the original estimates, requiring adjustments to these balances in future periods. The critical accounting estimates that affect the unaudited condensed consolidated financial statements and the judgments and assumptions used are consistent with those described in the notes to the audited consolidated financial statements in our annual report on Form 10-K for the year ended December 31, 2018, with the exception of our adoption of Topic 842. See Note 11 to the accompanying unaudited condensed consolidated financial statements for further details regarding our adoption of Topic 842.

Item 3.  Quantitative and Qualitative Disclosures About Market Risk

InfuSystem is a smaller reporting company as defined by Rule 12b-2 of the Exchange Act and is not required to provide the information required under this item.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures and Changes in Internal Control over Financial Reporting

We maintain a set of disclosure controls and procedures designed to ensure that material information required to be disclosed in our filings under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that material information is accumulated and communicated to our management, including our Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”), as appropriate, to allow timely decisions regarding required disclosures. Our CEO and CFO have evaluated these disclosure controls and procedures as of the end of the period covered by this quarterly report on Form 10-Q and have determined that such disclosure controls and procedures were effective.

There has been no change in our internal control over financial reporting during our most recent calendar quarter that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

PART II—OTHER INFORMATION

Item 1. Legal Proceedings

From time to time in the ordinary course of our business, we may be involved in legal proceedings, the outcomes of which may not be determinable. The results of litigation are inherently unpredictable. Any claims against us, 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. We are 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. We have insurance policies covering potential losses where such coverage is cost effective.

We are not involved in any legal proceedings that we currently believe could have a material effect on our business, financial condition, results of operations or cash flows.

Item 1A. Risk Factors

For information regarding factors that could affect our results of operations, financial condition and liquidity, refer to the section entitled “Risk Factors” in Part I, Item 1A in our Annual Report on Form 10-K for the year ended December 31, 2018.

20

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

None. 

Item 3. Defaults Upon Senior Securities

None.

Item 4. Mine Safety Disclosures

Not applicable.

Item 5. Other Information

None.

21

Item 6.     Exhibits

Exhibits
3.1	Amended and Restated Certificate of Incorporation, as amended (incorporated by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K (File No. 1-35020) filed on May 12, 2014)
3.2	Amended and Restated By-Laws (incorporated by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K (File No. 1-35020) filed on July 9, 2018)
31.1*	Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
31.2*	Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
32.1*	Certification of the Chief Executive Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
32.2*	Certification of the Chief Financial Officer pursuant to 18 U.S.C. 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

101.INS*	XBRL Instance Document
101.SCH*	XBRL Taxonomy Extension Schema Document
101.CAL*	XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF*	XBRL Taxonomy Extension Definition Linkbase Document
101.LAB*	XBRL Taxonomy Extension Label Linkbase Document
101.PRE* *	XBRL Taxonomy Extension Presentation Linkbase Document Filed herewith

22

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

	INFUSYSTEM HOLDINGS, INC.
Date: August 14, 2019		/s/ Richard DiIorio
		Richard DiIorio
		Chief Executive Officer, President and Director (Principal Executive Officer)
Date: August 14, 2019		/s/ Gregory Schulte
		Gregory Schulte Chief Financial Officer (Principal Financial Officer)

23

EX-31.1

Exhibit 31.1

CERTIFICATION BY CHIEF EXECUTIVE OFFICER

I, Richard DiIorio, certify that:

1. I have reviewed this quarterly report on Form 10-Q of InfuSystem Holdings, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and we have:

a. designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b. designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c. evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting.

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a. all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: August 14, 2019	/s/ Richard DiIorio
	Richard DiIorio Chief Executive Officer, President and Director

EX-31.2

Exhibit 31.2

CERTIFICATION BY CHIEF FINANCIAL OFFICER

I, Gregory Schulte, certify that:

1. I have reviewed this quarterly report on Form 10-Q of InfuSystem Holdings, Inc.

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and we have:

a. designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b. designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c. evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d. disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting.

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a. all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b. any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: August 14, 2019	/s/ Gregory Schulte
	Gregory Schulte Chief Financial Officer

EX-32.1

Exhibit 32.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER

Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

(Subsections (a) and (b) of Section 1350, Chapter 63 of Title 18, United States Code)

Pursuant to section 906 of the Sarbanes-Oxley Act of 2002 (subsections (a) and (b) of section 1350, chapter 63 of title 18, United States Code), the undersigned officer of InfuSystem Holdings, Inc., a Delaware corporation (the “Company”), does hereby certify, to such officer’s knowledge, that:

The quarterly report on Form 10-Q for the quarter ended June 30, 2019 (the “Form 10-Q”) of the Company fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, and information contained in the Form 10-Q fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: August 14, 2019	/s/ Richard DiIorio
	Richard DiIorio Chief Executive Officer, President and Director

EX-32.2

Exhibit 32.2

CERTIFICATION OF CHIEF FINANCIAL OFFICER

Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

(Subsections (a) and (b) of Section 1350, Chapter 63 of Title 18, United States Code)

Pursuant to section 906 of the Sarbanes-Oxley Act of 2002 (subsections (a) and (b) of section 1350, chapter 63 of title 18, United States Code), the undersigned officer of InfuSystem Holdings, Inc., a Delaware corporation (the “Company”), does hereby certify, to such officer’s knowledge, that:

The quarterly report on Form 10-Q for the quarter ended June 30, 2019 (the “Form 10-Q”) of the Company fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, and information contained in the Form 10-Q fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: August 14, 2019	/s/ Gregory Schulte
	Gregory Schulte Chief Financial Officer

XML

Document And Entity Information - shares	6 Months Ended
	Jun. 30, 2019	Aug. 09, 2019
Document Information [Line Items]
Entity Registrant Name	InfuSystem Holdings, Inc
Entity Central Index Key	0001337013
Trading Symbol	infu
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Current Reporting Status	Yes
Entity Emerging Growth Company	false
Entity Small Business	true
Entity Common Stock, Shares Outstanding (in shares)		19,782,548
Entity Shell Company	false
Document Type	10-Q
Document Period End Date	Jun. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Amendment Flag	false
Title of 12(b) Security	Common Stock

XML

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 1,702	$ 4,318
Accounts receivable, net	11,218	9,593
Inventories	2,742	2,254
Other current assets	1,368	1,372
Total current assets	17,030	17,537
Medical equipment for sale or rental	1,927	1,601
Medical equipment in rental service, net of accumulated depreciation	28,873	23,488
Property & equipment, net of accumulated depreciation	1,539	1,445
Intangible assets, net	17,616	19,865
Operating lease right of use assets	5,182
Other assets	194	137
Total assets	72,361	64,073
Current liabilities:
Accounts payable	10,206	7,091
Current portion of long-term debt	6,084	4,903
Other current liabilities	4,244	2,796
Total current liabilities	20,534	14,790
Long-term debt, net of current portion	27,478	28,842
Deferred income taxes	76
Operating lease liabilities, net of current portion	4,021
Total liabilities	52,109	43,632
Stockholders’ equity:
Preferred stock, $.0001 par value: authorized 1,000,000 shares; none issued
Common stock, $.0001 par value: authorized 200,000,000 shares; issued and outstanding 23,237,703 and 19,719,214, respectively, as of June 30, 2019 and 23,095,513 and 19,577,024, respectively, as of December 31, 2018	2	2
Additional paid-in capital	83,557	83,167
Retained deficit	(63,307)	(62,728)
Total stockholders’ equity	20,252	20,441
Total liabilities and stockholders’ equity	$ 72,361	$ 64,073

XML

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Jun. 30, 2019	Dec. 31, 2018
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock, shares authorized (in shares)	1,000,000	1,000,000
Preferred stock, shares issued (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	23,237,703	23,095,513
Common stock, shares outstanding (in shares)	19,719,214	19,577,024

XML

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Net revenues	$ 19,723	$ 16,415	$ 37,916	$ 32,898
Cost of revenues	8,367	6,729	16,219	12,975
Gross profit	11,356	9,686	21,697	19,923
Selling, general and administrative expenses:
Amortization of intangibles	1,124	1,165	2,249	2,352
Selling and marketing	2,476	2,326	5,078	4,627
General and administrative	6,785	6,399	13,819	12,560
Total selling, general and administrative	10,385	9,890	21,146	19,539
Operating income (loss)	971	(204)	551	384
Other expense:
Interest expense	(488)	(296)	(948)	(611)
Other (expense) income	(39)	1	(60)	(10)
Income (loss) before income taxes	444	(499)	(457)	(237)
Provision for income taxes	(63)	(6)	(122)	(64)
Net income (loss)	$ 381	$ (505)	$ (579)	$ (301)
Net income (loss) per share:
Basic (in dollars per share)	$ 0.02	$ (0.02)	$ (0.03)	$ (0.01)
Diluted (in dollars per share)	$ 0.02	$ (0.02)	$ (0.03)	$ (0.01)
Weighted average common shares outstanding:
Basic (in shares)	19,708,422	22,703,415	19,644,590	22,751,318
Diluted (in shares)	20,583,434	22,703,415	19,644,590	22,751,318

XML

Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Treasury Stock [Member]	Total
Balances (in shares) at Dec. 31, 2017	22,978			(198)
Balances at Dec. 31, 2017	$ 2	$ 92,584	$ (61,633)		$ 30,953
Stock based shares issued upon vesting - gross (in shares)	29
Stock based shares issued upon vesting - gross
Stock-based compensation expense		226			226
Employee stock purchase plan (in shares)	25
Employee stock purchase plan		46			46
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(5)			(5)
Common stock repurchased as part of Repurchase Program (in shares)				(380)
Common stock repurchased as part of Repurchase Program		(1,264)			(1,264)
Net income (loss)			(301)		(301)
Balances (in shares) at Jun. 30, 2018	23,032			(578)
Balances at Jun. 30, 2018	$ 2	91,587	(61,934)		29,655
Balances (in shares) at Mar. 31, 2018	23,003			(230)
Balances at Mar. 31, 2018	$ 2	92,659	(61,429)		31,232
Stock based shares issued upon vesting - gross (in shares)	4
Stock based shares issued upon vesting - gross
Stock-based compensation expense		114			114
Employee stock purchase plan (in shares)	25
Employee stock purchase plan
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(5)			(5)
Common stock repurchased as part of Repurchase Program (in shares)				(348)
Common stock repurchased as part of Repurchase Program		(1,181)			(1,181)
Net income (loss)			(505)		(505)
Balances (in shares) at Jun. 30, 2018	23,032			(578)
Balances at Jun. 30, 2018	$ 2	91,587	(61,934)		29,655
Balances (in shares) at Dec. 31, 2018	23,096			(3,518)
Balances at Dec. 31, 2018	$ 2	83,167	(62,728)		20,441
Stock based shares issued upon vesting - gross (in shares)	167
Stock based shares issued upon vesting - gross		15			15
Stock-based compensation expense		530			530
Employee stock purchase plan (in shares)	19
Employee stock purchase plan		53			53
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)	(45)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(208)			(208)
Net income (loss)			(579)		(579)
Balances (in shares) at Jun. 30, 2019	23,237			(3,518)
Balances at Jun. 30, 2019	$ 2	83,557	(63,307)		20,252
Balances (in shares) at Mar. 31, 2019	23,221			(3,518)
Balances at Mar. 31, 2019	$ 2	83,429	(63,688)		19,743
Stock based shares issued upon vesting - gross (in shares)	16
Stock based shares issued upon vesting - gross		15			15
Stock-based compensation expense		284			284
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation		(171)			(171)
Net income (loss)			381		381
Balances (in shares) at Jun. 30, 2019	23,237			(3,518)
Balances at Jun. 30, 2019	$ 2	$ 83,557	$ (63,307)		$ 20,252

XML

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
NET CASH PROVIDED BY OPERATING ACTIVITIES	$ 4,319	$ 4,846
INVESTING ACTIVITIES
Purchase of medical equipment, property and equipment	(7,893)	(2,743)
Proceeds from sale of medical equipment, property and equipment	1,333	1,720
NET CASH USED IN INVESTING ACTIVITIES	(6,560)	(1,023)
FINANCING ACTIVITIES
Principal payments on term loans, capital lease obligations and other financing	(2,256)	(3,708)
Cash proceeds from other financing	2,024
Debt issuance costs	(3)
Common stock repurchased to satisfy statutory withholding on employee stock based compensation plans	(208)	(5)
Common stock repurchased as part of Repurchase Program		(1,264)
Cash proceeds from stock plans	68	46
NET CASH USED IN FINANCING ACTIVITIES	(375)	(4,931)
Net change in cash and cash equivalents	(2,616)	(1,108)
Cash and cash equivalents, beginning of period	4,318	3,469
Cash and cash equivalents, end of period	$ 1,702	$ 2,361

XML

Note 1 - Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Basis of Presentation and Significant Accounting Policies [Text Block]

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. The Company provides products and services to hospitals, oncology practices and facilities and other alternative site healthcare providers. Headquartered in Madison Heights, Michigan, the Company delivers local, field-based customer support, and also operates pump repair Centers of Excellence in Michigan, Kansas, California, Massachusetts and Ontario, Canada.

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, 2018

as filed with the SEC.

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.

Certain prior period reclassifications were made to conform with the current period presentation. These reclassifications had

no

effect on reported income (loss), overall cash flows, total assets, total liabilities or stockholders’ equity as previously reported.

XML

Note 2 - Recent Accounting Pronouncements and Developments

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

New Accounting Pronouncements and Changes in Accounting Principles [Text Block]

2 . Recent Accounting Pronouncements and Developments

In

June 2016,

the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”)

No.

2016

-

13,

“Financial Instruments (Topic

326

) Credit Losses”. Topic

326

changes the impairment model for most financial assets and certain other instruments. Under the new standard, entities holding financial assets and net investment in leases that are

not

accounted for at fair value through net income are to be presented at the net amount expected to be collected. An allowance for credit losses will be a valuation account that will be deducted from the amortized cost basis of the financial asset to present the net carrying value at the amount expected to be collected on the financial asset. Topic

326

is effective as of

January 1, 2020.

Early adoption is permitted. The Company is currently evaluating the impact of Topic

326

on its consolidated balance sheets, statements of operations, statements of cash flows and related disclosures.

XML

Note 3 - Revenue Recognition

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Revenue from Contract with Customer [Text Block]

3. Revenue Recognition

          The following table presents disaggregated revenue by offering type:

	Three Months Ended						Six Months Ended
	June 30						June 30
	2019			2018			2019			2018
Third-Party Payor Rentals		49.4	%		47.5	%		48.8	%		48.0	%
Direct Payor Rentals		33.0	%		38.1	%		33.8	%		38.5	%
Product Sales		17.6	%		14.4	%		17.4	%		13.5	%
Total - Net revenues		100.0	%		100.0	%		100.0	%		100.0	%

XML

Note 4 - Medical Equipment

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Medical Equipment and Property Disclosure [Text Block]

4 . Medical Equipment

Medical equipment consists of the following (in thousands):

	June 30,			December 31,
	2019			2018
Medical Equipment for sale or rental	$	1,927		$	1,601
Medical Equipment in rental service		68,721			61,429
Medical Equipment in rental service - pump reserve		(614	)		(530	)
Accumulated depreciation		(39,234	)		(37,411	)
Medical Equipment in rental service - net		28,873			23,488
Total	$	30,800		$	25,089

Depreciation expense for medical equipment for the

three

and

six

months ended

June 30, 2019

was

$1.8

million and

$3.5

million, respectively, compared to

$1.5

million and

$3.0

million for the same prior year periods, respectively, which were recorded in “cost of revenues” for each period.

XML

Note 5 - Property and Equipment

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Property, Plant and Equipment Disclosure [Text Block]

5. Property and Equipment

Property and equipment consists of the following (in thousands):

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Depreciation			Total		Gross Assets		Accumulated Depreciation			Total
Furniture, fixtures, and equipment	$	4,025	$	(3,385	)	$	640	$	3,717	$	(3,257	)	$	460
Automobiles		117		(84	)		33		118		(95	)		23
Leasehold improvements		2,002		(1,136	)		866		2,219		(1,257	)		962
Total	$	6,144	$	(4,605	)	$	1,539	$	6,054	$	(4,609	)	$	1,445

Depreciation expense for property and equipment for the

three

and

six

months ended

June 30, 2019

was

$0.1

million and

$0.2

million, respectively, compared to

$0.1

million and

$0.2

million for the same prior year periods, respectively. This expense was recorded in general and administrative expenses.

XML

Note 6 - Intangible Assets

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Intangible Assets Disclosure [Text Block]

6 . Intangible Assets

The carrying amount and accumulated amortization of intangible assets is comprised of the following (in thousands):

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Amortization			Net		Gross Assets		Accumulated Amortization			Net
Nonamortizable intangible assets
Trade names	$	2,000	$	-		$	2,000	$	2,000	$	-		$	2,000
Amortizable intangible assets:
Trade names		23		(23	)		-		23		(23	)		-
Physician and customer relationships		36,534		(25,362	)		11,172		36,534		(24,175	)		12,359
Non-competition agreements		1,136		(1,136	)		-		1,136		(1,136	)		-
Software		11,230		(6,786	)		4,444		11,230		(5,724	)		5,506
Total nonamortizable and amortizable intangible assets	$	50,923	$	(33,307	)	$	17,616	$	50,923	$	(31,058	)	$	19,865

Amortization expense for the

three

and

six

months ended

June 30, 2019

was

$1.1

million and

$2.2

million, respectively, compared to

$1.2

million and

$2.4

million for the same prior year periods, respectively. Expected annual amortization expense for intangible assets recorded as of

June 30, 2019

is as follows (in thousands):

	7/1 -										2024 and
	12/31/2019		2020		2021		2022		2023		thereafter
Amortization expense	$	2,153	$	4,285	$	3,930	$	2,051	$	548	$	2,649

XML

Note 7 - Debt

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Debt Disclosure [Text Block]

7 . Debt

On

April 15, 2019,

the Company sold for

$2.0

million and immediately leased back certain medical equipment in rental service to a

third

party specializing in such transactions. The leaseback term is

36

months. Because the arrangement contains a purchase option that the Company is reasonably certain to exercise, this transaction did

not

qualify for the sale-leaseback accounting under ASC

842.

The medical equipment remains recorded on the accompanying condensed consolidated balance sheet and the proceeds received have been classified as an Other Financing liability, which is being paid off monthly over the term of the lease. The balance of Other Financing as of

June 30, 2019

was

$1.9

million.

On

February 5, 2019,

the Company and its primary lender entered into the

fifth

amendment (the “Fifth Amendment”) to its existing credit facility (the “Credit Agreement”). Among other things, the Fifth Amendment amended the Credit Agreement to (

1

) increase our borrowing capacity under our existing equipment line to

$8.0

million, (

2

) revise the definition of earnings before interest, taxes, depreciation and amortization, a non-GAAP financial measure, to include additional add-back adjustments for the years ended or ending

December 31, 2018

and

2019,

(

3

) revise the definition of fixed charge coverage ratio for the year ending

December 31, 2019

to include an unfinanced portion of capital expenditures of up to

$7.0

million for the year ending

December 31, 2019, (

4

) revise the Credit Agreement’s maximum permitted indebtedness to finance the acquisition, construction or improvement of any fixed or capital assets and (

5

) revise the maximum leverage ratio for each of the quarters during

December 31, 2018

and

December 31, 2019.

As of

June 30, 2019,

the Company’s term loans and equipment line under its credit facility had balances of

$29.2

million and

$2.6

million, respectively. The net availability under the revolving credit line under the credit facility is based upon our eligible accounts receivable and eligible inventory and is computed as follows (in thousands):

	June 30,			December 31,
	2019			2018
Revolver:
Gross availability	$	11,000		$	9,973
Outstanding draws		-			-
Letters of credit		(1,750	)		(750	)
Landlord reserves		(71	)		(70	)
Net availability	$	9,179		$	9,153

The Company had future maturities of loans and other financing as of

June 30, 2019

as follows (in thousands):

	2019			2020			2021			2022		2023 and thereafter		Total
Term Loan A	$	1,792		$	3,584		$	16,143		$	-	$	-	$	21,519
Term Loan C		921			1,229			5,529			-		-		7,679
Equipment Line		128			512			512			512		898		2,562
Unamortized value of the debt issuance costs		(20	)		(39	)		(39	)		-		-		(98	)
Other financing		301			652			725			222		-		1,900
Total	$	3,122		$	5,938		$	22,870		$	734	$	898	$	33,562

The following is a breakdown of the Company’s current and long-term debt as follows (in thousands):

June 30, 2019										December 31, 2018
	Current Portion			Long-Term Portion			Total				Current Portion			Long-Term Portion			Total
Term Loan A	$	3,584		$	17,935		$	21,519		Term Loan A	$	3,584		$	19,727		$	23,311
Term Loan C		1,536			6,143			7,679		Term Loan C		1,229			6,757			7,986
Equipment Line		384			2,178			2,562		Equipment Line		128			2,434			2,562
Unamortized value of debt issuance costs		(39	)		(59	)		(98	)	Unamortized value of debt issuance costs		(38	)		(76	)		(114	)
Other financing		619			1,281			1,900		Other financing		-			-			-
Total	$	6,084		$	27,478		$	33,562		Total	$	4,903		$	28,842		$	33,745

As of

June 30, 2019,

interest on the credit facility is payable at our option as a (i) Eurodollar Loan, which bears interest at a per annum rate equal to the applicable

30

-day London Interbank Offered Rate (“LIBOR”) plus an applicable margin ranging from

2.00%

to

3.00%

or (ii) CB Floating Rate (“CBFR”) Loan, which bears interest at a per annum rate equal to the greater of (a) the lender’s prime rate or (b) LIBOR plus

2.50%,

in each case, plus a margin ranging from -

1.00%

to

0.25%.

The actual rate at

June 30, 2019

was

5.19%

(LIBOR of

2.44%

plus

2.75%

). The actual CBFR Loan rate at

June 30, 2019

was

5.50%

(lender’s prime rate of

5.50%

).

As of

June 30, 2019,

the Company was in compliance with all debt-related covenants under the Credit Agreement.

XML

Note 8 - Income Taxes

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Income Tax Disclosure [Text Block]

8. Income Taxes

During both the

three

and

six

months ended

June 30, 2019,

the Company recorded expense provision for income taxes of

$0.1

million. The income tax provision relates principally to the Company’s state and local taxes and foreign operations in Canada. During the

three

and

six

months ended

June 30, 2018,

the Company recorded expense provision for income taxes of less than

$0.1

million and

$0.1

million, respectively.

 

The Company’s realization of its deferred tax assets is dependent upon many factors, including, but 

not

 limited to, the Company’s ability to generate sufficient taxable income. Management assesses the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. The Company’s management has determined that it is

not

more likely than 

not

 that the Company will recognize the benefits of its federal and state deferred tax assets. Accordingly, the Company had a full valuation allowance for all deferred tax assets at

June 30, 2019

and

December 31, 2018.

XML

Note 9 - Commitments, Contingencies and Litigation

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Commitments and Contingencies Disclosure [Text Block]

9. Commitments , Contingencies and Litigation

From time to time in the ordinary course of its business, the Company

may

be involved in legal proceedings, the outcomes of which

may

not

be determinable. The results of litigation 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

involved in any legal proceedings that the Company currently believes could have a material effect on the Company’s financial condition, results of operations or cash flows.

XML

Note 10 - Earnings (Loss) Per Share

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Earnings Per Share [Text Block]

10. 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:	2019		2018			2019			2018
Net income (loss) (in thousands)	$	381	$	(505	)	$	(579	)	$	(301	)
Denominator:
Weighted average common shares outstanding:
Basic		19,708,422		22,703,415			19,644,590			22,751,318
Dilutive effect of non-vested awards		875,012		-			-			-
Diluted		20,583,434		22,703,415			19,644,590			22,751,318
Net income (loss) per share:
Basic	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)
Diluted	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)

For the

three

months ended

June 30, 2019,

less than

0.1

million of stock options with an exercise price above the current market value of the Company’s common stock were

not

included in the calculation because they would have an anti-dilutive effect. For the

six

months ended

June 30, 2019

and the

three

and

six

months ended

June 30, 2018,

all options were anti-dilutive due to the Company’s net losses for those periods and therefore

not

included in the calculation.

XML

Note 11 - Leases

6 Months Ended

Jun. 30, 2019

Notes to Financial Statements

Lessee, Operating Leases [Text Block]

11. Leases

On

January 1, 2019 (

the “Effective Date”), the Company adopted ASU

2016

-

02,

Leases (Topic

842

); ASU

2018

-

10,

Codification Improvements to Topic

842,

Leases; and ASU

2018

-

11,

Targeted Improvements (collectively, “Topic

842”

) using a modified retrospective transition approach, which requires Topic

842

to be applied to all leases existing at the date of initial application. Under Topic

842,

lessees are required to recognize a lease liability and right-of-use asset (“ROU asset”) for all leases and to disclose key information about leasing arrangements. Additionally, leases will be classified as either financing or operating; the classification will determine the pattern of expense recognition and classification within the statement of operations. The Company has elected to apply its lease accounting policy only to leases with a term greater than

twelve

months.

The Effective Date is the Company’s date of initial application. Consequently, our financial information was

not

updated and the disclosures required under the new standard are

not

provided for dates and periods prior to

January 1, 2019.

Topic

842

provides several optional practical expedients that can be adopted at transition. We have elected the “package of practical expedients”, which does

not

require us to reassess our prior conclusions regarding lease identification, lease classification and initial direct costs. We did

not

elect the practical expedient of hindsight to the evaluation of lease options (e.g. renewal).

The most significant effects related to this adoption relate to (i) the recognition of new ROU assets and lease liabilities on our balance sheet for our real estate and equipment operating leases; and (ii) significant new disclosures about our leasing activities. Upon adoption, we recognized approximately

$3.1

million in additional operating lease liabilities with corresponding ROU assets of approximately the same amount.

Topic

842

also provides practical expedients for an entity’s ongoing accounting. We have elected the “combining lease and non-lease components” practical expedient and also elected to apply the short-term lease recognition exemption to certain leases; therefore, we did

not

recognize ROU assets and lease liabilities for these leases.

In adopting Topic

842,

we have determined and will continue to determine whether an arrangement is a lease at inception. Our operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next

ten

years. Our leases do

not

contain any restrictive covenants. Our office leases generally contain renewal options for periods ranging from

one

to

five

years. Because we are

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. Our office leases do

not

contain any material residual value guarantees. Our equipment leases generally do

not

contain renewal options. We are

not

reasonably certain to exercise the renewal options for those equipment leases that do contain renewal options, thus, the options are

not

considered in determining the lease term and payments associated with the option years are excluded from lease payments.

For our equipment leases, we have used and will use the implicit rate in the lease as the discount rate, when available, otherwise, we use our incremental borrowing rate as the discount rate. For our office leases, the implicit rate is typically

not

available, so we have used and will use our incremental borrowing rate as the discount rate. Our lease agreements include both lease and non-lease components. We have elected the practical expedient that allows us to combine lease and non-lease components for all of our leases.

Payments due under our operating leases include fixed payments as well as variable payments. For our 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 our equipment leases, variable payments

may

consist of sales taxes, property taxes and other fees.

The components of lease costs for the

three

and

six

months ended

June 30, 2019

are as follows (in thousands):

	Three Months Ended		Six Months Ended
	June 30, 2019		June 30, 2019
Operating lease cost	$	290	$	677
Variable lease cost		53		126
Total lease cost	$	343	$	803

Operating lease expense for the

three

and

six

months ended

June 30, 2018

was

$0.4

million and

$0.7

million, respectively.

Amounts reported in the condensed consolidated balance sheet as of

June 30, 2019

for our operating leases are as follows (in thousands):

	June 30, 2019
Operating lease ROU assets	$	5,182
Current operating lease liabilities (included in other current liabilities)	$	1,374
Operating lease liabilities, net of current portion		4,021
Total operating lease liabilities	$	5,395

Supplemental cash flow information and non-cash activity related to our leases are as follows (in thousands):

	Six Months Ended
	June 30, 2019
Cash paid for amounts included in the measurement of lease liabilities and ROU assets:
Operating cash flow from operating leases	$	771
ROU assets obtained in exchange for lease obligations:
Operating leases	$	3,015

Weighted average remaining lease terms and discount rates for our leases as of

June 30, 2019

are as follows:

	Years
Weighted average remaining lease term:
Operating leases		7.3

	Rate
Weighted average discount rate:
Operating leases		7.5	%

Future maturities of lease liabilities as of

June 30, 2019

are as follows (in thousands):

	Operating Leases (a)
2019	$	779
2020		1,262
2021		716
2022		655
2023		666
Thereafter		3,430
Total undiscounted lease payments		7,508
Less: Imputed interest		(2,113	)
Total lease liabilities	$	5,395

(a) Excludes $0.3 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of six years and is expected to commence later in 2019.

The Company disclosed in our

2018

Annual Report on Form

10

-K maturities of lease liabilities as of

December 31, 2018,

in accordance with ASC

840.

During the quarter ended

March 31, 2019,

the Company determined that it improperly included certain lease commitments in the maturities table as of

December 31, 2018

in Note

10

of the

2018

Annual Report on Form

10

-K. The table overstated our lease maturities as follows (in thousands):

$121

in

2019,

$370

in

2020,

$381

in

2021,

$392

in

2022,

$404

in

2023

and

$2,528

in the thereafter period.

The Company assessed the materiality of this error, considering both the qualitative and quantitative factors and determined that for the year ended

December 31, 2018,

the error was immaterial. The Company has decided to correct this immaterial error as a revision to our previously issued financial statements by adjusting the maturities of the lease liabilities as of

December 31, 2018

for the overstated amounts as reflected in the table below (in thousands):

				Operating
	Capital Leases			Leases (As Revised)		Total (As Revised)
2019	$	33		$	1,745	$	1,778
2020		-			1,347		1,347
2021		-			726		726
2022		-			624		624
2023		-			636		636
Thereafter		-			3,071		3,071
Total require payments	$	33		$	8,149	$	8,182
Less amounts representing interest (3.5%)		-
Present value of minimum lease payments		33
Less current maturities		(33	)
Long-term capital lease liability	$	-

XML

Note 3 - Revenue Recognition (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Disaggregation of Revenue [Table Text Block]

	Three Months Ended						Six Months Ended
	June 30						June 30
	2019			2018			2019			2018
Third-Party Payor Rentals		49.4	%		47.5	%		48.8	%		48.0	%
Direct Payor Rentals		33.0	%		38.1	%		33.8	%		38.5	%
Product Sales		17.6	%		14.4	%		17.4	%		13.5	%
Total - Net revenues		100.0	%		100.0	%		100.0	%		100.0	%

XML

Note 4 - Medical Equipment (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Schedule of Medical Equipment [Table Text Block]

	June 30,			December 31,
	2019			2018
Medical Equipment for sale or rental	$	1,927		$	1,601
Medical Equipment in rental service		68,721			61,429
Medical Equipment in rental service - pump reserve		(614	)		(530	)
Accumulated depreciation		(39,234	)		(37,411	)
Medical Equipment in rental service - net		28,873			23,488
Total	$	30,800		$	25,089

XML

Note 5 - Property and Equipment (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Property, Plant and Equipment [Table Text Block]

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Depreciation			Total		Gross Assets		Accumulated Depreciation			Total
Furniture, fixtures, and equipment	$	4,025	$	(3,385	)	$	640	$	3,717	$	(3,257	)	$	460
Automobiles		117		(84	)		33		118		(95	)		23
Leasehold improvements		2,002		(1,136	)		866		2,219		(1,257	)		962
Total	$	6,144	$	(4,605	)	$	1,539	$	6,054	$	(4,609	)	$	1,445

XML

Note 6 - Intangible Assets (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets [Table Text Block]

	June 30, 2019							December 31, 2018
	Gross Assets		Accumulated Amortization			Net		Gross Assets		Accumulated Amortization			Net
Nonamortizable intangible assets
Trade names	$	2,000	$	-		$	2,000	$	2,000	$	-		$	2,000
Amortizable intangible assets:
Trade names		23		(23	)		-		23		(23	)		-
Physician and customer relationships		36,534		(25,362	)		11,172		36,534		(24,175	)		12,359
Non-competition agreements		1,136		(1,136	)		-		1,136		(1,136	)		-
Software		11,230		(6,786	)		4,444		11,230		(5,724	)		5,506
Total nonamortizable and amortizable intangible assets	$	50,923	$	(33,307	)	$	17,616	$	50,923	$	(31,058	)	$	19,865

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]

	7/1 -										2024 and
	12/31/2019		2020		2021		2022		2023		thereafter
Amortization expense	$	2,153	$	4,285	$	3,930	$	2,051	$	548	$	2,649

XML

Note 7 - Debt (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Schedule of Line of Credit Facilities [Table Text Block]

	June 30,			December 31,
	2019			2018
Revolver:
Gross availability	$	11,000		$	9,973
Outstanding draws		-			-
Letters of credit		(1,750	)		(750	)
Landlord reserves		(71	)		(70	)
Net availability	$	9,179		$	9,153

Schedule of Maturities of Long-term Debt [Table Text Block]

	2019			2020			2021			2022		2023 and thereafter		Total
Term Loan A	$	1,792		$	3,584		$	16,143		$	-	$	-	$	21,519
Term Loan C		921			1,229			5,529			-		-		7,679
Equipment Line		128			512			512			512		898		2,562
Unamortized value of the debt issuance costs		(20	)		(39	)		(39	)		-		-		(98	)
Other financing		301			652			725			222		-		1,900
Total	$	3,122		$	5,938		$	22,870		$	734	$	898	$	33,562

Schedule of Debt [Table Text Block]

June 30, 2019										December 31, 2018
	Current Portion			Long-Term Portion			Total				Current Portion			Long-Term Portion			Total
Term Loan A	$	3,584		$	17,935		$	21,519		Term Loan A	$	3,584		$	19,727		$	23,311
Term Loan C		1,536			6,143			7,679		Term Loan C		1,229			6,757			7,986
Equipment Line		384			2,178			2,562		Equipment Line		128			2,434			2,562
Unamortized value of debt issuance costs		(39	)		(59	)		(98	)	Unamortized value of debt issuance costs		(38	)		(76	)		(114	)
Other financing		619			1,281			1,900		Other financing		-			-			-
Total	$	6,084		$	27,478		$	33,562		Total	$	4,903		$	28,842		$	33,745

XML

Note 10 - Earnings (Loss) Per Share (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

	Three Months Ended June 30					Six Months Ended June 30
Numerator:	2019		2018			2019			2018
Net income (loss) (in thousands)	$	381	$	(505	)	$	(579	)	$	(301	)
Denominator:
Weighted average common shares outstanding:
Basic		19,708,422		22,703,415			19,644,590			22,751,318
Dilutive effect of non-vested awards		875,012		-			-			-
Diluted		20,583,434		22,703,415			19,644,590			22,751,318
Net income (loss) per share:
Basic	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)
Diluted	$	0.02	$	(0.02	)	$	(0.03	)	$	(0.01	)

XML

Note 11 - Leases (Tables)

6 Months Ended

Jun. 30, 2019

Notes Tables

Lease, Cost [Table Text Block]

	Three Months Ended		Six Months Ended
	June 30, 2019		June 30, 2019
Operating lease cost	$	290	$	677
Variable lease cost		53		126
Total lease cost	$	343	$	803

	Six Months Ended
	June 30, 2019
Cash paid for amounts included in the measurement of lease liabilities and ROU assets:
Operating cash flow from operating leases	$	771
ROU assets obtained in exchange for lease obligations:
Operating leases	$	3,015

	Years
Weighted average remaining lease term:
Operating leases		7.3

	Rate
Weighted average discount rate:
Operating leases		7.5	%

Lessee, Operating Lease, Assets and Liabilities [Table Text Block]

	June 30, 2019
Operating lease ROU assets	$	5,182
Current operating lease liabilities (included in other current liabilities)	$	1,374
Operating lease liabilities, net of current portion		4,021
Total operating lease liabilities	$	5,395

Lessee, Operating Lease, Liability, Maturity [Table Text Block]

	Operating Leases (a)
2019	$	779
2020		1,262
2021		716
2022		655
2023		666
Thereafter		3,430
Total undiscounted lease payments		7,508
Less: Imputed interest		(2,113	)
Total lease liabilities	$	5,395

Schedule of Future Minimum Lease Payments for Capital and Operating Leases [Table Text Block]

				Operating
	Capital Leases			Leases (As Revised)		Total (As Revised)
2019	$	33		$	1,745	$	1,778
2020		-			1,347		1,347
2021		-			726		726
2022		-			624		624
2023		-			636		636
Thereafter		-			3,071		3,071
Total require payments	$	33		$	8,149	$	8,182
Less amounts representing interest (3.5%)		-
Present value of minimum lease payments		33
Less current maturities		(33	)
Long-term capital lease liability	$	-

XML

Note 3 - Revenue Recognition - Disaggregated Revenue by Revenue Stream (Details) - Customer Concentration Risk [Member]	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Third-Party Payor Rental Revenue [Member]
Revenue	49.40%	47.50%	48.80%	48.00%
Director Payer Rentals [Member]
Revenue	33.00%	38.10%	33.80%	38.50%
Revenue, Product and Service Benchmark [Member]
Revenue	17.60%	14.40%	17.40%	13.50%
Revenue from Contract with Customer Benchmark [Member]
Revenue	100.00%	100.00%	100.00%	100.00%

XML

Note 4 - Medical Equipment (Details Textual) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Depreciation Expense Related to Medical Equipment	$ 1.8	$ 1.5	$ 3.5	$ 3.0

XML

Note 4 - Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Medical Equipment for sale or rental	$ 1,927	$ 1,601
Medical Equipment in rental service	68,721	61,429
Medical Equipment in rental service - pump reserve	(614)	(530)
Accumulated depreciation	(39,234)	(37,411)
Medical Equipment in rental service - net	28,873	23,488
Total	$ 30,800	$ 25,089

XML

Note 5 - Property and Equipment (Details Textual) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Depreciation, Nonproduction	$ 0.1	$ 0.1	$ 0.2	$ 0.2

XML

Note 5 - Property and Equipment - Property and Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Gross Assets	$ 6,144	$ 6,054
Accumulated Depreciation	(4,605)	(4,609)
Total	1,539	1,445
Furniture and Fixtures [Member]
Gross Assets	4,025	3,717
Accumulated Depreciation	(3,385)	(3,257)
Total	640	460
Automobiles [Member]
Gross Assets	117	118
Accumulated Depreciation	(84)	(95)
Total	33	23
Leasehold Improvements [Member]
Gross Assets	2,002	2,219
Accumulated Depreciation	(1,136)	(1,257)
Total	$ 866	$ 962

XML

Note 6 - Intangible Assets (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Amortization of Intangible Assets, Total	$ 1,124	$ 1,165	$ 2,249	$ 2,352

XML

Note 6 - Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Amortizable intangible assets, accumulated amortization	$ (33,307)	$ (31,058)
Total nonamortizable and amortizable intangible assets, gross assets	50,923	50,923
Total nonamortizable and amortizable intangible assets, net	17,616	19,865
Trade Names [Member]
Amortizable intangible assets, gross assets	23	23
Amortizable intangible assets, accumulated amortization	(23)	(23)
Amortizable intangible assets, net
Physician and Customer Relationships [Member]
Amortizable intangible assets, gross assets	36,534	36,534
Amortizable intangible assets, accumulated amortization	(25,362)	(24,175)
Amortizable intangible assets, net	11,172	12,359
Noncompete Agreements [Member]
Amortizable intangible assets, gross assets	1,136	1,136
Amortizable intangible assets, accumulated amortization	(1,136)	(1,136)
Amortizable intangible assets, net
Computer Software, Intangible Asset [Member]
Amortizable intangible assets, gross assets	11,230	11,230
Amortizable intangible assets, accumulated amortization	(6,786)	(5,724)
Amortizable intangible assets, net	4,444	5,506
Trade Names 1 [Member]
Nonamortizable intangible assets	$ 2,000	$ 2,000

XML

Note 6 - Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands	Jun. 30, 2019 USD ($)
Amortization expense, 2019	$ 2,153
Amortization expense, 2020	4,285
Amortization expense, 2021	3,930
Amortization expense, 2022	2,051
Amortization expense, 2023	548
Amortization expense, 2024 and thereafter	$ 2,649

XML

Note 7 - Debt (Details Textual) - USD ($) $ in Thousands		6 Months Ended	12 Months Ended
	Apr. 15, 2019	Jun. 30, 2019	Dec. 31, 2019	Feb. 05, 2019	Dec. 31, 2018
Long-term Debt, Total		$ 33,562			$ 33,745
Equipment Line [Member]
Long-term Debt, Total		2,562			2,562
Financing Agreement [Member]
Long-term Debt, Total		1,900
Financing Agreement [Member] | Medical Equipment [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 2,000
Debt Instrument, Term	3 years
Line of Credit Facility, Current Borrowing Capacity		$ 1,900
Credit Facility [Member] | Eurodollar Loan [Member]
Debt Instrument, Interest Rate, Effective Percentage		5.19%
LIBOR Rate		2.44%
Credit Facility [Member] | CB Floating Rate Loan [Member]
Debt Instrument, Interest Rate, Effective Percentage		5.50%
Lender Prime Rate		5.50%
Credit Facility [Member] | London Interbank Offered Rate (LIBOR) [Member] | Eurodollar Loan [Member]
Debt Instrument, Basis Spread on Variable Rate		2.75%
Credit Facility [Member] | London Interbank Offered Rate (LIBOR) [Member] | CB Floating Rate Loan [Member]
Debt Instrument, Basis Spread on Variable Rate, Before Margin Rate		2.50%
Credit Facility [Member] | Maximum [Member] | London Interbank Offered Rate (LIBOR) [Member] | Eurodollar Loan [Member]
Debt Instrument, Basis Spread on Variable Rate		3.00%
Credit Facility [Member] | Maximum [Member] | Greater of Prime Rate or LIBOR Plus 2.5% [Member] | CB Floating Rate Loan [Member]
Debt Instrument, Basis Spread on Variable Rate		0.25%
Credit Facility [Member] | Minimum [Member] | London Interbank Offered Rate (LIBOR) [Member] | Eurodollar Loan [Member]
Debt Instrument, Basis Spread on Variable Rate		2.00%
Credit Facility [Member] | Minimum [Member] | Greater of Prime Rate or LIBOR Plus 2.5% [Member] | CB Floating Rate Loan [Member]
Debt Instrument, Basis Spread on Variable Rate		(1.00%)
Credit Facility [Member] | Equipment Line [Member]
Line of Credit Facility, Maximum Borrowing Capacity				$ 8,000
Long-term Debt, Total		$ 29,200
Long-term Line of Credit, Total		$ 2,600
Credit Facility [Member] | Equipment Line [Member] | Maximum [Member] | Forecast [Member]
Capital Expenditures Incurred but Not yet Paid			$ 7,000

XML

Note 7 - Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Credit Facility [Member] - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Gross availability	$ 11,000	$ 9,973
Outstanding draws
Letters of credit	(1,750)	(750)
Landlord reserves	(71)	(70)
Net availability	$ 9,179	$ 9,153

XML

Note 7 - Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
2019	$ 3,122
2020	5,938
2021	22,870
2022	734
2023 and thereafter	898
Long-term Debt, Total	33,562	$ 33,745
Unamortized value of the debt issuance costs, 2019	(20)
Unamortized value of the debt issuance costs, 2020	(39)
Unamortized value of the debt issuance costs, 2021	(39)
Unamortized value of the debt issuance costs, 2022
Unamortized value of the debt issuance costs, 2023 and thereafter
Unamortized value of the debt issuance costs, Total	(98)	(114)
Financing Agreement [Member]
2019	301
2020	652
2021	725
2022	222
2023 and thereafter
Long-term Debt, Total	1,900
Equipment Line [Member]
2019	128
2020	512
2021	512
2022	512
2023 and thereafter	898
Long-term Debt, Total	2,562	2,562
Term Loan A [Member]
2019	1,792
2020	3,584
2021	16,143
2022
2023 and thereafter
Long-term Debt, Total	21,519	23,311
Term Loan C [Member]
2019	921
2020	1,229
2021	5,529
2022
2023 and thereafter
Long-term Debt, Total	$ 7,679	$ 7,986

XML

Note 7 - Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current portion of long-term debt	$ 6,084	$ 4,903
Long-term debt	27,478	28,842
Total	33,562	33,745
Unamortized value of the debt issuance costs, current portion of long-term debt	(39)	(38)
Unamortized value of the debt issuance costs, long-term debt	(59)	(76)
Unamortized value of the debt issuance costs, Total	(98)	(114)
Financing Agreement [Member]
Current portion of long-term debt	619
Long-term debt	1,281
Total	1,900
Equipment Line [Member]
Current portion of long-term debt	384	128
Long-term debt	2,178	2,434
Total	2,562	2,562
Term Loan A [Member]
Current portion of long-term debt	3,584	3,584
Long-term debt	17,935	19,727
Total	21,519	23,311
Term Loan C [Member]
Current portion of long-term debt	1,536	1,229
Long-term debt	6,143	6,757
Total	$ 7,679	$ 7,986

XML

Note 8 - Income Taxes (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Income Tax Expense (Benefit), Total	$ 63	$ 6	$ 122	$ 64

XML

Note 10 - Earnings (Loss) Per Share (Details Textual) shares in Millions	3 Months Ended
	Jun. 30, 2019 shares
Share-based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	0.1

XML

Note 10 - Earnings (Loss) Per Share - Summary of Income and Share Amounts Utilized to Calculate Basic and Diluted Net Income Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Net income (loss) (in thousands)	$ 381	$ (505)	$ (579)	$ (301)
Weighted average common shares outstanding:
Basic (in shares)	19,708,422	22,703,415	19,644,590	22,751,318
Dilutive effect of non-vested awards (in shares)	875,012
Diluted (in shares)	20,583,434	22,703,415	19,644,590	22,751,318
Basic (in dollars per share)	$ 0.02	$ (0.02)	$ (0.03)	$ (0.01)
Diluted (in dollars per share)	$ 0.02	$ (0.02)	$ (0.03)	$ (0.01)

XML

Note 11 - Leases (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019		Jun. 30, 2019		Jan. 01, 2019	Dec. 31, 2018
Operating Lease, Liability, Total	$ 5,395	[1]	$ 5,395	[1]	$ 3,100
Operating Lease, Expense	400		700
Lessee, Operating Lease, Lease Not yet Commenced, Amount	$ 300		$ 300
Lessor, Operating Lease, Lease Not yet Commenced, Term of Contract	6 years		6 years
Operating Leases, Future Minimum Payments Due, Next Twelve Months						$ 1,745
Operating Leases, Future Minimum Payments, Due in Two Years						1,347
Operating Leases, Future Minimum Payments, Due in Three Years						726
Operating Leases, Future Minimum Payments, Due in Four Years						624
Operating Leases, Future Minimum Payments, Due in Five Years						636
Operating Leases, Future Minimum Payments, Due Thereafter						3,071
Operating Lease, Right-of-Use Asset	$ 5,182		$ 5,182		$ 3,100
Restatement Adjustment [Member] | Error Correction for Overstated Lease Maturities Under Previous Lease Accounting as of December 31, 2018 [Member]
Operating Leases, Future Minimum Payments Due, Next Twelve Months	(121)		(121)
Operating Leases, Future Minimum Payments, Due in Two Years	(370)		(370)
Operating Leases, Future Minimum Payments, Due in Three Years	(381)		(381)
Operating Leases, Future Minimum Payments, Due in Four Years	(392)		(392)
Operating Leases, Future Minimum Payments, Due in Five Years	(404)		(404)
Operating Leases, Future Minimum Payments, Due Thereafter	$ (2,528)		$ (2,528)
Minimum [Member]
Lessee, Operating Lease, Renewal Term	1 year		1 year
Maximum [Member]
Lessee, Operating Lease, Renewal Term	5 years		5 years

[1] Excludes $0.3 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of six years and is expected to commence later in 2019.

XML

Note 11 - Leases - Lease Cost (Details) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)
Operating lease cost	$ 290	$ 677
Variable lease cost	53	126
Total lease cost	$ 343	803
Operating cash flow from operating leases		771
Operating leases		$ 3,015
Operating leases (Year)	7 years 109 days	7 years 109 days
Operating leases	7.50%	7.50%

XML

Note 11 - Leases - Operating Lease Assets and Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2019		Jan. 01, 2019	Dec. 31, 2018
Operating Lease, Right-of-Use Asset	$ 5,182		$ 3,100
Current operating lease liabilities (included in other current liabilities)	1,374
Operating lease liabilities, net of current portion	4,021
Total operating lease liabilities	$ 5,395	[1]	$ 3,100

[1] Excludes $0.3 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of six years and is expected to commence later in 2019.

XML

Note 11 - Leases - Maturities of Lease Liabilities (Details) - USD ($) $ in Thousands		Jun. 30, 2019		Jan. 01, 2019
2019	[1]	$ 779
2020	[1]	1,262
2021	[1]	716
2022	[1]	655
2023	[1]	666
Thereafter	[1]	3,430
Total undiscounted lease payments	[1]	7,508
Less: Imputed interest	[1]	(2,113)
Total lease liabilities		$ 5,395	[1]	$ 3,100

[1] Excludes $0.3 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of six years and is expected to commence later in 2019.

XML

Note 11 - Leases - Schedule of Future Minimum Rental Payments Pursuant to Capital and Operating Leases (Details) $ in Thousands	Dec. 31, 2018 USD ($)
2019, capital leases	$ 33
Operating Leases, Future Minimum Payments Due, Next Twelve Months	1,745
2019	1,778
2020, capital leases
Operating Leases, Future Minimum Payments, Due in Two Years	1,347
2020	1,347
2021, capital leases
Operating Leases, Future Minimum Payments, Due in Three Years	726
2021	726
2022, capital leases
Operating Leases, Future Minimum Payments, Due in Four Years	624
2022	624
2023, capital leases
Operating Leases, Future Minimum Payments, Due in Five Years	636
2023	636
Thereafter, capital leases
Operating Leases, Future Minimum Payments, Due Thereafter	3,071
Thereafter	3,071
Total required payments, capital leases	33
Total required payments, operating leases	8,149
Total required payments	8,182
Less amounts representing interest (3.5%), capital leases
Present value of minimum lease payments, capital leases	33
Less current maturities, capital leases	(33)
Long-term capital lease liability, capital leases

XML

Note 11 - Leases - Schedule of Future Minimum Rental Payments Pursuant to Capital and Operating Leases (Details) (Parentheticals)	Dec. 31, 2018
Capital lease interest	3.50%