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UNITED
STATES
SECURITIES
AND EXCHANGE COMMISSION
Washington,
D.C. 20549
Form
10-Q
(Mark
one)
| ☒ | QUARTERLY
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For
the quarterly period ended March 31, 2024
or
| ☐ | TRANSITION
REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For
the transition period from to
Commission
File Number: 001-36529
![](https://www.sec.gov/Archives/edgar/data/1582982/000149315224019276/form10-q_001.jpg)
CareCloud,
Inc.
(Exact
name of registrant as specified in its charter)
Delaware |
|
22-3832302 |
(State
or other jurisdiction of
incorporation
or organization) |
|
(I.R.S.
Employer
Identification
Number) |
7
Clyde Road
Somerset,
New Jersey |
|
08873 |
(Address
of principal executive offices) |
|
(Zip
Code) |
(732)
873-5133
(Registrant’s
telephone number, including area code)
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 $0.001 per share |
|
CCLD |
|
Nasdaq
Global Market |
11%
Series A Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share |
|
CCLDP
|
|
Nasdaq
Global Market
|
8.75%
Series B Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share |
|
CCLDO
|
|
Nasdaq
Global Market
|
Indicate
by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange
Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2)
has been subject to such filing requirements for the past 90 days. Yes ☒ 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 (§232.405 of this chapter) 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 Exchange Act). Yes ☐ No ☒
At
May 10, 2024, the registrant had 16,120,767 shares of common stock, par value $0.001 per share, outstanding.
INDEX
Forward-Looking
Statements
Certain
statements that we make from time to time, including statements contained in this Quarterly Report on Form 10-Q, constitute “forward-looking
statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, or the Securities Act, and Section 21E
of the Securities Exchange Act of 1934, as amended, or the Exchange Act. All statements other than statements of historical fact contained
in this Quarterly Report on Form 10-Q are forward-looking statements. These statements relate to anticipated future events, future results
of operations or future financial performance. In some cases, you can identify forward-looking statements by terminology such as “may,”
“might,” “will,” “shall,” “should,” “could,” “intends,” “expects,”
“plans,” “goals,” “projects,” “anticipates,” “believes,” “seeks,”
“estimates,” “forecasts,” “predicts,” “possible,” “potential,” “target,”
or “continue” or the negative of these terms or other comparable terminology. Our operations involve risks and uncertainties,
many of which are outside of our control, and any one of which, or a combination of which, could materially affect our results of operations
and whether the forward-looking statements ultimately prove to be correct. Forward-looking statements in this Quarterly Report on Form
10-Q include, without limitation, statements reflecting management’s expectations for future financial performance and operating
expenditures (including our ability to continue as a going concern, to raise additional capital and to succeed in our future operations),
expected growth, profitability and business outlook, increased sales and marketing expenses, and the expected results from the integration
of our acquisitions.
Forward-looking
statements are only predictions, are uncertain and involve substantial known and unknown risks, uncertainties, and other factors that
may cause our (or our industry’s) actual results, levels of activity or performance to be materially different from any future
results, levels of activity or performance expressed or implied by these forward-looking statements. These factors include, among other
things, the unknown risks and uncertainties that we believe could cause actual results to differ from these forward-looking statements
as set forth under the heading “Risk Factors” in our Annual Report on Form 10-K filed with the SEC on March 21, 2024. New
risks and uncertainties emerge from time to time, and it is not possible for us to predict all of the risks and uncertainties that could
have an impact on the forward-looking statements, including without limitation, risks and uncertainties relating to:
| ● | our
ability to manage our growth, including acquiring, partnering with, and effectively integrating
acquired businesses into our infrastructure and avoiding legal exposure and liabilities associated
with acquired companies and assets; |
| | |
| ● | our
ability to retain our clients and revenue levels, including effectively migrating new clients
and maintaining or growing the revenue levels of our new and existing clients; |
| | |
| ● | our
ability to maintain operations in Pakistan, Azad Jammu and Kashmir, and Sri Lanka (together,
the “Offshore Offices”) in a manner that continues to enable us to offer competitively
priced products and services; |
| | |
| ● | our
ability to keep pace with a rapidly changing healthcare industry; |
| | |
| ● | our
ability to consistently achieve and maintain compliance with a myriad of federal, state,
foreign, local, payor and industry requirements, regulations, rules, laws and contracts; |
| | |
| ● | our
ability to maintain and protect the privacy of confidential and protected Company, client
and patient information; |
| | |
| ● | our
ability to develop new technologies, upgrade and adapt legacy and acquired technologies to
work with evolving industry standards and third-party software platforms and technologies,
and protect and enforce all of these and other intellectual property rights; |
| | |
| ● | our
ability to attract and retain key officers and employees, and the continued involvement of
Mahmud Haq as Executive Chairman and A. Hadi Chaudhry as Chief Executive Officer, all of
which are critical to our ongoing operations and growing our business; |
| | |
| ● | our
ability to realize the expected cost savings and benefits from our restructuring activities
and structural cost reductions; |
| | |
| ● | our
ability to comply with covenants contained in our credit agreement with our senior secured
lender, Silicon Valley Bank, a division of First Citizens Bank, and other future debt facilities; |
| | |
| ● | our
ability to resume and then continue to pay our monthly dividends to the holders of our Series
A and Series B preferred stock; |
| | |
| ● | our
ability to incorporate AI into our products faster and more successfully than our competitors,
protecting the privacy of medical records and cybersecurity threats; |
| | |
| ● | our
ability to compete with other companies developing products and selling services competitive
with ours, and who may have greater resources and name recognition than we have; |
| | |
| ● | our
ability to effectively integrate, manage and keep our information systems secure and operational
in the event of a cyber-attack; |
| | |
| ● | our
ability to respond to the uncertainty resulting from pandemics, epidemics or other public
health emergencies and the impact they may have on our operations, the demand for our services,
our projected results of operations, financial performance or other financial metrics or
any of the foregoing risks and economic activity in general; |
| | |
| ● | our
ability to keep and increase market acceptance of our products and services; |
| | |
| ● | changes
in domestic and foreign business, market, financial, political and legal conditions; and |
| | |
| ● | other
factors disclosed in this Quarterly Report on Form 10-Q or our other filings with the Securities
and Exchange Commission (the “SEC”). |
The
forward-looking statements contained in this Quarterly Report on Form 10-Q are based on our current expectations, beliefs and views as
of the date of this Quarterly Report on Form 10-Q concerning future developments and their potential effects on our business.
Although we believe that the expectations reflected in the
forward-looking statements contained in this Quarterly Report on Form 10-Q are reasonable, we cannot guarantee future results, levels
of activity, performance, or achievements. We anticipate that subsequent events and developments
may cause our assessments to change. Except as required by law, we are under no duty to update or revise any of such forward-looking
statements, whether as a result of new information, future events, or otherwise, after the date of this Quarterly Report on Form 10-Q.
You
should read this Quarterly Report on Form 10-Q with the understanding that our actual future results, levels of activity, performance
and events and circumstances may be materially different from what we currently expect. The forward-looking
statements contained herein should not be relied upon as representing our assessments as of any date subsequent to the date of this Quarterly
Report on Form 10-Q.
PART
I. FINANCIAL INFORMATION
Item
1. Condensed Consolidated Financial Statements
CARECLOUD, INC.
CONDENSED
CONSOLIDATED BALANCE SHEETS
($ in thousands, except share and per share amounts)
| |
March 31, | | |
December 31, | |
| |
2024 | | |
2023 | |
| |
(Unaudited) | | |
| |
ASSETS | |
| | | |
| | |
Current assets: | |
| | | |
| | |
Cash | |
$ | 4,138 | | |
$ | 3,331 | |
Accounts receivable - net | |
| 11,962 | | |
| 11,888 | |
Contract asset | |
| 5,455 | | |
| 5,094 | |
Inventory | |
| 480 | | |
| 465 | |
Current assets - related party | |
| 16 | | |
| 16 | |
Prepaid expenses and other current assets | |
| 2,225 | | |
| 2,449 | |
Total current assets | |
| 24,276 | | |
| 23,243 | |
Property and equipment - net | |
| 5,438 | | |
| 5,317 | |
Operating lease right-of-use assets | |
| 4,107 | | |
| 4,365 | |
Intangible assets - net | |
| 23,237 | | |
| 25,074 | |
Goodwill | |
| 19,186 | | |
| 19,186 | |
Other assets | |
| 641 | | |
| 641 | |
TOTAL ASSETS | |
$ | 76,885 | | |
$ | 77,826 | |
LIABILITIES AND SHAREHOLDERS’ EQUITY | |
| | | |
| | |
Current liabilities: | |
| | | |
| | |
Accounts payable | |
$ | 5,921 | | |
$ | 5,798 | |
Accrued compensation | |
| 2,765 | | |
| 3,444 | |
Accrued expenses | |
| 6,350 | | |
| 5,065 | |
Operating lease liability (current portion) | |
| 1,775 | | |
| 1,888 | |
Deferred revenue (current portion) | |
| 1,386 | | |
| 1,380 | |
Notes payable (current portion) | |
| 167 | | |
| 292 | |
Dividend payable | |
| 5,438 | | |
| 5,433 | |
Total current liabilities | |
| 23,802 | | |
| 23,300 | |
Notes payable | |
| 35 | | |
| 37 | |
Borrowings under line of credit | |
| 9,000 | | |
| 10,000 | |
Operating lease liability | |
| 2,320 | | |
| 2,516 | |
Deferred revenue | |
| 308 | | |
| 256 | |
Total liabilities | |
| 35,465 | | |
| 36,109 | |
COMMITMENTS AND CONTINGENCIES (NOTE 7) | |
| - | | |
| - | |
SHAREHOLDERS’ EQUITY: | |
| | | |
| | |
Preferred stock, $0.001 par value - authorized 7,000,000 shares. Series A, issued and outstanding 4,526,231 shares at March 31, 2024 and December 31, 2023. Series B, issued and outstanding 1,482,792 and 1,468,792 shares at March 31, 2024 and December 31, 2023, respectively | |
| 6 | | |
| 6 | |
Common stock, $0.001 par value - authorized 35,000,000 shares. Issued 16,859,291 and 16,620,891 shares at March 31, 2024 and December 31, 2023, respectively. Outstanding 16,118,492 and 15,880,092 shares at March 31, 2024 and December 31, 2023, respectively | |
| 17 | | |
| 17 | |
Additional paid-in capital | |
| 120,622 | | |
| 120,706 | |
Accumulated deficit | |
| (74,722 | ) | |
| (74,481 | ) |
Accumulated other comprehensive loss | |
| (3,841 | ) | |
| (3,869 | ) |
Less: 740,799 common shares held in treasury, at cost at March 31, 2024 and December 31, 2023 | |
| (662 | ) | |
| (662 | ) |
Total shareholders’ equity | |
| 41,420 | | |
| 41,717 | |
TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY | |
$ | 76,885 | | |
$ | 77,826 | |
See notes to condensed
consolidated financial statements.
CARECLOUD, INC.
CONDENSED
CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED)
FOR THE THREE MONTHS ENDED MARCH 31, 2024 AND 2023
($
in thousands, except share and per share amounts)
| |
| | | |
| | |
| |
March 31, | |
| |
2024 | | |
2023 | |
NET REVENUE | |
$ | 25,962 | | |
$ | 30,001 | |
OPERATING EXPENSES: | |
| | | |
| | |
Direct operating costs | |
| 15,177 | | |
| 18,107 | |
Selling and marketing | |
| 1,770 | | |
| 2,612 | |
General and administrative | |
| 3,721 | | |
| 5,120 | |
Research and development | |
| 913 | | |
| 1,078 | |
Depreciation and amortization | |
| 3,930 | | |
| 3,038 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| 269 | |
Total operating expenses | |
| 25,833 | | |
| 30,224 | |
OPERATING INCOME (LOSS) | |
| 129 | | |
| (223 | ) |
OTHER: | |
| | | |
| | |
Interest income | |
| 27 | | |
| 20 | |
Interest expense | |
| (365 | ) | |
| (150 | ) |
Other income - net | |
| 7 | | |
| 17 | |
Income tax provision | |
| 39 | | |
| 65 | |
NET LOSS | |
$ | (241 | ) | |
$ | (401 | ) |
| |
| | | |
| | |
Preferred stock dividend | |
| 5 | | |
| 3,931 | |
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS | |
$ | (246 | ) | |
$ | (4,332 | ) |
| |
| | | |
| | |
Net loss per common share: basic and diluted | |
$ | (0.02 | ) | |
$ | (0.28 | ) |
Weighted-average common shares used to compute basic and diluted loss per share | |
| 16,014,309 | | |
| 15,421,096 | |
See notes to condensed
consolidated financial statements.
CARECLOUD, INC.
CONDENSED
CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (UNAUDITED)
FOR
THE THREE MONTHS ENDED MARCH 31, 2024 AND 2023
($
in thousands)
| |
2024 | | |
2023 | |
| |
March 31, | |
| |
2024 | | |
2023 | |
NET LOSS | |
$ | (241 | ) | |
$ | (401 | ) |
OTHER COMPREHENSIVE INCOME (LOSS), NET OF TAX | |
| | | |
| | |
Foreign currency translation adjustment (a) | |
| 28 | | |
| (1,711 | ) |
COMPREHENSIVE LOSS | |
$ | (213 | ) | |
$ | (2,112 | ) |
See
notes to condensed consolidated financial statements.
CARECLOUD, INC.
CONDENSED
CONSOLIDATED STATEMENTS OF SHAREHOLDERS’ EQUITY (UNAUDITED)
FOR THE THREE MONTHS ENDED MARCH 31, 2024 AND MARCH 31, 2023
($ in thousands, except for number of shares)
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
| |
Preferred Stock Series A | | |
Preferred Stock Series B | | |
Common Stock | | |
Additional Paid-in | | |
Accumulated | | |
Accumulated Other Comprehensive | | |
Treasury (Common) | | |
Total Shareholders’ | |
| |
Shares | | |
Amount | | |
Shares | | |
Amount | | |
Shares | | |
Amount | | |
Capital | | |
Deficit | | |
Loss | | |
Stock | | |
Equity | |
Balance - January 1, 2024 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,468,792 | | |
$ | 1 | | |
| 16,620,891 | | |
$ | 17 | | |
$ | 120,706 | | |
$ | (74,481 | ) | |
$ | (3,869 | ) | |
$ | (662 | ) | |
$ | 41,717 | |
Cumulative effect of adopting ASC 326 | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance - January 1, 2023 after adoption | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance - January 1, 2023 after adoption, shares | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Net loss | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (241 | ) | |
| - | | |
| - | | |
| (241 | ) |
Foreign currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 28 | | |
| - | | |
| 28 | |
Issuance of stock under the equity incentive plan | |
| - | | |
| - | | |
| 14,000 | | |
| - | | |
| 238,400 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (79 | ) | |
| - | | |
| - | | |
| - | | |
| (79 | ) |
Preferred stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (5 | ) | |
| - | | |
| - | | |
| - | | |
| (5 | ) |
Balance - March 31, 2024 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,482,792 | | |
$ | 1 | | |
| 16,859,291 | | |
$ | 17 | | |
$ | 120,622 | | |
$ | (74,722 | ) | |
$ | (3,841 | ) | |
$ | (662 | ) | |
$ | 41,420 | |
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance - January 1, 2023 before adoption of ASC 326 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,344,128 | | |
$ | 1 | | |
| 15,970,204 | | |
$ | 16 | | |
$ | 130,987 | | |
$ | (25,621 | ) | |
$ | (3,037 | ) | |
$ | (662 | ) | |
$ | 101,689 | |
Balance | |
| 4,526,231 | | |
$ | 5 | | |
| 1,344,128 | | |
$ | 1 | | |
| 15,970,204 | | |
$ | 16 | | |
$ | 130,987 | | |
$ | (25,621 | ) | |
$ | (3,037 | ) | |
$ | (662 | ) | |
$ | 101,689 | |
Cumulative effect of adopting ASC 326 | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (186 | ) | |
| - | | |
| - | | |
| (186 | ) |
Balance - January 1, 2023 after adoption | |
| 4,526,231 | | |
| 5 | | |
| 1,344,128 | | |
| 1 | | |
| 15,970,204 | | |
| 16 | | |
| 130,987 | | |
| (25,807 | ) | |
| (3,037 | ) | |
| (662 | ) | |
| 101,503 | |
Net loss | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (401 | ) | |
| - | | |
| - | | |
| (401 | ) |
Foreign currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (1,711 | ) | |
| - | | |
| (1,711 | ) |
Issuance of stock under the equity incentive plan | |
| - | | |
| - | | |
| 41,491 | | |
| - | | |
| 343,203 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,185 | | |
| - | | |
| - | | |
| - | | |
| 1,185 | |
Shares issued for services | |
| - | | |
| - | | |
| - | | |
| - | | |
| 20,000 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Issuance of Series B Preferred Stock | |
| - | | |
| - | | |
| 59,773 | | |
| - | | |
| - | | |
| - | | |
| 1,437 | | |
| - | | |
| - | | |
| - | | |
| 1,437 | |
Preferred stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (3,931 | ) | |
| - | | |
| - | | |
| - | | |
| (3,931 | ) |
Balance - March 31, 2023 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,445,392 | | |
$ | 1 | | |
| 16,333,407 | | |
$ | 16 | | |
$ | 129,678 | | |
$ | (26,208 | ) | |
$ | (4,748 | ) | |
$ | (662 | ) | |
$ | 98,082 | |
Balance | |
| 4,526,231 | | |
$ | 5 | | |
| 1,445,392 | | |
$ | 1 | | |
| 16,333,407 | | |
$ | 16 | | |
$ | 129,678 | | |
$ | (26,208 | ) | |
$ | (4,748 | ) | |
$ | (662 | ) | |
$ | 98,082 | |
For
the three months ended March 2023, the preferred stock dividends were paid monthly at the rate of $2.75 and $2.19 for Series A and Series
B, respectively, per share per annum.
No
dividends were paid for the three months ended March 2024.
See notes to condensed consolidated financial statements.
CARECLOUD, INC.
CONDENSED
CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED)
FOR THE THREE MONTHS ENDED MARCH 31, 2024 AND 2023
($ in thousands)
| |
2024 | | |
2023 | |
OPERATING ACTIVITIES: | |
| | | |
| | |
Net loss | |
$ | (241 | ) | |
$ | (401 | ) |
Adjustments to reconcile net loss to net cash provided by operating activities: | |
| | | |
| | |
Depreciation and amortization | |
| 4,020 | | |
| 3,205 | |
Lease amortization | |
| 509 | | |
| 683 | |
Deferred revenue | |
| 58 | | |
| 16 | |
Provision for expected credit losses | |
| 37 | | |
| 97 | |
Provision for deferred income taxes | |
| - | | |
| 26 | |
Foreign exchange gain | |
| (11 | ) | |
| (11 | ) |
Interest accretion | |
| 168 | | |
| 166 | |
Stock-based compensation (benefit) expense | |
| (708 | ) | |
| 1,072 | |
Changes in operating assets and liabilities: | |
| | | |
| | |
Accounts receivable | |
| (111 | ) | |
| (156 | ) |
Contract asset | |
| (361 | ) | |
| (619 | ) |
Inventory | |
| (15 | ) | |
| 116 | |
Other assets | |
| - | | |
| (615 | ) |
Accounts payable and other liabilities | |
| 721 | | |
| (2,556 | ) |
Net cash provided by operating activities | |
| 4,066 | | |
| 1,023 | |
INVESTING ACTIVITIES: | |
| | | |
| | |
Purchases of property and equipment | |
| (298 | ) | |
| (835 | ) |
Capitalized software and other intangible assets | |
| (1,570 | ) | |
| (2,204 | ) |
Net cash used in investing activities | |
| (1,868 | ) | |
| (3,039 | ) |
FINANCING ACTIVITIES: | |
| | | |
| | |
Preferred stock dividends paid | |
| - | | |
| (3,875 | ) |
Settlement of tax withholding obligations on stock issued to employees | |
| (151 | ) | |
| (1,113 | ) |
Repayments of notes payable | |
| (223 | ) | |
| (236 | ) |
Proceeds from issuance of Series B Preferred Stock, net of expenses | |
| - | | |
| 1,437 | |
Proceeds from line of credit | |
| - | | |
| 12,700 | |
Repayment of line of credit | |
| (1,000 | ) | |
| (10,700 | ) |
Net cash used in financing activities | |
| (1,374 | ) | |
| (1,787 | ) |
EFFECT OF EXCHANGE RATE CHANGES ON CASH | |
| (17 | ) | |
| (335 | ) |
NET INCREASE (DECREASE) IN CASH | |
| 807 | | |
| (4,138 | ) |
CASH - Beginning of the period | |
| 3,331 | | |
| 12,299 | |
CASH - End of the period | |
$ | 4,138 | | |
$ | 8,161 | |
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES: | |
| | | |
| | |
Dividends declared, not paid | |
$ | 5 | | |
$ | 3,931 | |
Purchase of prepaid insurance with assumption of note | |
$ | 96 | | |
$ | - | |
Reclass of deposits for property and equipment placed in service | |
$ | 296 | | |
$ | - | |
SUPPLEMENTAL INFORMATION - Cash paid during the period for: | |
| | | |
| | |
Income taxes | |
$ | 6 | | |
$ | 2 | |
Interest | |
$ | 295 | | |
$ | 75 | |
See
notes to condensed consolidated financial statements.
CARECLOUD,
INC.
NOTES
TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
AS
OF AND FOR THE THREE MONTHS ENDED MARCH 31, 2024
AND
2023 (UNAUDITED)
1. ORGANIZATION AND BUSINESS
CareCloud,
Inc., (together with its consolidated subsidiaries, “CareCloud,” the “Company,” “we,” “us”
and/or “our”) is a leading provider of technology-enabled services and solutions that redefine the healthcare revenue cycle.
We provide technology-enabled revenue cycle management and a full suite of proprietary cloud-based solutions to healthcare providers,
from small practices to enterprise medical groups, hospitals, and health systems throughout the United States. Healthcare organizations
today operate in highly complex and regulated environments. Our suite of technology-enabled solutions helps our clients increase financial
and operational performance, streamline clinical workflows, and improve the patient experience.
Our
portfolio of proprietary software and business services includes: technology-enabled business solutions that maximize revenue cycle
management and create efficiencies through platform agnostic AI-driven applications; cloud-based software that helps providers
manage their practice and patient engagement while leveraging analytics to improve provider performance; digital health services to
address value-based care and enable the delivery of remote patient care; healthcare IT professional services & staffing to
address physician burnout, staffing shortages and leverage consulting expertise to transition into the next generation of
healthcare; and, medical practice management services to assist medical providers with operating models and the tools needed to run
their practice. Our high-value business services, such as revenue cycle management, are often paired with our cloud-based software,
premiere healthcare consulting and implementation services, and on-demand workforce staffing capabilities for high-performance
medical groups and health systems nationwide.
CareCloud
has its corporate office in Somerset, New Jersey and maintains client support teams throughout the U.S., and offshore offices in Pakistan
and Azad Jammu and Kashmir, a region administered by Pakistan (the “Pakistan Offices”), and in Sri Lanka. Effective February
1, 2024, MTBC Acquisition Corp. (“MAC”) and its wholly owned subsidiary were merged into CareCloud, Inc. (“CCI”).
There was no financial or operational impact as a result of the merger.
2. BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
The
accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles
generally accepted in the United States of America (“GAAP”) for interim financial reporting and as required by
Regulation S-X, Rule 8-03. Accordingly, they do not include all of the information and notes required by GAAP for complete financial
statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements
contain all adjustments (consisting of items of a normal and recurring nature) necessary to present fairly the Company’s
financial position as of March 31, 2024, the results of operations for the three months ended March 31, 2024 and 2023 and cash flows
for the three months ended March 31, 2024 and 2023. When preparing financial statements in conformity with GAAP, the Company must
make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and
liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period.
Actual results could differ significantly from those estimates. The condensed consolidated financial statements include the accounts
of the Company and its wholly owned subsidiaries. All intercompany balances and transactions have been eliminated in
consolidation.
The
accompanying unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the audited
consolidated financial statements for the year ended December 31, 2023, which are included in the Company’s Annual Report on
Form 10-K, filed with the SEC on March 21, 2024.
Liquidity
and Going Concern — Primarily due to a decline in revenue associated with our Healthcare IT segment and a goodwill impairment
of $42.0 million for the year ended December 31, 2023, the Company generated a net loss of $48.7 million and had a net decrease in cash
of $9.0 million. For the three months ended March 31, 2024, the Company had a net loss of $241,000. At December 31, 2023, the Company
had negative working capital of $57,000 and cash of $3.3 million. At March 31, 2024, the Company had positive working capital of $474,000
and cash of $4.1 million. Absent any other action, the Company may require additional liquidity to continue its operations over the next
12 months.
However,
management has considered its plans to continue the Company as a going concern and believes substantial doubt is alleviated by focusing
on cost-control. As discussed in Note 9, the Company approved a restructuring plan to reduce headcount and operating costs and generate
positive cash flow. In addition, the Company has suspended the dividend on the Company’s Preferred Stock, which saves approximately
$1.3 million of cash each month. The dividend will continue to accrue in arrears each month since it is cumulative, but would not be
a legal obligation until the dividend is reinstated. The dividend will not be recorded as a liability until it is declared by the Board
of Directors. The Company projects that this restructuring plan, which was implemented in 2023 and will be completed by the end of 2024,
will reduce expenses, thereby reducing ongoing liquidity needs to enable continuation of operations and compliance with the debt covenants
for the foreseeable future. Although there are no guarantees that the Company will be successful, it believes such initiatives will enable
it to continue as a going concern through at least the next twelve months.
Significant
Accounting Policies — During the three months ended March 31, 2024, there were no changes to the Company’s significant
accounting policies from its disclosures in the Annual Report on Form 10-K for the year ended December 31, 2023, filed with the SEC on
March 21, 2024.
Recent
Accounting Pronouncements — From time to time, new accounting pronouncements are issued by the Financial
Accounting Standards Board (“FASB”) and are adopted by us as of the specified effective date. Unless otherwise
discussed, we believe that the impact of recently adopted and recently issued accounting pronouncements will not have a material
impact on our condensed consolidated financial position, results of operations and cash flows.
In
June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments.
The guidance in Accounting Standards Update (“ASU”) 2016-13 replaces the incurred loss impairment methodology under current
GAAP. The new impairment model requires immediate recognition of estimated credit losses expected to occur for most financial assets
and certain other instruments. It will apply to all entities. For trade receivables, loans and held-to-maturity debt securities, entities
will be required to estimate lifetime expected credit losses. This may result in the earlier recognition of credit losses. In November
2019, the FASB issued ASU No. 2019-10, which delayed this standard’s effective date for SEC smaller reporting companies to the fiscal
years beginning on or after December 15, 2022. The Company adopted this guidance on January 1, 2023 using a modified retrospective adoption
methodology, whereby the cumulative impact of all prior periods is recorded in accumulated deficit or other impacted balance sheet items
upon adoption. The impact to the accumulated deficit as of January 1, 2023 was a charge of approximately $186,000 and a corresponding
increase to the allowance for expected credit losses.
In
March 2023, the FASB issued ASU 2023-01, Leases (Topic 842): Common Control Arrangements – Issue 2. The amendments in this
update require that leasehold improvements associated with common control leases be: (1) amortized by the lessee over the useful life
of the leasehold improvements to the common control group as long as the lessee controls the use of the underlying asset through a lease
and (2) accounted for as a transfer between entities under common control through an adjustment to equity if, and when, the lessee no
longer controls the use of the underlying asset. The amendments in this update are effective for fiscal years beginning after December
15, 2023. There was no impact on the condensed consolidated financial statements as a result of this standard.
In
October 2023, the FASB issued ASU 2023-06, Disclosure Improvements: Codification Amendments in Response to the SEC’s Disclosure
Update and Simplification Initiative. This update amends the disclosure or presentation requirements related to various subtopics
in the FASB Accounting Standards Codification (the “Codification”). The new guidance is intended to align U.S. GAAP requirements
with those of the SEC and to facilitate the application of U.S. GAAP for all entities. The effective date for each amendment will be
the date on which the SEC’s removal of that related disclosure requirement from Regulation S-X or Regulation S-K becomes effective,
with early adoption prohibited. If by June 30, 2027 the SEC has not removed the applicable requirement from Regulation S-X or Regulation
S-K, the pending content of the associated amendment will be removed from the Codification and will not become effective.
In
November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280), Improvements to Reportable Disclosures. The amendments
in this update improve segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The
amendments are effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after
December 15, 2024. Early adoption is permitted. The expected impact would only be to the financial statement disclosures.
In
December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740), Improvements to Income Tax Disclosures. The amendments in
this update enhance the transparency and decision usefulness of income tax disclosures primarily related to rate reconciliation and income
taxes paid information. The update also includes certain other amendments to improve the effectiveness of income tax disclosures. The
amendments are effective for annual periods beginning after December 15, 2024. Early adoption is permitted. The Company does not expect
this update to have a material impact on the condensed consolidated financial statements.
In
March 2024, the FASB issued ASU 2024-02, Codification Improvements – Amendments to Remove References to the Concepts Statements.
This update contains amendments to the Codification that remove references to various FASB Concepts Statements. This Codification updates
are for technical corrections such as conforming amendments, clarifications to guidance, simplifications to wording or the structure
of guidance and other minor improvements. The resulting amendments are referred to as Codification improvements. The amendments in this
update are effective for public business entities for fiscal years beginning after December 15, 2024. Early adoption is permitted. The
Company does not expect this update to have a material impact on the condensed consolidated financial statements.
3. GOODWILL AND INTANGIBLE ASSETS-NET
Goodwill
consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. At March 31, 2024
and December 31, 2023, approximately $90,000 of goodwill was allocated to the Medical Practice Management segment and the balance was
allocated to the Healthcare IT segment.
The
Company tests goodwill for impairment at the reporting unit level annually or more frequently if a change in circumstances or the
occurrence of events indicates that potential impairment exists. As a result of a triggering event in December 2023 resulting from
the decreased equity market value following the suspension of the Preferred Stock dividend, the Company updated its annual goodwill
impairment test that was performed as of October 31, 2023 for the Healthcare IT segment. It was determined that the fair value of
the Healthcare IT reporting unit was less than the carrying value at both October 31 and as of the date of the triggering event.
Accordingly, impairment charges of approximately $42.0 million
were recorded during the fourth quarter of 2023. The conclusion was based upon the value determined using the discounted cash flow
method as supported by the guideline company transaction method and the guideline public company method. During the three months
ended March 31, 2024, the Company determined that there was no further impact on the valuation of goodwill.
The
following is the summary of the carrying amount of goodwill for the three months ended March 31, 2024 and the year ended December 31,
2023:
SCHEDULE
OF CHANGES TO THE CARRYING AMOUNT OF GOODWILL
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning gross balance | |
$ | 19,186 | | |
$ | 61,186 | |
Impairment charges | |
| - | | |
| (42,000 | ) |
Ending gross balance | |
$ | 19,186 | | |
$ | 19,186 | |
Intangible
assets – net as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF INTANGIBLE ASSETS
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Contracts and relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 30,979 | | |
| 29,379 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other intangible assets | |
| 8,417 | | |
| 8,417 | |
Total intangible assets | |
| 88,229 | | |
| 86,629 | |
Less: Accumulated amortization | |
| 64,992 | | |
| 61,555 | |
Intangible assets - net | |
$ | 23,237 | | |
$ | 25,074 | |
Capitalized
software represents payroll and development costs incurred for internally developed software. Other intangible assets primarily represent
purchased intangibles. Amortization expense was approximately $3.4 million and $2.5 million for the three months ended March 31, 2024
and 2023, respectively. The weighted-average amortization period is three years.
As
of March 31, 2024, future amortization is scheduled to be expensed as follows:
SCHEDULE
OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 8,556 | |
2025 | |
| 8,915 | |
2026 | |
| 4,533 | |
2027 | |
| 483 | |
2028 | |
| 300 | |
Thereafter | |
| 450 | |
Total | |
$ | 23,237 | |
4. NET LOSS PER COMMON SHARE
The
following table reconciles the weighted-average shares outstanding for basic and diluted net loss per share for the three months ended
March 31, 2024 and 2023:
SCHEDULE
OF RECONCILIATION OF WEIGHTED-AVERAGE SHARES OUTSTANDING FOR BASIC AND DILUTED NET LOSS PER COMMON SHARE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands, except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | |
Net loss attributable to common shareholders | |
$ | (246 | ) | |
$ | (4,332 | ) |
Weighted-average common shares used to compute basic and diluted loss per share | |
| 16,014,309 | | |
| 15,421,096 | |
Net loss attributable to common shareholders per share - basic and diluted | |
$ | (0.02 | ) | |
$ | (0.28 | ) |
At
March 31, 2024, the 192,125 unvested equity restricted stock units (“RSUs”) as discussed in Note 12 have been excluded from
the above calculations as they were anti-dilutive. All of the warrants previously outstanding expired unexercised in 2023 and are excluded
from the above calculations. At March 31, 2023, the 630,094 unvested equity RSUs have been excluded from the above calculations as they
were anti-dilutive. Vested RSUs, vested restricted shares and exercised warrants have been included in the above calculations.
5. ACCRUED
EXPENSES AND DEBT
Accrued
expenses as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF ACCRUED EXPENSES
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
|
|
($ in thousands) |
|
Accrued expenses |
|
$ |
3,506 |
|
|
$ |
4,030 |
|
Payable to managed practices |
|
|
2,396 |
|
|
|
593 |
|
Taxes and other |
|
|
448 |
|
|
|
442 |
|
Total |
|
$ |
6,350 |
|
|
$ |
5,065 |
|
Bank
Debt —The Company has a revolving line of credit with Silicon Valley Bank (“SVB”). The Company’s credit facility
is a secured revolving line of credit where borrowings are based on a formula of 200%
of repeatable revenue adjusted by an annualized attrition rate as defined in the credit agreement. During February 2023, the line of
credit was increased to $25
million and the term was extended for two additional
years maturing on October 31, 2025. The financial covenants were also slightly modified for 2023 and subsequent years. Effective August
31, 2023, the credit facility agreement was amended whereby the interest rate was temporarily increased from the prime rate plus 1.50%
to the prime rate plus 2.00%
and the requirement for the minimum liquidity ratio was slightly reduced. The amendments expired March
31, 2024 and the credit facility reverted to its
previous terms.
As
of March 31, 2024 and December 31, 2023, there was $9 million and $10 million of borrowings, respectively, under the credit facility.
Interest on the revolving line of credit was charged at the prime rate plus 2.0% for the current quarter, but decreased to the prime
rate plus 1.5% on April 1, 2024. There is also a fee of one-half of 1% annually for the unused portion of the credit line. The debt is
secured by all of the Company’s domestic assets and 65% of the shares in its offshore subsidiaries. Future acquisitions are subject
to approval by SVB. At March 31, 2024, the unused borrowing base was approximately $3.6 million.
In
connection with the original SVB debt agreement, the Company paid SVB approximately $50,000 of fees upfront and issued warrants for SVB
to purchase 125,000 shares of its common stock, and committed to pay an annual anniversary fee of $50,000 a year. Based on the terms
in the original SVB credit agreement, these warrants had a strike price equal to $3.92. They had a five-year exercise window and net
exercise rights, and were valued at $3.12 per warrant. These warrants were exercised during 2022. As a result of the revision in the
credit line in the third quarter of 2018, the Company paid approximately $50,000 of fees upfront and issued an additional 28,489 warrants,
with a strike price equal to $5.26, a five-year exercise window and net exercise rights. The additional warrants were valued at $3.58
per warrant and expired in September 2023. The credit agreement contains various covenants and conditions governing the revolving line
of credit including a current annual fee of $100,000. These covenants include a minimum level of adjusted EBITDA and a minimum liquidity
ratio. At March 31, 2024 and December 31, 2023, the Company was in compliance with all covenants.
During
March 2023, SVB became a division of First Citizens Bank & Trust Company. The agreements that governed the former SVB relationship
remain in place. As a result, there was no change to the terms of the credit agreement.
The
Company maintains cash balances at SVB in excess of the FDIC insurance coverage limits. The Company performs periodic evaluations of
the relative credit standing of this financial institution to ensure its credit worthiness. As of March 31, 2024 and December 31, 2023,
the Company held cash of approximately $155,000 and $255,000, respectively, in the name of its subsidiaries at banks in Pakistan and
Sri Lanka. The banking systems in these countries do not provide deposit insurance coverage. The Company has not experienced any losses
on its cash accounts.
Vehicle
Financing Note — The Company financed a vehicle purchase in the United States. The vehicle financing note has a six year term
and was issued at current market rates.
Insurance
Financing — The Company finances certain insurance purchases over the term of the policy life. The interest rate charged is
currently 9.40%.
6. LEASES
We
determine if an arrangement is a lease at inception. We have operating leases for office and temporary living space as well as for
some office equipment. Operating leases are included in operating lease right-of-use (“ROU”) assets, current operating
lease liability and non-current operating lease liability in our condensed consolidated balance sheets as of March 31, 2024 and
December 31, 2023. The Company does not have any finance leases.
As
most of our leases do not provide an implicit rate, we use our estimated incremental borrowing rates, which are derived from information
available at the lease commencement date, in determining the present value of lease payments. We give consideration to our bank financing
arrangements, geographical location and collateralization of assets when calculating our incremental borrowing rates. We review our incremental
borrowing rate on a quarterly basis.
Our
lease terms include options to extend the lease when we believe that we may want the right to exercise that option. Leases
with a term of less than 12 months are not recorded in the condensed consolidated balance sheets. Our lease agreements do not
contain any residual value guarantees. For real estate leases, we account for the lease and non-lease components as a single lease
component. Some leases include escalation clauses and termination options that are factored in the determination of the lease
payments when appropriate.
If
a lease is modified after the effective date, the operating lease ROU asset and liability are re-measured using the current incremental
borrowing rate. During the three months ended March 31, 2023, there was approximately $153,000 of unoccupied lease charges for two of
the Company’s facilities. There were no unoccupied lease charges for the quarter ended March 31, 2024.
During
the three months ended March 31, 2023, the Miami office lease that we assumed in connection with an acquisition ended, and we entered
into a new lease arrangement with the landlord for significantly less office space. Charges of approximately $71,000 were incurred during
the three months ended March 31, 2023 as a result of vacating the former premises. During the year ended December 31, 2022, a facility
lease was terminated in conjunction with the Company ceasing its document storage services. This termination resulted in additional costs
for the three months ended March 31, 2023 of approximately $45,000. These amounts are included in net loss on lease terminations, unoccupied
lease charges and restructuring costs in the condensed consolidated statements of operations.
Lease
expense is included in direct operating costs, general and administrative expense, selling and marketing expense and research and
development expense in the condensed consolidated statements of operations based on the nature of the expense. Our lease terms are
determined taking into account lease renewal options, the Company’s anticipated operating plans and leases that are on a
month-to-month basis. The Company also has some related party leases – see Note 8.
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Operating lease cost | |
$ | 637 | | |
$ | 801 | |
Short-term lease cost | |
| 4 | | |
| - | |
Variable lease cost | |
| 5 | | |
| 5 | |
Total - net lease cost | |
$ | 646 | | |
$ | 806 | |
Short-term
lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2024 or the beginning of the lease
was less than 12 months. Variable lease costs include utilities, real estate taxes and common area maintenance costs.
Supplemental
balance sheet information related to leases is as follows:
SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,775 | | |
$ | 1,888 | |
Non-current operating lease liabilities | |
| 2,320 | | |
| 2,516 | |
Total operating lease liabilities | |
$ | 4,095 | | |
$ | 4,404 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 4,614 | | |
$ | 6,571 | |
Asset lease expense | |
| (509 | ) | |
| (2,152 | ) |
Foreign exchange gain/(loss) | |
| 2 | | |
| (54 | ) |
ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
Operating lease right-of-use assets | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 4.5 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 13.7 | % | |
| 13.3 | % |
Operating leases, Weighted average discount rate | |
| 13.7 | % | |
| 13.3 | % |
Supplemental
cash flow and other information related to leases is as follows:
SCHEDULE
OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 668 | | |
$ | 907 | |
| |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 249 | | |
$ | 287 | |
Maturities
of lease liabilities are as follows:
SCHEDULE
OF MATURITIES OF LEASE LIABILITIES
Operating leases - Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 1,756 | |
2025 | |
| 1,350 | |
2026 | |
| 577 | |
2027 | |
| 453 | |
2028 | |
| 385 | |
Thereafter | |
| 1,429 | |
Total lease payments | |
| 5,950 | |
Less: imputed interest | |
| (1,855 | ) |
Total lease obligations | |
| 4,095 | |
Less: current obligations | |
| 1,775 | |
Long-term lease obligations | |
$ | 2,320 | |
The
Company leases certain apartments which are subleased to others. The sublease agreements are currently on a month-to-month basis and
are considered operating leases. For the three months ended March 31, 2024, the Company received sublease income of approximately $28,000.
There was no sublease income for the three months ended March 31, 2023.
7. COMMITMENTS AND CONTINGENCIES
Legal
Proceedings — On December 22, 2023, an arbitrator rendered a decision in favor of Ramapo Anesthesiologists, PC (“Ramapo”)
and granted in part and denied in part certain claims brought against Origin Healthcare Solutions, LLC; Meridian Medical Management,
Inc.; and the Company for alleged breach of contract and other allegations. Ramapo was awarded mitigation related costs of $117,000.
The payment for such an award was made during the first quarter of 2024. The deadline for Ramapo to file a summary action in New Jersey
seeking to overturn the arbitrator’s decision was April 20, 2024. The Company’s portion of the settlement was approximately
$32,000 and the insurance company paid the balance. The Company’s portion was recorded in accrued expenses at December 31, 2023
in the condensed consolidated balance sheet.
A
former customer filed a complaint against the Company in New Jersey State Court to recover damages claimed to have been caused by
the mishandling of their account. In March 2021, the parties engaged in mediation, which did not result in a resolution of the
matter. Plaintiff alleges at least approximately $750,000
in damages which is disputed by the Company. The parties participated in a one-day court-ordered, non-binding arbitration. At that
time, the arbitrator awarded Plaintiff $288,750
on its contract claims, and awarded the Company $21,698
on its cross-claim for unpaid fees. Plaintiff filed to reject this award. The Company previously filed a partial motion for summary
judgment on the alleged punitive damages, but the court denied that motion finding there is an issue of fact as to whether those can
be awarded at trial. The Company filed an offer of judgment for $200,000
during April 2024 in advance of the trial that was scheduled for April 2024. Plaintiff indicated that they are willing to accept that amount set forth in the
offer of judgment. We are working with plaintiff to finalize the documents in anticipation of a likely final resolution of the
matter.
From
time to time, we may become involved in other legal proceedings arising in the ordinary course of our business. We are not presently
a party to any legal proceedings that, in the opinion of our management, would individually or taken together have a material adverse
effect on our business, consolidated results of operations, financial position or cash flows of the Company.
8. Related PARTIES
The
Company had sales to a related party, a physician who is the wife of the Executive Chairman. Revenues from this customer were approximately
$24,000 and $19,000 for the three months ended March 31, 2024 and 2023, respectively. As of both March 31, 2024 and December 31, 2023,
the accounts receivable balance due from this customer was approximately $8,000 and $18,000, respectively, and is included in accounts
receivable - net in the condensed consolidated balance sheets.
The
Company leases its corporate office in New Jersey, temporary housing for its foreign visitors, a storage facility, its backup
operations center in Bagh, Pakistan and an apartment for temporary housing in Dubai, the UAE, from the Executive Chairman. The
related party rent expense was approximately $70,000
and $51,000
for the three months ended March 31, 2024 and 2023, respectively, and is included in direct operating costs, general and
administrative expense, selling and marketing expense and research and development expense in the condensed consolidated statements
of operations. During the three months ended March 31, 2024 and 2023, the Company spent approximately $227,000
and $502,000,
respectively, to upgrade the related party leased facilities. During the year ended December 31, 2023, the Company temporarily
advanced the Executive Chairman approximately $330,000
to purchase vacant land surrounding the Bagh facility for the sole use and benefit of the Company in order to expedite the purchase
on the Company’s behalf as only individuals with citizenship in Kashmir are allowed to purchase land in this region. All
advanced amounts were repaid shortly after the advance was made. Current assets-related party in the condensed consolidated balance
sheets includes security deposits related to the leases of the Company’s corporate offices in the amount of approximately
$16,000
as of both March 31, 2024 and December 31, 2023. The Company also leases two facilities used for temporary housing from a management
employee for approximately $6,200
per month.
Included
in the ROU asset at March 31, 2024 is approximately $303,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at March 31, 2024 is approximately $164,000 and $133,000, respectively, applicable to the related party leases.
Included
in the ROU asset at December 31, 2023 is approximately $331,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at December 31, 2023 is approximately $182,000 and $142,000, respectively, applicable to the related party
leases.
During
June 2022, the Company entered into a one-year consulting agreement with an entity owned and controlled by one of its former
non-independent directors whereby that director received 10,000
shares of the Company’s 8.75%
Series B Cumulative Redeemable Perpetual Preferred Stock (“Series B Preferred Stock”) in exchange for assisting the
Company to identify and acquire additional companies, including performing due diligence. In addition, the Company may make
additional payments under the agreement for any successful acquisitions by the Company based on the purchase price of the
transaction. No such additional payments were made in 2022. During February 2023, the agreement was amended and extended through
December 2024 whereby the former director received 14,000
shares of Series B Preferred Stock in February 2023 and received an additional 14,000
shares in January 2024. All of the payments made were capitalized and are being amortized over the service period. The amortization
is recorded as stock compensation in general and administrative expense in the condensed consolidated statement of operations. All
such shares of the Series B Preferred Stock are issued in accordance with the Company’s Amended and Restated 2014 Equity
Incentive Plan. In addition to the extension of the consulting agreement, the amendment provides that any transaction fees due will
be offset against the last two above payments before any amounts are due to that former director. There were no transaction fees
through March 31, 2024. Effective February 1, 2024, the Company added an additional Statement of Work (“SOW”) to the
consulting agreement with the same entity. As compensation for the SOW, the entity will receive $25,000
per month. The SOW is cancellable with ten days’ notice. The consulting agreement and SOW, through mutual consent, were
terminated as of April 30, 2024. Effective May 1, 2024, the former non-independent director became President of the
Company.
Effective
January 9, 2024, and as amended February 12, 2024, the Company entered into a consulting agreement with an entity owned and controlled
by a member of its Board of Directors to provide investor relations services for $8,000 per month and other services as requested by
the Company to be paid on an hourly basis. The consulting agreement is cancelable with ten days’ notice.
During
2020, a New Jersey corporation, talkMD Clinicians, PA (“talkMD”), was formed by the wife of the Executive Chairman, who is
a licensed physician, to provide telehealth services. talkMD was determined to be a variable interest entity (“VIE”) for
financial reporting purposes because the entity will be controlled by the Company. As of March 31, 2024, talkMD had not yet commenced
operations. Cumulatively, the Company has paid approximately $5,500 on behalf of talkMD for income taxes.
9. RESTRUCTURING COSTS
On
October 2, 2023, the Company committed to effectively align resources with business priorities and improve profitability through a reduction
in the workforce for the Healthcare IT segment. The Company identified opportunities for improvements in its workforce realignment, strategy
and staffing, and increased its focus on performance management, to ensure it has the right skillsets and number of employees to execute
its long-term vision. In addition, the Company instituted certain other expense reductions.
A
majority of the impacted employees exited in the fourth quarter of 2023. The Company estimates that it will incur expenses of approximately
$1.3 million related to the reduction in workforce of which approximately $645,000 was incurred in 2023, $322,000 was incurred during
the three months ended March 31, 2024 with the remaining expenses to be incurred during the remainder of 2024. These restructuring expenses
consisted of one-time termination benefits, including, but not limited to, severance payments and healthcare benefits. Also as previously
noted, the dividends on the Preferred Stock have been suspended in order to increase cash flow.
The
expense associated with the restructuring is included in net loss on lease terminations, unoccupied lease charges and restructuring
cost in the condensed consolidated statement of operations for the three months ended March 31, 2024. This line also includes net
loss on lease terminations and unoccupied lease charges. The liabilities associated with restructuring costs are included in accrued
expenses and other current liabilities in the March 31, 2024 and December 31, 2023 condensed consolidated balance sheets. The
following table summarizes activity related to liabilities associated with restructuring costs:
SCHEDULE OF LIABILITIES ASSOCIATED WITH RESTRUCTURING COSTS
| |
Severance and separation costs | | |
Equity awards acceleration costs | | |
Other exit related costs | | |
Total restructuring and other costs | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Additions | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Payments and other adjustments | |
| (202 | ) | |
| - | | |
| (26 | ) | |
| (228 | ) |
Balance as of March 31, 2024 | |
$ | 265 | | |
$ | - | | |
$ | - | | |
$ | 265 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Beginning balance | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Additions | |
| 439 | | |
| 170 | | |
| 36 | | |
| 645 | |
Payments and other adjustments | |
| (294 | ) | |
| (170 | ) | |
| (10 | ) | |
| (474 | ) |
Balance as of December 31, 2023 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Ending balance | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
10. SHAREHOLDERS’ EQUITY
The
Company had the right to sell up to $35 million of its Series B Preferred Stock using its preferred stock at-the-market facility (“ATM”).
This right terminated when the Company suspended the Preferred Stock dividends in December 2023. The Company also had the right to sell
up to $50 million of its common stock using a common stock ATM facility. This right also terminated when the Company suspended the Preferred
Stock dividends. The underwriters of the ATMs receive 3% of the gross proceeds actually received.
On
December 11, 2023, the Board of Directors suspended the monthly cash dividends for Series A Preferred Stock and Series B Preferred Stock
beginning with the payment scheduled for December 15, 2023 together with the remaining dividends that were declared. The suspension of
these dividends will defer approximately $1.3 million in cash dividend payments each month. During this suspension, dividends will continue
to accrue in arrears on the Series A and Series B Preferred Stock. The Board of Directors will regularly review and consider when the
suspension should be lifted.
During
the quarter ended March 31, 2024, no dividends were declared by the Board of Directors. At March 31, 2024, the Company owed
approximately $5.4
million for dividends that had previously been declared through February 2024 (but whose payment has been suspended), and also had
total undeclared dividends of approximately $1.3
million, which represents the accrued (but undeclared) dividends due to preferred shareholders of record on March 31, 2024.
Dividends in arrears that have not been declared by the Board of Directors are not recorded in the condensed consolidated balance
sheets.
11. REVENUE
Introduction
The
Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers. All revenue is recognized as our
performance obligations are satisfied. A performance obligation is a promise in a contract to transfer a distinct good or service to
a customer, and is the unit of account under ASC 606. The Company recognizes revenue when the revenue cycle management services begin
on the medical billing claims, which is generally upon receipt of the claim from the provider. For many services, the Company recognizes
revenue as a percentage of the amount the customer collects on the medical billing claims. The Company’s software is utilized at
the time the provider sees the patient, and the Company estimates the value of the consideration it will earn over the remaining contractual
period as our services are provided and recognizes the fees over the term; this estimation involves predicting the amounts our clients
will ultimately collect associated with the services they provided. Certain significant estimates, such as payment-to-charge ratios,
effective billing rates and the estimated contractual payment periods are required to measure revenue cycle management revenue under
the standard.
Most
of our current contracts with customers contain a single performance obligation. For contracts where we provide multiple services, such
as where we perform multiple ancillary services, each service represents its own performance obligation. The standalone selling prices
are based on the contractual price for the service.
We
apply the portfolio approach as permitted by ASC 606 as a practical expedient to contracts with similar characteristics and we use estimates
and assumptions when accounting for those portfolios. Our contracts generally include standard commercial payment terms. We have no significant
obligations for refunds, warranties or similar obligations and our revenue does not include taxes collected from our customers.
Disaggregation
of Revenue from Contracts with Customers
We
derive revenue from five primary sources: (1) technology-enabled business solutions, (2) professional services, (3) printing and mailing
services, (4) group purchasing services and (5) medical practice management services.
The
following table represents a disaggregation of revenue for the three months ended March 31, 2024 and 2023:
SCHEDULE OF DISAGGREGATION OF REVENUE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 17,283 | | |
$ | 19,495 | |
Professional services | |
| 4,422 | | |
| 6,560 | |
Printing and mailing services | |
| 861 | | |
| 713 | |
Group purchasing services | |
| 155 | | |
| 186 | |
Medical Practice Management: | |
| | | |
| | |
Medical practice management services | |
| 3,241 | | |
| 3,047 | |
Total | |
$ | 25,962 | | |
$ | 30,001 | |
Revenue | |
$ | 25,962 | | |
$ | 30,001 | |
Technology-enabled
business solutions:
Revenue
derived on an on-going basis from our technology-enabled solutions, which typically include revenue cycle management services, is billed
as a percentage of payments collected by our customers. The fee for our services often includes the ability to use our electronic health
records (“EHR”) and practice management software as well as revenue cycle management (“RCM”) as part of the bundled
fee. The Software-as-a-Service (“SaaS”) component is not a material portion of the contract compared to the stand-alone value
of RCM.
Technology-assisted
revenue cycle management services are the recurring process of submitting and following up on claims with health insurance companies
in order for the healthcare providers to receive payment for the services they rendered. The Company typically invoices customers on
a monthly basis based on the actual collections received by its customers and the agreed-upon rate in the sales contract. The fee for
these services typically includes use of practice management software and related tools (on a SaaS basis), electronic health records
(on a SaaS basis), medical billing services and use of mobile health solutions. We consider the services to be one performance obligation
since the promises are not distinct in the context of the contract. The performance obligation consists of a series of distinct services
that are substantially the same and have the same periodic pattern of transfer to our customers.
In
many cases, our clients may terminate their agreements with 90 days’ notice without cause, thereby limiting the term in which we
have enforceable rights and obligations, although this time period can vary between clients. Our payment terms are normally net 30 days.
Although our contracts typically have stated terms of one or more years, under ASC 606 our contracts are considered month-to-month and
accordingly, there is no financing component.
For
the majority of our revenue cycle management contracts, the total transaction price is variable because our obligation is to process
an unknown quantity of claims, as and when requested by our customers over the contract period. When a contract includes variable consideration,
we evaluate the estimate of the variable consideration to determine whether the estimate needs to be constrained; therefore, we include
variable consideration in the transaction price only to the extent that it is probable that a significant reversal of the amount of cumulative
revenue recognized will not occur when the uncertainty associated with variable consideration is subsequently resolved. Estimates to
determine variable consideration such as payment-to-charge ratios, effective billing rates, and the estimated contractual payment periods
are updated at each reporting date. Revenue is recognized over the performance period using the input method.
Our
proprietary, cloud-based practice management application automates the labor-intensive workflow of a medical office in a unified and
streamlined SaaS platform. The Company has a large number of clients who utilize the Company’s practice management software, electronic
health records software, patient experience management solutions, business intelligence software and/or robotic process automation software
on a SaaS basis, but who do not utilize the Company’s revenue cycle management services. SaaS fees may be fixed based on the number
of providers, or may be variable.
Our
digital health services, which began generating revenue in 2022, include chronic care management, where a care manager has remote visits
with patients with one or more chronic conditions under the supervision of a physician who is our client. The performance obligation
for chronic care management is satisfied at a point in time once the patient receives the remote visit. The digital health services also
include remote patient monitoring where our system monitors recordings from FDA approved internet connected devices. These devices record
patient trends and alert the physician to changes which might trigger the need for additional follow-up visits. The performance obligations
for remote patient monitoring are satisfied over time as the recordings are received and the patient receives the remote visit. The revenue
for chronic care management for the three months ended March 31, 2024 and 2023, was approximately $440,000 and $135,000, respectively.
The revenue for remote patient monitoring for the three months ended March 31, 2024 and 2023 was approximately $140,000 and $11,000,
respectively.
The
medical billing clearinghouse service takes claim information from customers, checks the claims for errors and sends this information
electronically to insurance companies. The Company invoices customers on a monthly basis based on the number of claims submitted and
the agreed-upon rate in the agreement. This service is provided to medical practices and providers to medical practices who are not revenue
cycle management customers. The performance obligation is satisfied once the relevant submissions are completed.
Additional
services such as coding and transcription are rendered in connection with the delivery of revenue cycle management and related medical
services. The Company invoices customers monthly, based on the actual amount of services performed at the agreed-upon rate in the contract.
These services are only offered to revenue cycle management customers. These services do not represent a material right because the services
are optional to the customer and customers electing these services are charged the same price for those services as if they were on a
standalone basis. Each individual coding or transcription transaction processed represents a performance obligation, which is satisfied
over time as that individual service is rendered.
Professional
services:
Our
professional services include an extensive set of services including EHR vendor-agnostic optimization and activation, project management,
IT transformation consulting, process improvement, training, education and staffing for large healthcare organizations including health
systems and hospitals. The performance obligation is satisfied over time using the input method. The revenue is recorded on a monthly
basis as the professional services are rendered. Unbilled revenue at March 31, 2024 and 2023 was approximately $47,000
and $100,000,
respectively.
Printing
and mailing services:
The
Company provides printing and mailing services for both revenue cycle management customers and a non-revenue cycle management customer,
and invoices on a monthly basis based on the number of prints, the agreed-upon rate per print and the postage incurred. The performance
obligation is satisfied once the printing and mailing is completed.
Group
purchasing services:
The
Company provides group purchasing services which enable medical providers to purchase various vaccines directly from selected pharmaceutical
companies at a discounted price. Currently, there are approximately 4,000 medical providers who are members of the program. Revenue is
recognized as the vaccine shipments are made to the medical providers. Fees from the pharmaceutical companies are paid either quarterly
or annually and the Company adjusts its revenue accrual at the time of payment. The Company makes significant judgments regarding the
variable consideration which we expect to be entitled to for the group purchasing services which includes the anticipated shipments to
the members enrolled in the program, anticipated volumes of purchases made by the members, and the changes in the number of members.
The amounts recorded are constrained by estimates of decreases in shipments and loss of members to avoid a significant revenue reversal
in the subsequent period. The only performance obligation is to provide the pharmaceutical companies with the medical providers who want
to become members in order to purchase vaccines. The performance obligation is satisfied once the medical provider agrees to purchase
a specific quantity of vaccines and the medical provider’s information is forwarded to the vaccine suppliers. The Company records
a contract asset for revenue earned and not paid as the ultimate payment is conditioned on achieving certain volume thresholds.
For
all of the above revenue streams other than group purchasing services and chronic care management, revenue is recognized over time, which
is typically one month or less, which closely matches the point in time that the customer simultaneously receives and consumes the benefits
provided by the Company. For the group purchasing services, revenue is recognized at a point in time. Each service is substantially the
same and has the same periodic pattern of transfer to the customer. Each of the services provided above is considered a separate performance
obligation.
There
were no unsatisfied performance obligations for contracts with an original duration greater than one year. The Company has elected to
utilize the practical expedient available with the guidance for contracts with an expected duration of one year or less.
Medical
practice management services:
The
Company also provides medical practice management services under long-term management service agreements to three medical practices.
We provide the medical practices with the nurses, administrative support, facilities, supplies, equipment, marketing, RCM,
accounting, and other non-clinical services needed to efficiently operate their practices. Revenue is recognized as the services are
provided to the medical practices. Revenue recorded in the condensed consolidated statements of operations represents the
reimbursement of costs paid by the Company for the practices and the management fee earned each month for managing the practice. The
management fee is based on either a fixed fee or a percentage of the net operating income.
The
Company assumes all financial risk for the performance of the managed medical practices. Revenue is impacted by the amount of the costs
incurred by the practices and their operating income. The gross billing of the practices is impacted by billing rates, changes in current
procedural terminology code reimbursement and collection trends which in turn impacts the management fee that the Company is entitled
to. Billing rates are reviewed at least annually and adjusted based on current insurer reimbursement practices. The performance obligation
is satisfied as the management services are provided.
Our
contracts for medical practice management services have approximately an additional 15 years remaining and are only cancellable
under very limited circumstances. The Company receives a management fee each month for managing the day-to-day business operations
of each medical group as a fixed fee or a percentage payment of the net operating income which is included in revenue in the
condensed consolidated statements of operations.
Our
medical practice management services obligations consist of a series of distinct services that are substantially the same and have the
same periodic pattern of transfer to our customers. Revenue is recognized over time, however for reporting and convenience purposes,
the management fee is computed at each month-end.
Information
about contract balances:
As
of March 31, 2024, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management performance
obligations outstanding was approximately $5.2
million. We expect to recognize substantially
all of the revenue for the remaining performance obligations over the next three months. Approximately $264,000
of the contract asset represents revenue earned,
not paid, from the group purchasing services.
Amounts
that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end
of each month when the services have been provided. The contract asset includes our right to payment for services already transferred
to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue
cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives
payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group
purchasing services.
Changes
in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle
management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional
and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced
when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. The opening and closing balances
of the Company’s accounts receivable, contract asset and deferred revenue are as follows:
SCHEDULE OF CHANGES IN ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE
| |
Accounts Receivable - Net | | |
Contract Asset | | |
Deferred Revenue (current) | | |
Deferred Revenue (long term) | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 11,888 | | |
$ | 5,094 | | |
$ | 1,380 | | |
$ | 256 | |
Increase, net | |
| 74 | | |
| 361 | | |
| 6 | | |
| 52 | |
Balance as of March 31, 2024 | |
$ | 11,962 | | |
$ | 5,455 | | |
$ | 1,386 | | |
$ | 308 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (127 | ) | |
| 619 | | |
| 8 | | |
| 8 | |
Balance as of March 31, 2023 | |
$ | 14,646 | | |
$ | 5,018 | | |
$ | 1,394 | | |
$ | 350 | |
Deferred
commissions:
Our
sales incentive plans include commissions payable to employees and third parties at the time of initial contract execution that are
capitalized as incremental costs to obtain a contract. The capitalized commissions are amortized over the period the related
services are transferred. As we do not offer commissions on contract renewals, we have determined the amortization period to be the
estimated client life, which is three years. Deferred commissions were approximately $488,000 and
$580,000 at
March 31, 2024 and 2023, respectively, and are included in the other assets amounts in the condensed consolidated balance sheets.
The amortization of deferred sales commissions during the three months ended March 31, 2024 and 2023 was approximately $90,000 and
$167,000,
respectively.
Trade
Accounts Receivable – Estimate of Credit Losses:
ASU
2016-13 requires the recognition of lifetime estimated credit losses expected to occur for trade accounts receivable. The guidance also
requires we pool assets with similar risk characteristics and consider current economic conditions when estimating losses. The adoption
of the ASU 2016-13 for trade accounts receivable was recorded as a charge to accumulated deficit of approximately $186,000
as of January 1, 2023.
At
adoption, we segmented the accounts receivable population into pools based on their risk assessment. Risks related to trade accounts
receivable are a customer’s inability to pay or bankruptcy. Each pool was defined by their internal credit assessment and business
size. The pools are aligned with management’s review of financial performance. For the three months ended March 31, 2024 and 2023,
no adjustment to the pools was necessary.
We
utilize a loss-rate method to measure the expected credit loss for each pool. The loss rate is calculated using a three-year lookback
period of write-offs and adjustments, divided by the revenue for each pool by aging category, net of customer payments during that period.
We consider current and future economic conditions, internal forecasts, customer collection experience and credit memos issued during
the current period when assessing loss rates. We reviewed these factors and concluded that no adjustments should be made to the historical
loss rate data for the current quarter. In addition, the Company uses specific account identification in determining the total allowance
for expected credit losses. Trade receivables are written off only after the Company has exhausted all collection efforts.
Changes
in the allowance for expected credit losses for trade accounts receivable are presented in the table below:
SCHEDULE OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 879 | | |
$ | 823 | |
Adoption of ASC 326 | |
| - | | |
| 186 | |
Provision | |
| 37 | | |
| 454 | |
Recoveries/adjustments | |
| 1 | | |
| 107 | |
Write-offs | |
| - | | |
| (691 | ) |
Ending balance | |
$ | 917 | | |
$ | 879 | |
12. STOCK-BASED COMPENSATION
As
of March 31, 2024, 710,694
shares of common stock and 28,000
shares of Series B Preferred Stock are available
for grant. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock,
RSUs, performance stock and cash-settled awards and other stock-based awards in the discretion of the Compensation Committee of the Board
of Directors including unrestricted stock grants.
Certain
equity-based RSU agreements contain a provision in which the units shall immediately vest and become converted into common shares at
the rate of one share per RSU, immediately after a change in control, as defined in the award agreement.
Common
and preferred stock RSUs
In
February 2023, the Compensation Committee approved executive bonuses to be paid in shares of Series B Preferred Stock, with the
number of shares and the amount based on specified criteria being achieved during the year 2023. During October, the Compensation
Committee approved the issuance 10,000
of the above shares to one of the executives who retired. The remaining 24,000
shares were forfeited in 2024.
In
March 2024, the Compensation Committee approved executive bonuses to be paid in shares of Series B Preferred Stock with the number
of shares and the amount based on specified criteria being achieved during the year 2024. There were 34,000
shares awarded. These criteria will be evaluated in early 2025. For the three months ended March 31, 2024, a net benefit of
approximately $708,000
was recorded primarily related to prior year bonuses that had been accrued but were not awarded. Stock compensation expense recorded
is based on the value of the shares at the grant date and recognized over the service period. The portion of the stock compensation
expense to be used for the payment of withholding and payroll taxes is included in accrued compensation in the condensed
consolidated balance sheets. The balance of the stock compensation expense has been recorded as additional paid-in
capital.
The
following table summarizes the RSU transactions related to the common and preferred stock under the A&R Plan for the three months
ended March 31, 2024 and 2023:
DISCLOSURE
OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD
| |
Common Stock | | |
Series A Preferred Stock | | |
Series B Preferred Stock | |
Outstanding and unvested shares at January 1, 2024 | |
| 753,495 | | |
| - | | |
| 57,199 | |
Granted | |
| - | | |
| - | | |
| 34,000 | |
Vested | |
| (326,501 | ) | |
| - | | |
| (14,000 | ) |
Forfeited | |
| (217,115 | ) | |
| - | | |
| (24,000 | ) |
Outstanding and unvested shares at March 31, 2024 | |
| 209,879 | | |
| - | | |
| 53,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 546,851 | | |
| - | | |
| 62,000 | |
Vested | |
| (498,660 | ) | |
| - | | |
| (57,263 | ) |
Forfeited | |
| (19,975 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at March 31, 2023 | |
| 673,691 | | |
| - | | |
| 85,199 | |
The
liability for the 17,754
cash-settled awards and the liability for withheld taxes in connection with the equity awards was approximately $80,000
and $767,000
at March 31, 2024 and December 31, 2023, respectively, and is included in accrued compensation in the condensed consolidated balance
sheets. No amounts were paid in connection with cash-settled awards during both the three months ended March 31, 2024 and
2023.
Stock-based
compensation expense
The
following table summarizes the components of share-based compensation (benefit) expense for the three months ended March 31, 2024 and
2023:
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | (45 | ) | |
$ | 88 | |
General and administrative | |
| (696 | ) | |
| 605 | |
Research and development | |
| 54 | | |
| 37 | |
Selling and marketing | |
| (21 | ) | |
| 342 | |
Total stock-based compensation (benefit) expense | |
$ | (708 | ) | |
$ | 1,072 | |
13. INCOME TAXES
The
income tax expense for the three months ended March 31, 2024 was approximately $39,000 comprised of current state tax expense of $30,000
and foreign tax expense of $9,000. There was no deferred income tax recorded. The income tax expense for the three months ended March
31, 2023 was approximately $65,000 comprised of a current state tax expense of $39,000 and a deferred tax expense of $26,000.
The
current income tax provision for the three months ended March 31, 2024 and 2023 primarily relates to state minimum taxes and foreign
income taxes. The deferred tax provision for the three months ended March 31, 2023 relates to the book and tax difference of amortization
on indefinite-lived intangibles, primarily goodwill. To the extent allowable, prior to January 1, 2024, the federal and state deferred
tax provision had been offset by the indefinite life net operating loss. As a result of the goodwill impairment charge recorded for the
year ended December 31, 2023, no deferred tax liability is required.
The
Company has incurred cumulative losses, which make realization of a deferred tax asset difficult to support in accordance with ASC 740.
Accordingly, a valuation allowance has been recorded against the federal and state deferred tax assets as of March 31, 2024 and December
31, 2023.
14. SEGMENT REPORTING
The
Company’s Chief Executive Officer and Executive Chairman jointly serve as the Chief Operating Decision Maker (“CODM”),
organize the Company, manage resource allocations and measure performance among two operating and reportable segments: (i) Healthcare
IT and (ii) Medical Practice Management.
The
Healthcare IT segment includes revenue cycle management, SaaS solutions and other services. The Medical Practice Management segment includes
the management of three medical practices. Each segment is considered a reporting unit. The CODM evaluates the financial performance
of the business units on the basis of revenue and direct operating costs excluding unallocated amounts that are mainly corporate overhead
costs. Our CODM does not evaluate operating segments using asset or liability information. The accounting policies of the segments are
the same as those disclosed in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 filed with the SEC
on March 21, 2024. The following table presents revenues, operating expenses and operating income (loss) by reportable segment:
SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2024 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 22,721 | | |
$ | 3,241 | | |
$ | - | | |
$ | 25,962 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 12,544 | | |
| 2,633 | | |
| - | | |
| 15,177 | |
Selling and marketing | |
| 1,760 | | |
| 10 | | |
| - | | |
| 1,770 | |
General and administrative | |
| 2,581 | | |
| 434 | | |
| 706 | | |
| 3,721 | |
Research and development | |
| 913 | | |
| - | | |
| - | | |
| 913 | |
Depreciation and amortization | |
| 3,845 | | |
| 85 | | |
| - | | |
| 3,930 | |
Loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Total operating expenses | |
| 21,965 | | |
| 3,162 | | |
| 706 | | |
| 25,833 | |
Operating income (loss) | |
$ | 756 | | |
$ | 79 | | |
$ | (706 | ) | |
$ | 129 | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 26,954 | | |
$ | 3,047 | | |
$ | - | | |
$ | 30,001 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,693 | | |
| 2,414 | | |
| - | | |
| 18,107 | |
Selling and marketing | |
| 2,604 | | |
| 8 | | |
| - | | |
| 2,612 | |
General and administrative | |
| 2,496 | | |
| 448 | | |
| 2,176 | | |
| 5,120 | |
Research and development | |
| 1,078 | | |
| - | | |
| - | | |
| 1,078 | |
Depreciation and amortization | |
| 2,949 | | |
| 89 | | |
| - | | |
| 3,038 | |
Net loss on lease terminations and unoccupied lease charges | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Total operating expenses | |
| 25,089 | | |
| 2,959 | | |
| 2,176 | | |
| 30,224 | |
Operating income (loss) | |
$ | 1,865 | | |
$ | 88 | | |
$ | (2,176 | ) | |
$ | (223 | ) |
Item
2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The
following is a discussion of our condensed consolidated financial condition and results of operations for the three months ended
March 31, 2024 and 2023, and other factors that are expected to affect our prospective financial condition. The following discussion
and analysis should be read together with our Condensed Consolidated Financial Statements and related notes beginning on page 4 of
this Quarterly Report on Form 10-Q and our Annual Report on Form 10-K for the year ended
December 31, 2023, filed with the SEC on March 21, 2024.
Some
of the statements set forth in this section are forward-looking statements relating to our future results of operations. Our actual results
may vary from the results anticipated by these statements. Please see “Forward-Looking Statements” on page 2 of this
Quarterly Report on Form 10-Q.
Financial
Risks
The
Company maintains cash balances at Silicon Valley Bank (“SVB”), a division of First Citizens Bank & Trust Company in
excess of the FDIC insurance coverage limits. The Company performs periodic evaluations of the relative credit standing of this financial
institution to ensure its credit worthiness. As of March 31, 2024 and December 31, 2023, the Company held cash of approximately $155,000
and $255,000, respectively, in the name of its subsidiaries at banks in Pakistan and Sri Lanka. The banking systems in these countries
do not provide deposit insurance coverage. The Company has not experienced any losses on its cash accounts.
During
the three months ended December 31, 2023, the Company suspended its preferred stock dividend and experienced a decline in its market
capitalization as a result of a sustained decrease in the Company’s stock price for its common and preferred shares. This was
considered a triggering event and resulted in a goodwill impairment charge. During the three months ended March 31, 2024, the Company’s stock price for its common and preferred shares declined from their
year-end values. The Company determined there was no impact on the valuation of goodwill. If the stock prices were to continue to decline, it
could result in another triggering event that could impact the valuation of goodwill.
Overview
The
Company is a healthcare information technology company that provides technology-enabled revenue cycle management and a full suite of
proprietary cloud-based solutions to healthcare providers, from small practices to enterprise medical groups, hospitals, and health systems
throughout the United States. Our integrated Software-as-a-Service (“SaaS”) platform includes revenue cycle management (“RCM”),
practice management (“PM”), electronic health records (“EHR”), business intelligence, telehealth, patient experience
management (“PXM”) solutions and complementary software tools and business services for high-performance medical groups and
health systems. The Company also offers printing and mailing and group purchasing services.
Our
technology-enabled business solutions can be categorized as follows:
| ● | Technology-enabled
revenue cycle management: |
| ○ | Revenue
Cycle Management services including end-to-end medical billing, eligibility,
analytics, and related services, all of which can be provided utilizing our technology platform
and robotic process automation tools or leveraging a third-party system; |
| ○ | Medical
coding and credentialing services to improve provider collections, back-end cost containment,
and drive total revenue realization for our healthcare clients; and |
| ○ | Healthcare
claims clearinghouse which enables our clients to electronically scrub and submit claims
and process payments from insurance companies. |
| ○ | Electronic
Health Records, which are easy to use and sometimes integrated with our business services,
and enable our healthcare provider clients to deliver better patient care, streamline their
clinical workflows, decrease documentation errors, and potentially qualify for government
incentives; |
| ○ | Practice
Management software and related capabilities, which support our clients’
day-to-day business operations and financial workflows, including automated insurance eligibility
software, a robust billing and claims rules engine, and other automated tools designed to
maximize reimbursement; |
| ○ | Artificial
intelligence (“AI”): |
| ● | CareCloud
cirrusAI is designed to serve as a digital healthcare assistant, helping to enhance clinical
decision-making, streamline workflows, reduce administrative burdens, optimize revenue management,
and promote patient-centered care. The functions include: |
| ● | AI-Powered
Clinical Decision Support: CareCloud cirrusAI Guide automates clinical data input, and assists
clinicians in workflow tasks, providing real-time, evidence-based recommendations and personalized
suggestions via Vertex AI’s generative AI tools for providers to consider. This innovation
can lead to enhanced diagnosis accuracy and treatment planning. |
| ● | AI-Powered
Virtual Support Assistant: CareCloud cirrusAI Chat facilitates natural language conversations
with practice staff members, offering valuable assistance in navigating CareCloud Electronic
Health Records workflows. This tool streamlines post-training and onboarding
for new staff, reducing response times and providing real-time assistance, ultimately saving
time. |
| ● | AI-Driven
Appeals: CareCloud cirrusAI Appeals generates customized appeal letters by analyzing patient
claim details, the appeal’s reason, and the specific payor involved for healthcare
workers to review, edit, and send. This functionality supports CareCloud’s RCM teams
in optimizing providers’ RCM and securing proper reimbursement. |
| ● | CareCloud
cirrusAI integrates with CareCloud’s EHR solution, talkEHR, making it easily accessible
to providers of all sizes. |
| ○ | Patient
Experience Management solutions designed to transform interactions between
patients and their clinicians, including smartphone applications that assist patients and
healthcare providers in the provision of healthcare services, contactless digital check-in
solutions, messaging, and online appointment scheduling tools; |
| ○ | Business
Intelligence (“BI”) and healthcare analytics platforms that allow our clients
to derive actionable insights from their vast amount of data; and |
| ○ | Customized
applications, interfaces, and a variety of other technology solutions that support our healthcare
clients. |
| ○ | Chronic
care management is a program that supports care for patients with chronic conditions by certified
care managers that operate under the supervision of the patient’s regular physician; |
| ○ | Remote
patient monitoring enables patient data collected outside the clinical setting through remote
devices to be fed into their provider’s EHR to enable proactive patient care; and |
| ○ | Telemedicine
solutions which allow healthcare providers to conduct remote patient visits and extend the
timely delivery of care to patients unable to travel to a provider’s office. |
| ● | Healthcare
IT professional services & staffing: |
| ○ | Professional
services consisting of a broad range of consulting services including full software implementations
and activation, revenue cycle optimization, data analytic services, and educational training
services; |
| ○ | Strategic
advisory services to manage system evaluations and selection, provide interim management,
and operational assessments; and |
| ○ | Workforce
augmentation and on-demand staffing to support our clients as they expand their businesses,
seek highly trained personnel, or struggle to address staffing shortages. |
Our
medical practice management solutions include:
| ● | Medical
practice management: |
| ○ | Medical
practice management services for medical providers, including facilities, equipment, supplies,
support services, nurses, and administrative support staff. |
We
are able to deliver our industry-leading solutions at very competitive prices because we leverage a combination of our proprietary software,
which automates our workflows and increases efficiency, together with our team of approximately 350 experienced health industry experts
throughout the United States. These experts are supported by our highly educated and specialized offshore workforce of approximately
3,100 team members that are approximately 15% of the cost of comparably educated and skilled workers in the U.S. Our unique business
model also allowed us to become a leading consolidator in our industry sector, gaining us a reputation for acquiring and positively transforming
distressed competitors into profitable operations of CareCloud.
Our
offshore operations in the Pakistan Offices and Sri Lanka together accounted for approximately 15% and 13% of total expenses for the
three months ended March 31, 2024 and 2023, respectively. A significant portion of those foreign expenses were personnel-related costs
(approximately 75% and 81% for the three months ended March 31, 2024 and 2023, respectively). Because personnel-related costs are significantly
lower in Pakistan and Sri Lanka than in the U.S. and many other offshore locations, we believe our offshore operations give us a competitive
advantage over many industry participants. We are able to achieve significant cost reductions and leverage technology to reduce manual
work and strategically transition a portion of the remaining manual tasks to our highly-specialized, cost-efficient team in the U.S.,
the Pakistan Offices and Sri Lanka.
Key
Performance Measures
We
consider numerous factors in assessing our performance. Key performance measures used by management, including adjusted EBITDA, adjusted
operating income, adjusted operating margin, adjusted net income and adjusted net income per share, are non-GAAP financial measures,
which we believe better enable management and investors to analyze and compare the underlying business results from period to period.
These
non-GAAP financial measures should not be considered in isolation, or as a substitute for or superior to, financial measures calculated
in accordance with accounting principles generally accepted in the United States of America (“GAAP”). Moreover, these non-GAAP
financial measures have limitations in that they do not reflect all the items associated with the operations of our business as determined
in accordance with GAAP. We compensate for these limitations by analyzing current and future results on a GAAP basis as well as a non-GAAP
basis, and we provide reconciliations from the most directly comparable GAAP financial measures to the non-GAAP financial measures. Our
non-GAAP financial measures may not be comparable to similarly titled measures of other companies. Other companies, including companies
in our industry, may calculate similarly titled non-GAAP financial measures differently than we do, limiting the usefulness of those
measures for comparative purposes.
Adjusted
EBITDA, adjusted operating income, adjusted operating margin, adjusted net income and adjusted net income per share provide an alternative
view of performance used by management and we believe that an investor’s understanding of our performance is enhanced by disclosing
these adjusted performance measures.
Adjusted
EBITDA excludes the following elements which are included in GAAP net loss:
| ● | Income
tax provision or the cash requirements to pay our taxes; |
| ● | Interest
expense, or the cash requirements necessary to service interest on principal payments, on
our debt; |
| ● | Foreign
currency gains and losses and other non-operating expenditures; |
| ● | Stock-based
compensation (benefit) expense includes cash-settled awards and the related taxes, based
on changes in the stock price; |
| ● | Depreciation
and amortization charges; |
| ● | Integration
costs, such as severance amounts paid to employees from acquired businesses, and transaction
costs, such as brokerage fees, pre-acquisition accounting costs and legal fees and exit costs
related to contractual agreements; and |
| ● | Net
loss on lease terminations, unoccupied lease charges and restructuring costs. |
Set
forth below is a presentation of our adjusted EBITDA for the three months ended March 31, 2024 and 2023:
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Net revenue | |
$ | 25,962 | | |
$ | 30,001 | |
| |
| | | |
| | |
GAAP net loss | |
| (241 | ) | |
| (401 | ) |
| |
| | | |
| | |
Provision for income taxes | |
| 39 | | |
| 65 | |
Net interest expense | |
| 338 | | |
| 130 | |
Foreign exchange gain | |
| (5 | ) | |
| (8 | ) |
Stock-based compensation (benefit) expense, net of restructuring costs | |
| (708 | ) | |
| 1,072 | |
Depreciation and amortization | |
| 3,930 | | |
| 3,038 | |
Transaction and integration costs | |
| 12 | | |
| 72 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| 269 | |
Adjusted EBITDA | |
$ | 3,687 | | |
$ | 4,237 | |
Adjusted
operating income and adjusted operating margin exclude the following elements that are included in GAAP operating loss:
| ● | Stock-based
compensation (benefit) expense includes cash-settled awards and the related taxes, based
on changes in the stock price; |
| ● | Amortization
of purchased intangible assets; |
| ● | Integration
costs, such as severance amounts paid to employees from acquired businesses, and transaction
costs, such as brokerage fees, pre-acquisition accounting costs and legal fees and exit costs
related to contractual agreements; and |
| ● | Net
loss on lease terminations, unoccupied lease charges and restructuring costs. |
Set
forth below is a presentation of our adjusted operating income and adjusted operating margin, which represents adjusted operating income
as a percentage of net revenue, for the three months ended March 31, 2024 and 2023:
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Net revenue | |
$ | 25,962 | | |
$ | 30,001 | |
| |
| | | |
| | |
GAAP net loss | |
| (241 | ) | |
| (401 | ) |
Provision for income taxes | |
| 39 | | |
| 65 | |
Net interest expense | |
| 338 | | |
| 130 | |
Other income - net | |
| (7 | ) | |
| (17 | ) |
GAAP operating income (loss) | |
| 129 | | |
| (223 | ) |
GAAP operating margin | |
| 0.5 | % | |
| (0.7 | %) |
| |
| | | |
| | |
Stock-based compensation (benefit) expense, net of restructuring costs | |
| (708 | ) | |
| 1,072 | |
Amortization of purchased intangible assets | |
| 840 | | |
| 1,323 | |
Transaction and integration costs | |
| 12 | | |
| 72 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| 269 | |
Non-GAAP adjusted operating income | |
$ | 595 | | |
$ | 2,513 | |
Non-GAAP adjusted operating margin | |
| 2.3 | % | |
| 8.4 | % |
Adjusted
net income and adjusted net income per share exclude the following elements which are included in GAAP net loss:
| ● | Foreign
currency gains and losses and other non-operating expenditures; |
| ● | Stock-based
compensation (benefit) expense includes cash-settled awards and the related taxes, based
on changes in the stock price; |
| ● | Amortization
of purchased intangible assets; |
| ● | Integration
costs, such as severance amounts paid to employees from acquired businesses, and transaction
costs, such as brokerage fees, pre-acquisition accounting costs and legal fees and exit costs
related to contractual agreements; |
| ● | Net
loss on lease terminations, unoccupied lease charges and restructuring costs; and |
| ● | Income
tax provision resulting from the amortization of goodwill related to our acquisitions. |
No
tax effect has been provided in computing non-GAAP adjusted net income and non-GAAP adjusted net income per share as the Company has
sufficient carry forward net operating losses to offset the applicable income taxes. The
following table shows our reconciliation of GAAP net loss to non-GAAP adjusted net income for the three months ended March 31, 2024 and
2023:
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
GAAP net loss | |
$ | (241 | ) | |
$ | (401 | ) |
| |
| | | |
| | |
Foreign exchange gain | |
| (5 | ) | |
| (8 | ) |
Stock-based compensation (benefit) expense, net of restructuring costs | |
| (708 | ) | |
| 1,072 | |
Amortization of purchased intangible assets | |
| 840 | | |
| 1,323 | |
Transaction and integration costs | |
| 12 | | |
| 72 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| 269 | |
Income tax provision related to goodwill | |
| - | | |
| 26 | |
Non-GAAP adjusted net income | |
$ | 220 | | |
$ | 2,353 | |
Set
forth below is a reconciliation of our GAAP net loss attributable to common shareholders, per share to our non-GAAP adjusted net income
per share:
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
GAAP net loss attributable to common shareholders, per share | |
$ | (0.02 | ) | |
$ | (0.28 | ) |
Impact of preferred stock dividend | |
| 0.00 | | |
| 0.25 | |
Net loss per end-of-period share | |
| (0.02 | ) | |
| (0.03 | ) |
| |
| | | |
| | |
Foreign exchange gain | |
| 0.00 | | |
| 0.00 | |
Stock-based compensation (benefit) expense | |
| (0.04 | ) | |
| 0.07 | |
Amortization of purchased intangible assets | |
| 0.05 | | |
| 0.09 | |
Transaction and integration costs | |
| 0.00 | | |
| 0.00 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 0.02 | | |
| 0.02 | |
Income tax provision related to goodwill | |
| 0.00 | | |
| 0.00 | |
Non-GAAP adjusted earnings per share | |
$ | 0.01 | | |
$ | 0.15 | |
| |
| | | |
| | |
End-of-period common shares | |
| 16,118,492 | | |
| 15,592,608 | |
In-the-money warrants and outstanding unvested RSUs | |
| 192,125 | | |
| 630,094 | |
Total fully diluted shares | |
| 16,310,617 | | |
| 16,222,702 | |
Non-GAAP adjusted diluted earnings per share | |
$ | 0.01 | | |
$ | 0.15 | |
For
purposes of determining non-GAAP adjusted earnings per share, the Company used the number of common shares outstanding at the end of
March 31, 2024 and 2023. Non-GAAP adjusted diluted earnings per share was computed using an as-converted method and includes warrants
that are in-the-money as of that date as well as outstanding unvested RSUs. Non-GAAP adjusted earnings per share and non-GAAP adjusted
diluted earnings per share do not take into account dividends paid on preferred stock. No tax effect has been provided in computing non-GAAP
adjusted earnings per share and non-GAAP adjusted diluted earnings per share as the Company has sufficient carry forward net operating
losses to offset the applicable income taxes.
Key
Metrics
In
addition to the line items in our condensed consolidated financial statements, we regularly review the following metrics. We believe
information on these metrics is useful for investors to understand the underlying trends in our business.
Providers
and Practices Served: As of both March 31, 2024 and 2023, we provided services to an estimated universe of approximately 40,000 providers
(which we define as physicians, nurses, nurse practitioners, physician assistants and other clinical staff that render bills for their
services), representing approximately 2,600 independent medical practices and hospitals. In addition, we served approximately 150 clients
who were not medical practices, but are service organizations who serve the healthcare community. The foregoing numbers include clients
leveraging any of our products or services and are based in part upon estimates in cases where the precise number of practices or providers
is unknown.
Sources
of Revenue
Revenue:
We primarily derive our revenues from subscription-based technology-enabled business solutions, reported in our Healthcare IT segment,
which are typically billed as a percentage of payments collected by our customers. This fee includes technology-enabled RCM, as well
as the ability to use our EHR, practice management system and other software as part of the bundled fee. These solutions accounted for
approximately 67% and 65% for the three months ended March 31, 2024 and 2023, respectively. Other healthcare IT services, including printing
and mailing operations, group purchasing and professional services, represented approximately 21% and 25% for the three months ended
March 31, 2024 and 2023, respectively.
We
earned approximately 12% and 10% of our revenue from medical practice management services during the three months ended March 31, 2024
and March 31, 2023, respectively. This revenue represents fees based on our actual costs plus a percentage of the operating profit and
is reported in our Medical Practice Management segment.
Operating
Expenses
Direct
Operating Costs. Direct operating cost consists primarily of salaries and benefits related to personnel who provide services to
our customers, claims processing costs, costs to operate the three managed practices, including facility lease costs, supplies,
insurance and other direct costs related to our services. Costs associated with the implementation of new customers are expensed as
incurred. The reported amounts of direct operating costs do not include depreciation and amortization, which are broken out
separately in the condensed consolidated statements of operations.
Selling
and Marketing Expense. Selling and marketing expense consists primarily of compensation and benefits, commissions, travel and advertising
expenses.
General
and Administrative Expense. General and administrative expense consists primarily of personnel-related expense for administrative
employees, including compensation, benefits, travel, facility lease costs and insurance, software license fees and outside professional
fees.
Research
and Development Expense. Research and development expense consists primarily of personnel-related costs, software expense and third-party
contractor costs.
Depreciation
and Amortization Expense. Depreciation expense is charged using the straight-line method over the estimated lives of the assets ranging
from three to five years. Amortization expense is charged on either an accelerated or on a straight-line basis over a period of three
or four years for most intangible assets acquired in connection with acquisitions including those intangibles related to the group purchasing
services. Amortization expense related to the value of our medical practice management clients is amortized on a straight-line basis
over a period of twelve years.
Net
Loss on Lease Terminations, Unoccupied Lease Charges and Restructuring Costs. Net loss on lease terminations represents the write-off
of leasehold improvements and gains or losses as the result of lease terminations. Unoccupied lease charges represent the portion of
the lease and related costs for that portion of the space that is vacant and not being utilized by the Company. Two of the leases that
had unoccupied space ended in February 2023. Restructuring costs consists of severance and separation costs associated with the optimization
of the Company’s operations and profitability improvements.
Interest
Income, Interest Expense and Other Expense - net. Interest income represents interest earned on temporary cash investments and late
fees from customers. Interest expense consists primarily of interest costs related to our line of credit, term loans and the amortization
of deferred financing costs. Other expense - net results primarily from foreign currency transaction (losses)/gains.
Income
Taxes. In preparing our condensed consolidated financial statements, we estimate income taxes in each of the jurisdictions in
which we operate. This process involves estimating actual current tax exposure together with assessing temporary differences
resulting from differing treatment of items for tax and financial reporting purposes. These differences result in deferred income
tax assets and liabilities. Although the Company is forecasting a return to profitability, it incurred losses historically and there
is uncertainty regarding future U.S. taxable income, which makes realization of a deferred tax asset difficult to support in
accordance with ASC 740. Accordingly, a valuation allowance has been recorded against all deferred tax assets as of March 31, 2024
and December 31, 2023.
Critical
Accounting Policies and Estimates
The
critical accounting policies and estimates used in the preparation of our condensed consolidated financial statements that we
believe affect our more significant judgments and estimates used in the preparation of our condensed consolidated financial
statements presented in this Report are described in Management’s Discussion and Analysis of Financial Condition and Results
of Operations and in the Notes to the consolidated financial statements included in our Annual Report on Form 10-K for the year
ended December 31, 2023.
Capitalized
Software Costs:
As
of March 31, 2024 and December 31, 2023, the carrying amounts of internally-developed capitalized software in use was $16.1 million and
$17.1 million, respectively. The decrease was due to the current period amortization exceeding the amounts being capitalized.
There
have been no material changes in our critical accounting policies and estimates from those described in the Management’s Discussion
and Analysis of Financial Condition and Results of Operations, included in our Annual Report on Form 10-K for the year ended December
31, 2023, filed with the SEC on March 21, 2024.
Results
of Operations
The
following table sets forth our consolidated results of operations as a percentage of total revenue for the periods
shown:
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
Net revenue | |
| 100.0 | % | |
| 100.0 | % |
Operating expenses: | |
| | | |
| | |
Direct operating costs | |
| 58.5 | % | |
| 60.3 | % |
Selling and marketing | |
| 6.8 | % | |
| 8.7 | % |
General and administrative | |
| 14.3 | % | |
| 17.1 | % |
Research and development | |
| 3.5 | % | |
| 3.6 | % |
Depreciation and amortization | |
| 15.1 | % | |
| 10.1 | % |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 1.2 | % | |
| 0.9 | % |
Total operating expenses | |
| 99.4 | % | |
| 100.7 | % |
| |
| | | |
| | |
Operating income (loss) | |
| 0.6 | % | |
| (0.7 | %) |
| |
| | | |
| | |
Net interest expense | |
| 1.3 | % | |
| 0.4 | % |
Other income - net | |
| 0.0 | % | |
| 0.0 | % |
Loss before provision for income taxes | |
| (0.7 | %) | |
| (1.1 | %) |
Income tax provision | |
| 0.2 | % | |
| 0.2 | % |
Net loss | |
| (0.9 | %) | |
| (1.3 | %) |
Comparison
of the three months ended March 31, 2024 and 2023:
| |
Three Months Ended March 31, | | |
Change | |
| |
2024 | | |
2023 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Net revenue | |
$ | 25,962 | | |
$ | 30,001 | | |
$ | (4,039 | ) | |
| (13 | %) |
Net
Revenue. Net revenue of $26.0 million for the three months ended March 31, 2024, decreased by $4.0 million or 13% from net revenue
of $30.0 million for the three months ended March 31, 2023. Revenue for the three months ended March 31, 2024 includes $17.3 million
relating to technology-enabled business solutions, $4.4 million related to professional services and $3.2 million for medical practice
management services.
There
was a $2.1 million decrease in project-based professional services revenue for the three months ended March 31, 2024 compared to the
same period in the prior year. The 2024 revenue was also negatively impacted by two large accounts that had each been previously acquired
prior to our beginning to serve them after a 2020 acquisition. The services provided to them were each winding down at the time of our
acquisition and they both transitioned to the systems of their acquirers during 2022. Revenue from these two customers for the three
months ended March 31, 2024 and 2023 was $186,000 and $1.0 million, respectively, accounting for approximately $800,000 of the decline
in revenue. Revenue from these customers is expected to be approximately $90,000 for the remainder of 2024. (Refer to Forward-Looking
Statements disclosure on page 2 of this Form 10-Q.)
| |
Three Months Ended March 31, | | |
Change | |
| |
2024 | | |
2023 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Direct operating costs | |
$ | 15,177 | | |
$ | 18,107 | | |
$ | (2,930 | ) | |
| (16 | %) |
Selling and marketing | |
| 1,770 | | |
| 2,612 | | |
| (842 | ) | |
| (32 | %) |
General and administrative | |
| 3,721 | | |
| 5,120 | | |
| (1,399 | ) | |
| (27 | %) |
Research and development | |
| 913 | | |
| 1,078 | | |
| (165 | ) | |
| (15 | %) |
Depreciation | |
| 503 | | |
| 492 | | |
| 11 | | |
| 2 | % |
Amortization | |
| 3,427 | | |
| 2,546 | | |
| 881 | | |
| 35 | % |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| 269 | | |
| 53 | | |
| 20 | % |
Total operating expenses | |
$ | 25,833 | | |
$ | 30,224 | | |
$ | (4,391 | ) | |
| (15 | %) |
Direct
Operating Costs. Direct operating costs of $15.2 million for the three months ended March 31, 2024 decreased by $2.9 million or 16%
compared to direct operating costs of $18.1 million for the three months ended March 31, 2023. During the three months ended March 31,
2024, salary costs decreased by $1.9 million, outsourcing and processing costs decreased by $658,000 and billable expenses decreased
by $435,000. The decrease in the salary costs was due to a decrease in the U.S. and Pakistan headcount and due to lower revenue, the
redeployment of employees performing functions that were previously classified as direct operating costs to functions classified as research
and development expense for the three months ended March 31, 2024.
Selling
and Marketing Expense. Selling and marketing expense of $1.8 million for the three months ended March 31, 2024 decreased by $842,000
or 32% from selling and marketing expense of $2.6 million for the three months ended March 31, 2023. The decrease for the three months
ended March 31, 2024 was due to lower spending on salaries and selling and marketing activities.
General
and Administrative Expense. General and administrative expense of $3.7 million for the three months ended March 31, 2024
decreased by $1.4 million or 27% compared to general and administrative expense of $5.1 million for the three months ended March 31,
2023. During the three months ended March 31, 2024, salary costs decreased by $1.2 million and legal and professional fees decreased
by $90,000. The decrease in salary costs was due to lower headcount. Also, there was a decrease in the Company’s contributions
to community-based projects in Pakistan.
Research
and Development Expense. Research and development expense of $913,000 for the three months ended March 31, 2024 decreased by approximately
$165,000 or 15% from research and development expense of $1.1 million for the three months ended March 31, 2023. During the three months
ended March 31, 2024 and 2023, the Company capitalized approximately $1.6 million and $2.2 million, respectively, of development costs
in connection with its internal-use software.
Depreciation.
Depreciation of $503,000 for the three months ended March 31, 2024 decreased by $11,000 or 2% from the depreciation of $492,000 for
the three months ended March 31, 2023.
Amortization
Expense. Amortization expense of $3.4 million for the three months ended March 31, 2024 increased by $881,000 or 35% from amortization
expense of $2.5 million for the three months ended March 31, 2023. The increase in amortization expense was due to the placement of additional
internal-use software into production and beginning the related amortization.
Net
Loss on Lease Terminations, Unoccupied Lease Charges and Restructuring Costs. Net loss on lease terminations represents the write-off
of leasehold improvements and gains or losses as the result of lease terminations. During the three months ended March 31, 2023, the
Miami office lease that we assumed in connection with an acquisition ended and we entered into a new lease arrangement with the landlord
for significantly less space. Charges of $71,000 for the three months ended March 31, 2023 were incurred as a result of vacating the
former premises. During the year ended December 31, 2022, a facility lease was terminated in conjunction with the Company ceasing its
document storage services resulting in additional costs for the three months ended March 31, 2023, of approximately $45,000. During the
three months ended March 31, 2023, there were $153,000 of unoccupied lease charges. There were $322,000 of restructuring costs being
recorded for the three months ended March 31, 2024, whereas in the same period for 2023, there were no restructuring costs. Restructuring
costs consists of severance and separation costs associated with the optimization of the Company’s operations and profitability
improvements. There were no net losses on lease terminations or unoccupied lease charges during the three months ended March 31, 2024.
| |
Three Months Ended March 31, | | |
Change | |
| |
2024 | | |
2023 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Interest income | |
$ | 27 | | |
$ | 20 | | |
$ | 7 | | |
| 35 | % |
Interest expense | |
| (365 | ) | |
| (150 | ) | |
| (215 | ) | |
| (143 | %) |
Other income - net | |
| 7 | | |
| 17 | | |
| (10 | ) | |
| (59 | %) |
Income tax provision | |
| 39 | | |
| 65 | | |
| (26 | ) | |
| (40 | %) |
Interest
Income. Interest income of $27,000 for the three months ended March 31, 2024 increased by $7,000 from interest income of $20,000
for the three months ended March 31, 2023. The interest income represents late fees from customers and interest earned on temporary cash
investments, which increased due to rising interest rates.
Interest
Expense. Interest expense of $365,000 for the three months ended March 31, 2024 increased by $215,000 from interest expense of $150,000
for the three months ended March 31, 2023. The increase in interest expense was due to the increased use of the line of credit and the
impact of a higher interest rate in 2024. Interest expense on the line of credit was $289,000 and $72,000 during the three months ended
March 31, 2024 and 2023, respectively.
Other
Income – net. Other income – net was $7,000 for the three months ended March 31, 2024 compared to other income
– net of $17,000 for the three months ended March 31, 2023. Other expense or income primarily represents foreign currency
transaction losses or gains. These transaction losses or gains result from revaluing intercompany accounts which are denominated in
U.S. dollars that represent amounts payable/receivable between the entities. Whenever the exchange rate varies, the losses or gains
are recorded in the condensed consolidated statements of operations.
Income
Tax Provision. The provision for income taxes was $39,000 for the three months ended March 31, 2024 compared to the provision for
income taxes of $65,000 for the three months ended March 31, 2023. As a result of the Company having certain net operating losses with
an indefinite life under the current federal tax rules, the federal and state deferred tax liability was offset against the net operating
loss to the extent allowable in 2023. Through December 31, 2023, the state deferred tax liability has also been offset against state
net operating losses to the extent allowable. There were no deferred income taxes for the three months ended March 31, 2024.
The
current income tax expense for the three months ended March 31, 2024 was approximately $39,000 and includes state minimum taxes and
foreign income taxes. The Company has incurred cumulative losses historically and there is uncertainty regarding future U.S. taxable
income, which makes realization of a deferred tax losses difficult to support in accordance with ASC 740. Accordingly, a valuation
allowance was recorded against all deferred tax assets at March 31, 2024 and December 31, 2023.
Liquidity
and Capital Resources
As
of March 31, 2024, the Company had total cash of $4.1 million and net working capital of $474,000. For the three months ended March 31,
2024, cash provided by operations was $4.1 million offset by cash used in investing and financing activities of $3.2 million resulting
in an increase in cash of $807,000 after accounting for the effect of $17,000 of exchange rate changes. During the quarter ended March
31, 2024, the Company repaid $1.0 million on its line of credit borrowings. Subsequent to March 31, 2024, an additional $1.0 million
was repaid on the line of credit.
In
fiscal year 2023, the Company incurred a net loss of $48.7 million compared to $5.4 million of net income in fiscal year 2022, and at
December 31, 2023, had cash of $3.3 million and a working capital deficit of $57,000. The decrease in cash for fiscal 2023 was $9 million
compared to an increase in cash of $2 million in fiscal 2022. The Company also had $10 million drawn on its line of credit. Together,
at December 31, 2023 these factors raised substantial doubt regarding the Company’s ability to continue as a going concern.
However,
management has considered its plans to continue the Company as a going concern and believes substantial doubt is alleviated by focusing
on cost-control. Management developed a plan that was substantially implemented during fiscal 2023 to improve liquidity in its operations
through reductions in payroll and operating expenses. After the reductions are implemented and through employee attrition, the Company
expects an improvement of approximately $20 million in annualized cost savings, of which approximately $14 million will be realized in
2024. The Company also suspended its Preferred Stock dividends in December 2023 resulting in cash savings of $1.3 million per month.
Additional headcount reductions occurred in 2024 and further cost reductions will continue throughout the year. The Company is focused
on reducing costs, returning to profitability, generating positive cash flow and maintaining compliance with its debt covenants. Although
there are no guarantees that the Company will be successful, it believes that such initiatives will enable it to continue as a going
concern through at least the next twelve months.
The
Company has begun realizing the effect of these plans and expects continued effects to be realized during the remainder of 2024 and beyond,
including a decrease in the Company’s operating costs and an improvement in the Company’s monthly cash flow from operations.
Management
continues to focus on the Company’s overall profitability, including managing expenses, and to the extent possible growing revenue,
and expects that these efforts will continue to enhance our liquidity and financial position. Based on management’s forecasts,
the Company will have sufficient liquidity to meet its obligations as they become due for the next twelve months from the date of the
financial statements’ issuance.
Change
Healthcare, a subsidiary of UnitedHealth Group, experienced an incident on February 21, 2024, in which a cybersecurity threat actor gained
access to some of its information technology systems (“Change Healthcare Cybersecurity Incident”). The Company uses Change
Healthcare to submit patient claims to Medicare and other payors for reimbursement. Since the time of the system disruption, the Company
has worked continuously to find alternative processes to maintain overall operations.
As
of March 31, 2024, the Company has not identified any compromise or unauthorized access of its systems or networks due to this third
party incident. As of the end of the first quarter of 2024, the Company reconnected to certain applications maintained by Change Healthcare
and resumed claims submission to several payors and utilized alternative platforms for the majority of its claims. The Company continues
to work through accumulated unprocessed claims and to establish full recovery with Change Healthcare’s applications.
During
the first quarter of 2024, the Company did not experience a material financial impact from the Change Healthcare Cybersecurity Incident
on the financial results as reported. The impact to the first quarter financial results was primarily related to decreased cash flows
from operations, which are expected to be recognized later in 2024. The Company continues to maintain its liquidity and, having substantially
resumed submission of claims to payors, has determined that the Change Healthcare Cybersecurity Incident is not reasonably likely to
materially impact the Company, including its business operations, financial condition or results of operations.
We
have not been adversely affected by inflation as typically we receive a percentage of the fees our clients collect from our revenue cycle
management services. Additionally, our medical practice management contracts are based on our costs plus a percentage of the medical
practice’s operating income. We continue to monitor the impact of inflation in order to minimize its effects through pricing strategies,
productivity improvements and cost reductions. In the event of inflation, we believe that we will be able to pass on any price increases
for fixed rate contracts to our customers, as the prices that we charge are not governed by long-term contracts. The interest rate on
our line of credit is based on prime rate which had been increasing through 2023 but has remained the same in 2024.
The
Company has a revolving line of credit, and as of March 31, 2024, there was $9 million outstanding. During April 2024, an additional
$1.0 million was repaid on the line of credit. As of March 31, 2024, the unused borrowing base was approximately $3.6 million.
The
following table summarizes our cash flows for the periods presented:
| |
Three Months Ended March 31, | | |
Change | |
| |
2024 | | |
2023 | | |
Amount | | |
Percent | |
| |
($ in thousands) | | |
| |
Net cash provided by operating activities | |
$ | 4,066 | | |
$ | 1,023 | | |
$ | 3,043 | | |
| 297 | % |
Net cash used in investing activities | |
| (1,868 | ) | |
| (3,039 | ) | |
| 1,171 | | |
| 39 | % |
Net cash used in financing activities | |
| (1,374 | ) | |
| (1,787 | ) | |
| 413 | | |
| 23 | % |
Effect of exchange rate changes on cash | |
| (17 | ) | |
| (335 | ) | |
| 318 | | |
| 95 | % |
Net increase (decrease) in cash | |
$ | 807 | | |
$ | (4,138 | ) | |
$ | 4,945 | | |
| 120 | % |
The
loss before income tax was $202,000 for the three months ended March 31, 2024, which included $3.9 million of non-cash depreciation and
amortization. The loss before income taxes was $336,000 for the three months ended March 31, 2023, which included $3.0 million of non-cash
depreciation and amortization.
Operating
Activities
Net
cash provided by operating activities was $4.1 million and $1.0 million during the three months ended March 31, 2024 and 2023, respectively.
This increase was primarily the result of the decrease in the net loss of $160,000 which included the following changes in non-cash items:
an increase in depreciation and amortization of $815,000 offset by a net decrease in stock-based compensation of $1.8 million. Accounts
receivable decreased $111,000 for the three months ended March 31, 2024, compared with a decrease of $156,000 for the three months ended
March 31, 2023. Accounts payable, accrued compensation and accrued expenses increased by $721,000 during the three months ended March
31, 2024, compared with a decrease of $2.6 million for the three months ended March 31, 2023. The contract asset decreased by $258,000
during the three months ended March 31, 2024 compared to the prior period.
Investing
Activities
Net
cash used in investing activities was $1.9 million and $3.0 million for the three months ended March 31, 2024 and 2023, respectively.
Capital expenditures were $298,000 and $835,000 for the three months ended March 31, 2024 and 2023, respectively. The capital expenditures
for the three months ended March 31, 2024 and 2023 primarily represented computer equipment purchased and leasehold improvements for
the Pakistan Offices. Software development costs of $1.6 million and $2.2 million for the three months ended March 31, 2024 and 2023,
respectively, were capitalized in connection with the development of software for providing technology-enabled business solutions.
Financing
Activities
Net
cash used in financing activities was $1.4 million and $1.8 million during the three months ended March 31, 2024 and 2023, respectively.
Cash used in financing activities during the three months ended March 31, 2024 included $223,000 of repayments for debt obligations and
$151,000 of tax withholding obligations paid in connection with stock awards issued to employees. Cash used in financing activities during
the three months ended March 31, 2023 included $3.9 million of preferred stock dividends, $1.4 million of proceeds from issuance of Series
B Preferred Stock, $236,000 of repayments for debt obligations and $1.1 million of tax withholding obligations paid in connection with
stock awards issued to employees. Repayments and net proceeds on the line of credit were $1.0 million and $2.0 million for the three
months ended March 31, 2024 and 2023, respectively.
Contractual
Obligations and Commitments
We
have contractual obligations under our line of credit. We were in compliance with all covenants as of March 31, 2024. We also maintain
operating leases for property and certain office equipment. For additional information, see Contractual Obligations and Commitments under
Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” in the Company’s
Annual Report on Form 10-K for the year ended December 31, 2023, filed with the SEC on March 21, 2024.
Off-Balance
Sheet Arrangements
As
of March 31, 2024, and 2023, we did not have any relationships with unconsolidated entities or financial partnerships, such as entities
often referred to as structured finance or special-purpose entities, which would have been established for the purpose of facilitating
off-balance sheet arrangements or other contractually narrow or limited purposes.
Item
3. Quantitative and Qualitative Disclosures about Market Risk
We
are a smaller reporting company as defined by 17 C.F.R. 229.10(f)(1) and are not required to provide information under this item, pursuant
to Item 305(e) of Regulation S-K.
Item
4. Controls and Procedures
Evaluation
of Disclosure Controls and Procedures
Our
management, with the participation of our Chief Executive Officer and Interim Chief Financial Officer, based on the Internal Control-Integrated
Framework (2013 framework) issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”), evaluated
the effectiveness of our disclosure controls and procedures as of March 31, 2024 as required by Rules 13a-15(b) and 15d-15(b) of the
Exchange Act. The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange
Act, means controls and other procedures of a company that are designed to ensure that information required to be disclosed by a company
in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods
specified in the SEC’s rules and forms.
Disclosure
controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed
by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to the company’s management,
including its principal executive and principal financial officer, to allow timely decisions regarding required disclosure. Management
recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving
their objectives and management necessarily applies its judgment in evaluating the cost-benefit relationship of possible controls and
procedures.
Based
on the evaluation of our disclosure controls and procedures, as of March 31, 2024, our Chief Executive Officer and Interim Chief Financial
Officer concluded that, as of such date, our disclosure controls and procedures were effective.
Changes
in Internal Control Over Financial Reporting
There
were no changes in our internal control over financial reporting (as defined in Rules 13a-15(f) and l5d-15(f) of the Exchange Act) that
occurred during our most recent fiscal quarter that have materially affected, or are reasonably likely to materially affect, our internal
control over financial reporting.
Part
II. Other Information
Item
1. Legal Proceedings
See
discussion of legal proceedings in “Note 7, Commitments And Contingencies” of the Notes to Condensed Consolidated
Financial Statements in this Quarterly Report, which is incorporated by reference herein.
Item
1A. Risk Factors
In
addition to the other information set forth in this Quarterly Report on Form 10-Q, you should carefully consider the factors discussed
in Part I—Item 1A. “Risk Factors” in our Annual Report on Form 10-K, filed with the SEC on March 21, 2024, which could
materially affect our business, financial condition and/or future results. The risks described in our Annual Report on Form 10-K are
not the only risks facing us. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial
may also materially adversely affect our business, financial condition, cash flows and/or future results.
We
Maintain Our Cash at Financial Institutions, Often in Balances That Exceed Federally Insured Limits.
The
financial markets recently have encountered volatility associated with concerns about the balance sheets of banks, especially small and
regional banks who may have significant losses associated with investments that make it difficult to fund demands to withdraw deposits
and other liquidity needs. Although the federal government has announced measures to assist these banks and protect depositors, some
banks have already been impacted and others may be materially and adversely impacted. Our business is dependent on bank relationships
and we are proactively monitoring the financial health of such bank relationships. Continued strain on the banking system may adversely
impact our business, financial condition and results of operations.
Item
2. Unregistered Sales of Equity Securities and Use of Proceeds
Not
applicable.
Item
3. Defaults Upon Senior Securities
On
December 11, 2023, the Board of Directors suspended the monthly cash dividends for Series A Preferred Stock and Series B Preferred Stock
beginning with the payment scheduled for December 15, 2023 together with the remaining dividends that were declared. The suspension of
these dividends will defer approximately $1.3 million in cash dividend payments each month. As a result of such suspension, as of the
filing date of this Quarterly Report, the Company has approximately $3.2 million of dividends in arrears. During this suspension, dividends
will continue to accrue in arrears on the Series A and Series B Preferred Stock. The Board of Directors will regularly review and consider
when the suspension should be lifted. See discussion of preferred stock dividend suspension in “Note 10, Shareholders’ Equity”
of the Notes to Condensed Consolidated Financial Statements in this Quarterly Report.
Item
4. Mine Safety Disclosures
Not
applicable.
Item
5. Other Information
Not
applicable.
Item
6. Exhibits
*The
certifications on Exhibit 32 hereto are not deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934,
as amended, or otherwise subject to the liability of that Section. Such certifications will not be deemed incorporated by reference into
any filing under the Securities Act or the Exchange Act.
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.
|
CareCloud, Inc. |
|
|
|
|
By: |
/s/
A. Hadi Chaudhry |
|
|
A.
Hadi Chaudhry |
|
|
Chief
Executive Officer |
|
|
Date:
May 14, 2024 |
|
|
|
|
By: |
/s/
Norman S. Roth |
|
|
Norman
S. Roth |
|
|
Interim
Chief Financial Officer and Corporate Controller |
|
|
Date:
May 14, 2024 |
Exhibit
31.1
CERTIFICATION
OF PRINCIPAL EXECUTIVE OFFICER
PURSUANT
TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002
I,
A. Hadi Chaudhry, certify that:
1. |
I
have reviewed this Quarterly Report on Form 10-Q of CareCloud, 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(s) 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 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 disclosures 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; and |
5. |
The
registrant’s other certifying officer(s) 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. |
|
CareCloud,
Inc. |
|
|
|
By:
|
/s/
A. Hadi Chaudhry |
|
|
A.
Hadi Chaudhry |
|
|
Chief
Executive Officer (Principal Executive Officer) |
|
|
|
Dated: |
|
|
May
14, 2024 |
|
|
Exhibit
31.2
CERTIFICATION
OF PRINCIPAL FINANCIAL OFFICER
PURSUANT
TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002
I,
Norman S. Roth, certify that:
1. |
I
have reviewed this Quarterly Report on Form 10-Q of CareCloud, 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(s) 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 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 disclosures 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; and |
5. |
The
registrant’s other certifying officer(s) 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. |
|
CareCloud,
Inc. |
|
|
|
By:
|
/s/
Norman S. Roth |
|
|
Norman
S. Roth |
|
|
Interim
Chief Financial Officer (Principal Financial Officer) |
|
|
|
Dated: |
|
|
May
14, 2024 |
|
|
Exhibit
32.1
CERTIFICATION
OF CHIEF EXECUTIVE OFFICER
PURSUANT
TO
18
U.S.C. SECTION 1350,
AS
ADOPTED PURSUANT TO
SECTION
906 OF THE SARBANES-OXLEY ACT OF 2002
Based
on my knowledge, I, A. Hadi Chaudhry, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley
Act of 2002, that the Quarterly Report of CareCloud, Inc. on Form 10-Q for the quarter ended March 31, 2024 fully complies with the requirements
of Section 13(a) or 15(d) of the Securities Exchange Act of 1934 and that information contained in such Form 10-Q fairly presents in
all material respects the financial condition and results of operations of CareCloud, Inc.
|
CareCloud,
Inc. |
|
|
|
By:
|
/s/
A. Hadi Chaudhry |
|
|
A.
Hadi Chaudhry |
|
|
Chief
Executive Officer (Principal Executive Officer) |
|
|
|
Dated: |
|
|
May
14, 2024 |
|
|
Exhibit
32.2
CERTIFICATION
OF CHIEF FINANCIAL OFFICER
PURSUANT
TO
18
U.S.C. SECTION 1350,
AS
ADOPTED PURSUANT TO
SECTION
906 OF THE SARBANES-OXLEY ACT OF 2002
Based
on my knowledge, I, Norman S. Roth, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the
Sarbanes-Oxley Act of 2002, that the Quarterly Report of CareCloud, Inc. on Form 10-Q for the quarter ended March 31, 2024 fully complies
with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934 and that information contained in such Form
10-Q fairly presents in all material respects the financial condition and results of operations of CareCloud, Inc.
|
CareCloud,
Inc. |
|
|
|
By:
|
/s/
Norman S. Roth |
|
|
Norman
S. Roth |
|
|
Interim
Chief Financial Officer (Principal Financial Officer) |
|
|
|
Dated: |
|
|
May
14, 2024 |
|
|
v3.24.1.1.u2
Cover - shares
|
3 Months Ended |
|
Mar. 31, 2024 |
May 10, 2024 |
Document Type |
10-Q
|
|
Amendment Flag |
false
|
|
Document Quarterly Report |
true
|
|
Document Transition Report |
false
|
|
Document Period End Date |
Mar. 31, 2024
|
|
Document Fiscal Period Focus |
Q1
|
|
Document Fiscal Year Focus |
2024
|
|
Current Fiscal Year End Date |
--12-31
|
|
Entity File Number |
001-36529
|
|
Entity Registrant Name |
CareCloud,
Inc.
|
|
Entity Central Index Key |
0001582982
|
|
Entity Tax Identification Number |
22-3832302
|
|
Entity Incorporation, State or Country Code |
DE
|
|
Entity Address, Address Line One |
7
Clyde Road
|
|
Entity Address, City or Town |
Somerset
|
|
Entity Address, State or Province |
NJ
|
|
Entity Address, Postal Zip Code |
08873
|
|
City Area Code |
(732)
|
|
Local Phone Number |
873-5133
|
|
Entity Current Reporting Status |
Yes
|
|
Entity Interactive Data Current |
Yes
|
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Entity Filer Category |
Non-accelerated Filer
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|
Entity Small Business |
true
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Entity Emerging Growth Company |
false
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false
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Entity Common Stock, Shares Outstanding |
|
16,120,767
|
Common Stock, par value $0.001 per share [Member] |
|
|
Title of 12(b) Security |
Common
Stock, par value $0.001 per share
|
|
Trading Symbol |
CCLD
|
|
Security Exchange Name |
NASDAQ
|
|
11% Series A Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share [Member] |
|
|
Title of 12(b) Security |
11%
Series A Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share
|
|
Trading Symbol |
CCLDP
|
|
Security Exchange Name |
NASDAQ
|
|
8.75% Series B Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share [Member] |
|
|
Title of 12(b) Security |
8.75%
Series B Cumulative Redeemable Perpetual Preferred Stock, par value $0.001 per share
|
|
Trading Symbol |
CCLDO
|
|
Security Exchange Name |
NASDAQ
|
|
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v3.24.1.1.u2
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Current assets: |
|
|
Cash |
$ 4,138
|
$ 3,331
|
Accounts receivable - net |
11,962
|
11,888
|
Contract asset |
5,455
|
5,094
|
Inventory |
480
|
465
|
Current assets - related party |
16
|
16
|
Prepaid expenses and other current assets |
2,225
|
2,449
|
Total current assets |
24,276
|
23,243
|
Property and equipment - net |
5,438
|
5,317
|
Operating lease right-of-use assets |
4,107
|
4,365
|
Intangible assets - net |
23,237
|
25,074
|
Goodwill |
19,186
|
19,186
|
Other assets |
641
|
641
|
TOTAL ASSETS |
76,885
|
77,826
|
Current liabilities: |
|
|
Accounts payable |
5,921
|
5,798
|
Accrued compensation |
2,765
|
3,444
|
Accrued expenses |
6,350
|
5,065
|
Operating lease liability (current portion) |
1,775
|
1,888
|
Deferred revenue (current portion) |
1,386
|
1,380
|
Notes payable (current portion) |
167
|
292
|
Dividend payable |
5,438
|
5,433
|
Total current liabilities |
23,802
|
23,300
|
Notes payable |
35
|
37
|
Borrowings under line of credit |
9,000
|
10,000
|
Operating lease liability |
2,320
|
2,516
|
Deferred revenue |
308
|
256
|
Total liabilities |
35,465
|
36,109
|
COMMITMENTS AND CONTINGENCIES (NOTE 7) |
|
|
SHAREHOLDERS’ EQUITY: |
|
|
Preferred stock, $0.001 par value - authorized 7,000,000 shares. Series A, issued and outstanding 4,526,231 shares at March 31, 2024 and December 31, 2023. Series B, issued and outstanding 1,482,792 and 1,468,792 shares at March 31, 2024 and December 31, 2023, respectively |
6
|
6
|
Common stock, $0.001 par value - authorized 35,000,000 shares. Issued 16,859,291 and 16,620,891 shares at March 31, 2024 and December 31, 2023, respectively. Outstanding 16,118,492 and 15,880,092 shares at March 31, 2024 and December 31, 2023, respectively |
17
|
17
|
Additional paid-in capital |
120,622
|
120,706
|
Accumulated deficit |
(74,722)
|
(74,481)
|
Accumulated other comprehensive loss |
(3,841)
|
(3,869)
|
Less: 740,799 common shares held in treasury, at cost at March 31, 2024 and December 31, 2023 |
(662)
|
(662)
|
Total shareholders’ equity |
41,420
|
41,717
|
TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY |
$ 76,885
|
$ 77,826
|
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v3.24.1.1.u2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares
|
Mar. 31, 2024 |
Dec. 31, 2023 |
Preferred stock, par or stated value per share |
$ 0.001
|
$ 0.001
|
Preferred stock, shares authorized |
7,000,000
|
7,000,000
|
Common stock, par or stated value per share |
$ 0.001
|
$ 0.001
|
Common stock, shares authorized |
35,000,000
|
35,000,000
|
Common stock, shares issued |
16,859,291
|
16,620,891
|
Common stock, shares outstanding |
16,118,492
|
15,880,092
|
Treasury stock common shares |
740,799
|
740,799
|
Series A Preferred Stock [Member] |
|
|
Preferred stock, shares issued |
4,526,231
|
4,526,231
|
Preferred stock, shares outstanding |
4,526,231
|
4,526,231
|
Series B Preferred Stock [Member] |
|
|
Preferred stock, shares issued |
1,482,792
|
1,468,792
|
Preferred stock, shares outstanding |
1,482,792
|
1,468,792
|
X |
- DefinitionFace amount or stated value per share of common stock.
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v3.24.1.1.u2
Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Income Statement [Abstract] |
|
|
NET REVENUE |
$ 25,962
|
$ 30,001
|
OPERATING EXPENSES: |
|
|
Direct operating costs |
15,177
|
18,107
|
Selling and marketing |
1,770
|
2,612
|
General and administrative |
3,721
|
5,120
|
Research and development |
913
|
1,078
|
Depreciation and amortization |
3,930
|
3,038
|
Net loss on lease terminations, unoccupied lease charges and restructuring costs |
322
|
269
|
Total operating expenses |
25,833
|
30,224
|
OPERATING INCOME (LOSS) |
129
|
(223)
|
OTHER: |
|
|
Interest income |
27
|
20
|
Interest expense |
(365)
|
(150)
|
Other income - net |
7
|
17
|
LOSS BEFORE PROVISION FOR INCOME TAXES |
(202)
|
(336)
|
Income tax provision |
39
|
65
|
NET LOSS |
(241)
|
(401)
|
Preferred stock dividend |
5
|
3,931
|
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS |
$ (246)
|
$ (4,332)
|
Net loss per common share: basic |
$ (0.02)
|
$ (0.28)
|
Net loss per common share: diluted |
$ (0.02)
|
$ (0.28)
|
Weighted-average common shares used to compute basic loss per share |
16,014,309
|
15,421,096
|
Weighted-average common shares used to compute diluted loss per share |
16,014,309
|
15,421,096
|
X |
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v3.24.1.1.u2
Condensed Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($) $ in Thousands |
Preferred Stock [Member]
Series A Preferred Stock [Member]
|
Preferred Stock [Member]
Series B Preferred Stock [Member]
|
Common Stock [Member] |
Additional Paid-in Capital [Member] |
Retained Earnings [Member] |
AOCI Attributable to Parent [Member] |
Treasury Stock, Common [Member] |
Total |
Balance at Dec. 31, 2022 |
$ 5
|
$ 1
|
$ 16
|
$ 130,987
|
$ (25,621)
|
$ (3,037)
|
$ (662)
|
$ 101,689
|
|
Balance, shares at Dec. 31, 2022 |
4,526,231
|
1,344,128
|
15,970,204
|
|
|
|
|
|
|
Cumulative effect of adopting ASC 326 |
|
|
|
|
(186)
|
|
|
(186)
|
|
Balance - January 1, 2023 after adoption |
$ 5
|
$ 1
|
$ 16
|
130,987
|
(25,807)
|
(3,037)
|
(662)
|
101,503
|
|
Balance - January 1, 2023 after adoption, shares |
4,526,231
|
1,344,128
|
15,970,204
|
|
|
|
|
|
|
Net loss |
|
|
|
|
(401)
|
|
|
(401)
|
|
Foreign currency translation adjustment |
|
|
|
|
|
(1,711)
|
|
(1,711)
|
[1] |
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
41,491
|
343,203
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
1,185
|
|
|
|
1,185
|
|
Preferred stock dividends |
|
|
|
(3,931)
|
|
|
|
(3,931)
|
|
Shares issued for services |
|
|
|
|
|
|
|
|
|
Shares issued for services, shares |
|
|
20,000
|
|
|
|
|
|
|
Issuance of Series B Preferred Stock |
|
|
|
1,437
|
|
|
|
1,437
|
|
Issuance of Series B Preferred Stock, shares |
|
59,773
|
|
|
|
|
|
|
|
Balance at Mar. 31, 2023 |
$ 5
|
$ 1
|
$ 16
|
129,678
|
(26,208)
|
(4,748)
|
(662)
|
98,082
|
|
Balance, shares at Mar. 31, 2023 |
4,526,231
|
1,445,392
|
16,333,407
|
|
|
|
|
|
|
Balance at Dec. 31, 2022 |
$ 5
|
$ 1
|
$ 16
|
130,987
|
(25,621)
|
(3,037)
|
(662)
|
101,689
|
|
Balance, shares at Dec. 31, 2022 |
4,526,231
|
1,344,128
|
15,970,204
|
|
|
|
|
|
|
Net loss |
|
|
|
|
|
|
|
(48,700)
|
|
Balance at Dec. 31, 2023 |
$ 5
|
$ 1
|
$ 17
|
120,706
|
(74,481)
|
(3,869)
|
(662)
|
41,717
|
|
Balance, shares at Dec. 31, 2023 |
4,526,231
|
1,468,792
|
16,620,891
|
|
|
|
|
|
|
Net loss |
|
|
|
|
(241)
|
|
|
(241)
|
|
Foreign currency translation adjustment |
|
|
|
|
|
28
|
|
28
|
[1] |
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
14,000
|
238,400
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
(79)
|
|
|
|
(79)
|
|
Preferred stock dividends |
|
|
|
(5)
|
|
|
|
(5)
|
|
Balance at Mar. 31, 2024 |
$ 5
|
$ 1
|
$ 17
|
$ 120,622
|
$ (74,722)
|
$ (3,841)
|
$ (662)
|
$ 41,420
|
|
Balance, shares at Mar. 31, 2024 |
4,526,231
|
1,482,792
|
16,859,291
|
|
|
|
|
|
|
|
|
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Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
12 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
OPERATING ACTIVITIES: |
|
|
|
Net loss |
$ (241)
|
$ (401)
|
$ (48,700)
|
Adjustments to reconcile net loss to net cash provided by operating activities: |
|
|
|
Depreciation and amortization |
4,020
|
3,205
|
|
Lease amortization |
509
|
683
|
|
Deferred revenue |
58
|
16
|
|
Provision for expected credit losses |
37
|
97
|
454
|
Provision for deferred income taxes |
|
26
|
|
Foreign exchange gain |
(11)
|
(11)
|
|
Interest accretion |
168
|
166
|
|
Stock-based compensation (benefit) expense |
(708)
|
1,072
|
|
Changes in operating assets and liabilities: |
|
|
|
Accounts receivable |
(111)
|
(156)
|
|
Contract asset |
(361)
|
(619)
|
|
Inventory |
(15)
|
116
|
|
Other assets |
|
(615)
|
|
Accounts payable and other liabilities |
721
|
(2,556)
|
|
Net cash provided by operating activities |
4,066
|
1,023
|
|
INVESTING ACTIVITIES: |
|
|
|
Purchases of property and equipment |
(298)
|
(835)
|
|
Capitalized software and other intangible assets |
(1,570)
|
(2,204)
|
|
Net cash used in investing activities |
(1,868)
|
(3,039)
|
|
FINANCING ACTIVITIES: |
|
|
|
Preferred stock dividends paid |
|
(3,875)
|
|
Settlement of tax withholding obligations on stock issued to employees |
(151)
|
(1,113)
|
|
Repayments of notes payable |
(223)
|
(236)
|
|
Proceeds from issuance of Series B Preferred Stock, net of expenses |
|
1,437
|
|
Proceeds from line of credit |
|
12,700
|
|
Repayment of line of credit |
(1,000)
|
(10,700)
|
|
Net cash used in financing activities |
(1,374)
|
(1,787)
|
|
EFFECT OF EXCHANGE RATE CHANGES ON CASH |
(17)
|
(335)
|
|
NET INCREASE (DECREASE) IN CASH |
807
|
(4,138)
|
9,000
|
CASH - Beginning of the period |
3,331
|
12,299
|
12,299
|
CASH - End of the period |
4,138
|
8,161
|
$ 3,331
|
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES: |
|
|
|
Dividends declared, not paid |
5
|
3,931
|
|
Purchase of prepaid insurance with assumption of note |
96
|
|
|
Reclass of deposits for property and equipment placed in service |
296
|
|
|
SUPPLEMENTAL INFORMATION - Cash paid during the period for: |
|
|
|
Income taxes |
6
|
2
|
|
Interest |
$ 295
|
$ 75
|
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v3.24.1.1.u2
ORGANIZATION AND BUSINESS
|
3 Months Ended |
Mar. 31, 2024 |
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
|
ORGANIZATION AND BUSINESS |
1. ORGANIZATION AND BUSINESS
CareCloud,
Inc., (together with its consolidated subsidiaries, “CareCloud,” the “Company,” “we,” “us”
and/or “our”) is a leading provider of technology-enabled services and solutions that redefine the healthcare revenue cycle.
We provide technology-enabled revenue cycle management and a full suite of proprietary cloud-based solutions to healthcare providers,
from small practices to enterprise medical groups, hospitals, and health systems throughout the United States. Healthcare organizations
today operate in highly complex and regulated environments. Our suite of technology-enabled solutions helps our clients increase financial
and operational performance, streamline clinical workflows, and improve the patient experience.
Our
portfolio of proprietary software and business services includes: technology-enabled business solutions that maximize revenue cycle
management and create efficiencies through platform agnostic AI-driven applications; cloud-based software that helps providers
manage their practice and patient engagement while leveraging analytics to improve provider performance; digital health services to
address value-based care and enable the delivery of remote patient care; healthcare IT professional services & staffing to
address physician burnout, staffing shortages and leverage consulting expertise to transition into the next generation of
healthcare; and, medical practice management services to assist medical providers with operating models and the tools needed to run
their practice. Our high-value business services, such as revenue cycle management, are often paired with our cloud-based software,
premiere healthcare consulting and implementation services, and on-demand workforce staffing capabilities for high-performance
medical groups and health systems nationwide.
CareCloud
has its corporate office in Somerset, New Jersey and maintains client support teams throughout the U.S., and offshore offices in Pakistan
and Azad Jammu and Kashmir, a region administered by Pakistan (the “Pakistan Offices”), and in Sri Lanka. Effective February
1, 2024, MTBC Acquisition Corp. (“MAC”) and its wholly owned subsidiary were merged into CareCloud, Inc. (“CCI”).
There was no financial or operational impact as a result of the merger.
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- DefinitionThe entire disclosure for organization, consolidation and basis of presentation of financial statements disclosure.
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v3.24.1.1.u2
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
|
3 Months Ended |
Mar. 31, 2024 |
Accounting Policies [Abstract] |
|
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES |
2. BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
The
accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles
generally accepted in the United States of America (“GAAP”) for interim financial reporting and as required by
Regulation S-X, Rule 8-03. Accordingly, they do not include all of the information and notes required by GAAP for complete financial
statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements
contain all adjustments (consisting of items of a normal and recurring nature) necessary to present fairly the Company’s
financial position as of March 31, 2024, the results of operations for the three months ended March 31, 2024 and 2023 and cash flows
for the three months ended March 31, 2024 and 2023. When preparing financial statements in conformity with GAAP, the Company must
make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and
liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period.
Actual results could differ significantly from those estimates. The condensed consolidated financial statements include the accounts
of the Company and its wholly owned subsidiaries. All intercompany balances and transactions have been eliminated in
consolidation.
The
accompanying unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the audited
consolidated financial statements for the year ended December 31, 2023, which are included in the Company’s Annual Report on
Form 10-K, filed with the SEC on March 21, 2024.
Liquidity
and Going Concern — Primarily due to a decline in revenue associated with our Healthcare IT segment and a goodwill impairment
of $42.0 million for the year ended December 31, 2023, the Company generated a net loss of $48.7 million and had a net decrease in cash
of $9.0 million. For the three months ended March 31, 2024, the Company had a net loss of $241,000. At December 31, 2023, the Company
had negative working capital of $57,000 and cash of $3.3 million. At March 31, 2024, the Company had positive working capital of $474,000
and cash of $4.1 million. Absent any other action, the Company may require additional liquidity to continue its operations over the next
12 months.
However,
management has considered its plans to continue the Company as a going concern and believes substantial doubt is alleviated by focusing
on cost-control. As discussed in Note 9, the Company approved a restructuring plan to reduce headcount and operating costs and generate
positive cash flow. In addition, the Company has suspended the dividend on the Company’s Preferred Stock, which saves approximately
$1.3 million of cash each month. The dividend will continue to accrue in arrears each month since it is cumulative, but would not be
a legal obligation until the dividend is reinstated. The dividend will not be recorded as a liability until it is declared by the Board
of Directors. The Company projects that this restructuring plan, which was implemented in 2023 and will be completed by the end of 2024,
will reduce expenses, thereby reducing ongoing liquidity needs to enable continuation of operations and compliance with the debt covenants
for the foreseeable future. Although there are no guarantees that the Company will be successful, it believes such initiatives will enable
it to continue as a going concern through at least the next twelve months.
Significant
Accounting Policies — During the three months ended March 31, 2024, there were no changes to the Company’s significant
accounting policies from its disclosures in the Annual Report on Form 10-K for the year ended December 31, 2023, filed with the SEC on
March 21, 2024.
Recent
Accounting Pronouncements — From time to time, new accounting pronouncements are issued by the Financial
Accounting Standards Board (“FASB”) and are adopted by us as of the specified effective date. Unless otherwise
discussed, we believe that the impact of recently adopted and recently issued accounting pronouncements will not have a material
impact on our condensed consolidated financial position, results of operations and cash flows.
In
June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments.
The guidance in Accounting Standards Update (“ASU”) 2016-13 replaces the incurred loss impairment methodology under current
GAAP. The new impairment model requires immediate recognition of estimated credit losses expected to occur for most financial assets
and certain other instruments. It will apply to all entities. For trade receivables, loans and held-to-maturity debt securities, entities
will be required to estimate lifetime expected credit losses. This may result in the earlier recognition of credit losses. In November
2019, the FASB issued ASU No. 2019-10, which delayed this standard’s effective date for SEC smaller reporting companies to the fiscal
years beginning on or after December 15, 2022. The Company adopted this guidance on January 1, 2023 using a modified retrospective adoption
methodology, whereby the cumulative impact of all prior periods is recorded in accumulated deficit or other impacted balance sheet items
upon adoption. The impact to the accumulated deficit as of January 1, 2023 was a charge of approximately $186,000 and a corresponding
increase to the allowance for expected credit losses.
In
March 2023, the FASB issued ASU 2023-01, Leases (Topic 842): Common Control Arrangements – Issue 2. The amendments in this
update require that leasehold improvements associated with common control leases be: (1) amortized by the lessee over the useful life
of the leasehold improvements to the common control group as long as the lessee controls the use of the underlying asset through a lease
and (2) accounted for as a transfer between entities under common control through an adjustment to equity if, and when, the lessee no
longer controls the use of the underlying asset. The amendments in this update are effective for fiscal years beginning after December
15, 2023. There was no impact on the condensed consolidated financial statements as a result of this standard.
In
October 2023, the FASB issued ASU 2023-06, Disclosure Improvements: Codification Amendments in Response to the SEC’s Disclosure
Update and Simplification Initiative. This update amends the disclosure or presentation requirements related to various subtopics
in the FASB Accounting Standards Codification (the “Codification”). The new guidance is intended to align U.S. GAAP requirements
with those of the SEC and to facilitate the application of U.S. GAAP for all entities. The effective date for each amendment will be
the date on which the SEC’s removal of that related disclosure requirement from Regulation S-X or Regulation S-K becomes effective,
with early adoption prohibited. If by June 30, 2027 the SEC has not removed the applicable requirement from Regulation S-X or Regulation
S-K, the pending content of the associated amendment will be removed from the Codification and will not become effective.
In
November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280), Improvements to Reportable Disclosures. The amendments
in this update improve segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The
amendments are effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after
December 15, 2024. Early adoption is permitted. The expected impact would only be to the financial statement disclosures.
In
December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740), Improvements to Income Tax Disclosures. The amendments in
this update enhance the transparency and decision usefulness of income tax disclosures primarily related to rate reconciliation and income
taxes paid information. The update also includes certain other amendments to improve the effectiveness of income tax disclosures. The
amendments are effective for annual periods beginning after December 15, 2024. Early adoption is permitted. The Company does not expect
this update to have a material impact on the condensed consolidated financial statements.
In
March 2024, the FASB issued ASU 2024-02, Codification Improvements – Amendments to Remove References to the Concepts Statements.
This update contains amendments to the Codification that remove references to various FASB Concepts Statements. This Codification updates
are for technical corrections such as conforming amendments, clarifications to guidance, simplifications to wording or the structure
of guidance and other minor improvements. The resulting amendments are referred to as Codification improvements. The amendments in this
update are effective for public business entities for fiscal years beginning after December 15, 2024. Early adoption is permitted. The
Company does not expect this update to have a material impact on the condensed consolidated financial statements.
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v3.24.1.1.u2
GOODWILL AND INTANGIBLE ASSETS-NET
|
3 Months Ended |
Mar. 31, 2024 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
GOODWILL AND INTANGIBLE ASSETS-NET |
3. GOODWILL AND INTANGIBLE ASSETS-NET
Goodwill
consists of the excess of the purchase price over the fair value of identifiable net assets of businesses acquired. At March 31, 2024
and December 31, 2023, approximately $90,000 of goodwill was allocated to the Medical Practice Management segment and the balance was
allocated to the Healthcare IT segment.
The
Company tests goodwill for impairment at the reporting unit level annually or more frequently if a change in circumstances or the
occurrence of events indicates that potential impairment exists. As a result of a triggering event in December 2023 resulting from
the decreased equity market value following the suspension of the Preferred Stock dividend, the Company updated its annual goodwill
impairment test that was performed as of October 31, 2023 for the Healthcare IT segment. It was determined that the fair value of
the Healthcare IT reporting unit was less than the carrying value at both October 31 and as of the date of the triggering event.
Accordingly, impairment charges of approximately $42.0 million
were recorded during the fourth quarter of 2023. The conclusion was based upon the value determined using the discounted cash flow
method as supported by the guideline company transaction method and the guideline public company method. During the three months
ended March 31, 2024, the Company determined that there was no further impact on the valuation of goodwill.
The
following is the summary of the carrying amount of goodwill for the three months ended March 31, 2024 and the year ended December 31,
2023:
SCHEDULE
OF CHANGES TO THE CARRYING AMOUNT OF GOODWILL
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning gross balance | |
$ | 19,186 | | |
$ | 61,186 | |
Impairment charges | |
| - | | |
| (42,000 | ) |
Ending gross balance | |
$ | 19,186 | | |
$ | 19,186 | |
Intangible
assets – net as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF INTANGIBLE ASSETS
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Contracts and relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 30,979 | | |
| 29,379 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other intangible assets | |
| 8,417 | | |
| 8,417 | |
Total intangible assets | |
| 88,229 | | |
| 86,629 | |
Less: Accumulated amortization | |
| 64,992 | | |
| 61,555 | |
Intangible assets - net | |
$ | 23,237 | | |
$ | 25,074 | |
Capitalized
software represents payroll and development costs incurred for internally developed software. Other intangible assets primarily represent
purchased intangibles. Amortization expense was approximately $3.4 million and $2.5 million for the three months ended March 31, 2024
and 2023, respectively. The weighted-average amortization period is three years.
As
of March 31, 2024, future amortization is scheduled to be expensed as follows:
SCHEDULE
OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 8,556 | |
2025 | |
| 8,915 | |
2026 | |
| 4,533 | |
2027 | |
| 483 | |
2028 | |
| 300 | |
Thereafter | |
| 450 | |
Total | |
$ | 23,237 | |
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v3.24.1.1.u2
NET LOSS PER COMMON SHARE
|
3 Months Ended |
Mar. 31, 2024 |
Earnings Per Share [Abstract] |
|
NET LOSS PER COMMON SHARE |
4. NET LOSS PER COMMON SHARE
The
following table reconciles the weighted-average shares outstanding for basic and diluted net loss per share for the three months ended
March 31, 2024 and 2023:
SCHEDULE
OF RECONCILIATION OF WEIGHTED-AVERAGE SHARES OUTSTANDING FOR BASIC AND DILUTED NET LOSS PER COMMON SHARE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands, except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | |
Net loss attributable to common shareholders | |
$ | (246 | ) | |
$ | (4,332 | ) |
Weighted-average common shares used to compute basic and diluted loss per share | |
| 16,014,309 | | |
| 15,421,096 | |
Net loss attributable to common shareholders per share - basic and diluted | |
$ | (0.02 | ) | |
$ | (0.28 | ) |
At
March 31, 2024, the 192,125 unvested equity restricted stock units (“RSUs”) as discussed in Note 12 have been excluded from
the above calculations as they were anti-dilutive. All of the warrants previously outstanding expired unexercised in 2023 and are excluded
from the above calculations. At March 31, 2023, the 630,094 unvested equity RSUs have been excluded from the above calculations as they
were anti-dilutive. Vested RSUs, vested restricted shares and exercised warrants have been included in the above calculations.
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v3.24.1.1.u2
ACCRUED EXPENSES AND DEBT
|
3 Months Ended |
Mar. 31, 2024 |
Accrued Expenses And Debt |
|
ACCRUED EXPENSES AND DEBT |
5. ACCRUED
EXPENSES AND DEBT
Accrued
expenses as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF ACCRUED EXPENSES
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
|
|
($ in thousands) |
|
Accrued expenses |
|
$ |
3,506 |
|
|
$ |
4,030 |
|
Payable to managed practices |
|
|
2,396 |
|
|
|
593 |
|
Taxes and other |
|
|
448 |
|
|
|
442 |
|
Total |
|
$ |
6,350 |
|
|
$ |
5,065 |
|
Bank
Debt —The Company has a revolving line of credit with Silicon Valley Bank (“SVB”). The Company’s credit facility
is a secured revolving line of credit where borrowings are based on a formula of 200%
of repeatable revenue adjusted by an annualized attrition rate as defined in the credit agreement. During February 2023, the line of
credit was increased to $25
million and the term was extended for two additional
years maturing on October 31, 2025. The financial covenants were also slightly modified for 2023 and subsequent years. Effective August
31, 2023, the credit facility agreement was amended whereby the interest rate was temporarily increased from the prime rate plus 1.50%
to the prime rate plus 2.00%
and the requirement for the minimum liquidity ratio was slightly reduced. The amendments expired March
31, 2024 and the credit facility reverted to its
previous terms.
As
of March 31, 2024 and December 31, 2023, there was $9 million and $10 million of borrowings, respectively, under the credit facility.
Interest on the revolving line of credit was charged at the prime rate plus 2.0% for the current quarter, but decreased to the prime
rate plus 1.5% on April 1, 2024. There is also a fee of one-half of 1% annually for the unused portion of the credit line. The debt is
secured by all of the Company’s domestic assets and 65% of the shares in its offshore subsidiaries. Future acquisitions are subject
to approval by SVB. At March 31, 2024, the unused borrowing base was approximately $3.6 million.
In
connection with the original SVB debt agreement, the Company paid SVB approximately $50,000 of fees upfront and issued warrants for SVB
to purchase 125,000 shares of its common stock, and committed to pay an annual anniversary fee of $50,000 a year. Based on the terms
in the original SVB credit agreement, these warrants had a strike price equal to $3.92. They had a five-year exercise window and net
exercise rights, and were valued at $3.12 per warrant. These warrants were exercised during 2022. As a result of the revision in the
credit line in the third quarter of 2018, the Company paid approximately $50,000 of fees upfront and issued an additional 28,489 warrants,
with a strike price equal to $5.26, a five-year exercise window and net exercise rights. The additional warrants were valued at $3.58
per warrant and expired in September 2023. The credit agreement contains various covenants and conditions governing the revolving line
of credit including a current annual fee of $100,000. These covenants include a minimum level of adjusted EBITDA and a minimum liquidity
ratio. At March 31, 2024 and December 31, 2023, the Company was in compliance with all covenants.
During
March 2023, SVB became a division of First Citizens Bank & Trust Company. The agreements that governed the former SVB relationship
remain in place. As a result, there was no change to the terms of the credit agreement.
The
Company maintains cash balances at SVB in excess of the FDIC insurance coverage limits. The Company performs periodic evaluations of
the relative credit standing of this financial institution to ensure its credit worthiness. As of March 31, 2024 and December 31, 2023,
the Company held cash of approximately $155,000 and $255,000, respectively, in the name of its subsidiaries at banks in Pakistan and
Sri Lanka. The banking systems in these countries do not provide deposit insurance coverage. The Company has not experienced any losses
on its cash accounts.
Vehicle
Financing Note — The Company financed a vehicle purchase in the United States. The vehicle financing note has a six year term
and was issued at current market rates.
Insurance
Financing — The Company finances certain insurance purchases over the term of the policy life. The interest rate charged is
currently 9.40%.
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v3.24.1.1.u2
LEASES
|
3 Months Ended |
Mar. 31, 2024 |
Leases [Abstract] |
|
LEASES |
6. LEASES
We
determine if an arrangement is a lease at inception. We have operating leases for office and temporary living space as well as for
some office equipment. Operating leases are included in operating lease right-of-use (“ROU”) assets, current operating
lease liability and non-current operating lease liability in our condensed consolidated balance sheets as of March 31, 2024 and
December 31, 2023. The Company does not have any finance leases.
As
most of our leases do not provide an implicit rate, we use our estimated incremental borrowing rates, which are derived from information
available at the lease commencement date, in determining the present value of lease payments. We give consideration to our bank financing
arrangements, geographical location and collateralization of assets when calculating our incremental borrowing rates. We review our incremental
borrowing rate on a quarterly basis.
Our
lease terms include options to extend the lease when we believe that we may want the right to exercise that option. Leases
with a term of less than 12 months are not recorded in the condensed consolidated balance sheets. Our lease agreements do not
contain any residual value guarantees. For real estate leases, we account for the lease and non-lease components as a single lease
component. Some leases include escalation clauses and termination options that are factored in the determination of the lease
payments when appropriate.
If
a lease is modified after the effective date, the operating lease ROU asset and liability are re-measured using the current incremental
borrowing rate. During the three months ended March 31, 2023, there was approximately $153,000 of unoccupied lease charges for two of
the Company’s facilities. There were no unoccupied lease charges for the quarter ended March 31, 2024.
During
the three months ended March 31, 2023, the Miami office lease that we assumed in connection with an acquisition ended, and we entered
into a new lease arrangement with the landlord for significantly less office space. Charges of approximately $71,000 were incurred during
the three months ended March 31, 2023 as a result of vacating the former premises. During the year ended December 31, 2022, a facility
lease was terminated in conjunction with the Company ceasing its document storage services. This termination resulted in additional costs
for the three months ended March 31, 2023 of approximately $45,000. These amounts are included in net loss on lease terminations, unoccupied
lease charges and restructuring costs in the condensed consolidated statements of operations.
Lease
expense is included in direct operating costs, general and administrative expense, selling and marketing expense and research and
development expense in the condensed consolidated statements of operations based on the nature of the expense. Our lease terms are
determined taking into account lease renewal options, the Company’s anticipated operating plans and leases that are on a
month-to-month basis. The Company also has some related party leases – see Note 8.
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Operating lease cost | |
$ | 637 | | |
$ | 801 | |
Short-term lease cost | |
| 4 | | |
| - | |
Variable lease cost | |
| 5 | | |
| 5 | |
Total - net lease cost | |
$ | 646 | | |
$ | 806 | |
Short-term
lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2024 or the beginning of the lease
was less than 12 months. Variable lease costs include utilities, real estate taxes and common area maintenance costs.
Supplemental
balance sheet information related to leases is as follows:
SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,775 | | |
$ | 1,888 | |
Non-current operating lease liabilities | |
| 2,320 | | |
| 2,516 | |
Total operating lease liabilities | |
$ | 4,095 | | |
$ | 4,404 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 4,614 | | |
$ | 6,571 | |
Asset lease expense | |
| (509 | ) | |
| (2,152 | ) |
Foreign exchange gain/(loss) | |
| 2 | | |
| (54 | ) |
ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
Operating lease right-of-use assets | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 4.5 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 13.7 | % | |
| 13.3 | % |
Operating leases, Weighted average discount rate | |
| 13.7 | % | |
| 13.3 | % |
Supplemental
cash flow and other information related to leases is as follows:
SCHEDULE
OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 668 | | |
$ | 907 | |
| |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 249 | | |
$ | 287 | |
Maturities
of lease liabilities are as follows:
SCHEDULE
OF MATURITIES OF LEASE LIABILITIES
Operating leases - Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 1,756 | |
2025 | |
| 1,350 | |
2026 | |
| 577 | |
2027 | |
| 453 | |
2028 | |
| 385 | |
Thereafter | |
| 1,429 | |
Total lease payments | |
| 5,950 | |
Less: imputed interest | |
| (1,855 | ) |
Total lease obligations | |
| 4,095 | |
Less: current obligations | |
| 1,775 | |
Long-term lease obligations | |
$ | 2,320 | |
The
Company leases certain apartments which are subleased to others. The sublease agreements are currently on a month-to-month basis and
are considered operating leases. For the three months ended March 31, 2024, the Company received sublease income of approximately $28,000.
There was no sublease income for the three months ended March 31, 2023.
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- DefinitionThe entire disclosure for operating leases of lessee. Includes, but is not limited to, description of operating lease and maturity analysis of operating lease liability.
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v3.24.1.1.u2
COMMITMENTS AND CONTINGENCIES
|
3 Months Ended |
Mar. 31, 2024 |
Commitments and Contingencies Disclosure [Abstract] |
|
COMMITMENTS AND CONTINGENCIES |
7. COMMITMENTS AND CONTINGENCIES
Legal
Proceedings — On December 22, 2023, an arbitrator rendered a decision in favor of Ramapo Anesthesiologists, PC (“Ramapo”)
and granted in part and denied in part certain claims brought against Origin Healthcare Solutions, LLC; Meridian Medical Management,
Inc.; and the Company for alleged breach of contract and other allegations. Ramapo was awarded mitigation related costs of $117,000.
The payment for such an award was made during the first quarter of 2024. The deadline for Ramapo to file a summary action in New Jersey
seeking to overturn the arbitrator’s decision was April 20, 2024. The Company’s portion of the settlement was approximately
$32,000 and the insurance company paid the balance. The Company’s portion was recorded in accrued expenses at December 31, 2023
in the condensed consolidated balance sheet.
A
former customer filed a complaint against the Company in New Jersey State Court to recover damages claimed to have been caused by
the mishandling of their account. In March 2021, the parties engaged in mediation, which did not result in a resolution of the
matter. Plaintiff alleges at least approximately $750,000
in damages which is disputed by the Company. The parties participated in a one-day court-ordered, non-binding arbitration. At that
time, the arbitrator awarded Plaintiff $288,750
on its contract claims, and awarded the Company $21,698
on its cross-claim for unpaid fees. Plaintiff filed to reject this award. The Company previously filed a partial motion for summary
judgment on the alleged punitive damages, but the court denied that motion finding there is an issue of fact as to whether those can
be awarded at trial. The Company filed an offer of judgment for $200,000
during April 2024 in advance of the trial that was scheduled for April 2024. Plaintiff indicated that they are willing to accept that amount set forth in the
offer of judgment. We are working with plaintiff to finalize the documents in anticipation of a likely final resolution of the
matter.
From
time to time, we may become involved in other legal proceedings arising in the ordinary course of our business. We are not presently
a party to any legal proceedings that, in the opinion of our management, would individually or taken together have a material adverse
effect on our business, consolidated results of operations, financial position or cash flows of the Company.
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- DefinitionThe entire disclosure for commitments and contingencies.
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v3.24.1.1.u2
Related PARTIES
|
3 Months Ended |
Mar. 31, 2024 |
Related Party Transactions [Abstract] |
|
Related PARTIES |
8. Related PARTIES
The
Company had sales to a related party, a physician who is the wife of the Executive Chairman. Revenues from this customer were approximately
$24,000 and $19,000 for the three months ended March 31, 2024 and 2023, respectively. As of both March 31, 2024 and December 31, 2023,
the accounts receivable balance due from this customer was approximately $8,000 and $18,000, respectively, and is included in accounts
receivable - net in the condensed consolidated balance sheets.
The
Company leases its corporate office in New Jersey, temporary housing for its foreign visitors, a storage facility, its backup
operations center in Bagh, Pakistan and an apartment for temporary housing in Dubai, the UAE, from the Executive Chairman. The
related party rent expense was approximately $70,000
and $51,000
for the three months ended March 31, 2024 and 2023, respectively, and is included in direct operating costs, general and
administrative expense, selling and marketing expense and research and development expense in the condensed consolidated statements
of operations. During the three months ended March 31, 2024 and 2023, the Company spent approximately $227,000
and $502,000,
respectively, to upgrade the related party leased facilities. During the year ended December 31, 2023, the Company temporarily
advanced the Executive Chairman approximately $330,000
to purchase vacant land surrounding the Bagh facility for the sole use and benefit of the Company in order to expedite the purchase
on the Company’s behalf as only individuals with citizenship in Kashmir are allowed to purchase land in this region. All
advanced amounts were repaid shortly after the advance was made. Current assets-related party in the condensed consolidated balance
sheets includes security deposits related to the leases of the Company’s corporate offices in the amount of approximately
$16,000
as of both March 31, 2024 and December 31, 2023. The Company also leases two facilities used for temporary housing from a management
employee for approximately $6,200
per month.
Included
in the ROU asset at March 31, 2024 is approximately $303,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at March 31, 2024 is approximately $164,000 and $133,000, respectively, applicable to the related party leases.
Included
in the ROU asset at December 31, 2023 is approximately $331,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at December 31, 2023 is approximately $182,000 and $142,000, respectively, applicable to the related party
leases.
During
June 2022, the Company entered into a one-year consulting agreement with an entity owned and controlled by one of its former
non-independent directors whereby that director received 10,000
shares of the Company’s 8.75%
Series B Cumulative Redeemable Perpetual Preferred Stock (“Series B Preferred Stock”) in exchange for assisting the
Company to identify and acquire additional companies, including performing due diligence. In addition, the Company may make
additional payments under the agreement for any successful acquisitions by the Company based on the purchase price of the
transaction. No such additional payments were made in 2022. During February 2023, the agreement was amended and extended through
December 2024 whereby the former director received 14,000
shares of Series B Preferred Stock in February 2023 and received an additional 14,000
shares in January 2024. All of the payments made were capitalized and are being amortized over the service period. The amortization
is recorded as stock compensation in general and administrative expense in the condensed consolidated statement of operations. All
such shares of the Series B Preferred Stock are issued in accordance with the Company’s Amended and Restated 2014 Equity
Incentive Plan. In addition to the extension of the consulting agreement, the amendment provides that any transaction fees due will
be offset against the last two above payments before any amounts are due to that former director. There were no transaction fees
through March 31, 2024. Effective February 1, 2024, the Company added an additional Statement of Work (“SOW”) to the
consulting agreement with the same entity. As compensation for the SOW, the entity will receive $25,000
per month. The SOW is cancellable with ten days’ notice. The consulting agreement and SOW, through mutual consent, were
terminated as of April 30, 2024. Effective May 1, 2024, the former non-independent director became President of the
Company.
Effective
January 9, 2024, and as amended February 12, 2024, the Company entered into a consulting agreement with an entity owned and controlled
by a member of its Board of Directors to provide investor relations services for $8,000 per month and other services as requested by
the Company to be paid on an hourly basis. The consulting agreement is cancelable with ten days’ notice.
During
2020, a New Jersey corporation, talkMD Clinicians, PA (“talkMD”), was formed by the wife of the Executive Chairman, who is
a licensed physician, to provide telehealth services. talkMD was determined to be a variable interest entity (“VIE”) for
financial reporting purposes because the entity will be controlled by the Company. As of March 31, 2024, talkMD had not yet commenced
operations. Cumulatively, the Company has paid approximately $5,500 on behalf of talkMD for income taxes.
|
X |
- DefinitionThe entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.
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v3.24.1.1.u2
RESTRUCTURING COSTS
|
3 Months Ended |
Mar. 31, 2024 |
Restructuring and Related Activities [Abstract] |
|
RESTRUCTURING COSTS |
9. RESTRUCTURING COSTS
On
October 2, 2023, the Company committed to effectively align resources with business priorities and improve profitability through a reduction
in the workforce for the Healthcare IT segment. The Company identified opportunities for improvements in its workforce realignment, strategy
and staffing, and increased its focus on performance management, to ensure it has the right skillsets and number of employees to execute
its long-term vision. In addition, the Company instituted certain other expense reductions.
A
majority of the impacted employees exited in the fourth quarter of 2023. The Company estimates that it will incur expenses of approximately
$1.3 million related to the reduction in workforce of which approximately $645,000 was incurred in 2023, $322,000 was incurred during
the three months ended March 31, 2024 with the remaining expenses to be incurred during the remainder of 2024. These restructuring expenses
consisted of one-time termination benefits, including, but not limited to, severance payments and healthcare benefits. Also as previously
noted, the dividends on the Preferred Stock have been suspended in order to increase cash flow.
The
expense associated with the restructuring is included in net loss on lease terminations, unoccupied lease charges and restructuring
cost in the condensed consolidated statement of operations for the three months ended March 31, 2024. This line also includes net
loss on lease terminations and unoccupied lease charges. The liabilities associated with restructuring costs are included in accrued
expenses and other current liabilities in the March 31, 2024 and December 31, 2023 condensed consolidated balance sheets. The
following table summarizes activity related to liabilities associated with restructuring costs:
SCHEDULE OF LIABILITIES ASSOCIATED WITH RESTRUCTURING COSTS
| |
Severance and separation costs | | |
Equity awards acceleration costs | | |
Other exit related costs | | |
Total restructuring and other costs | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Additions | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Payments and other adjustments | |
| (202 | ) | |
| - | | |
| (26 | ) | |
| (228 | ) |
Balance as of March 31, 2024 | |
$ | 265 | | |
$ | - | | |
$ | - | | |
$ | 265 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Beginning balance | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Additions | |
| 439 | | |
| 170 | | |
| 36 | | |
| 645 | |
Payments and other adjustments | |
| (294 | ) | |
| (170 | ) | |
| (10 | ) | |
| (474 | ) |
Balance as of December 31, 2023 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Ending balance | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
|
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v3.24.1.1.u2
SHAREHOLDERS’ EQUITY
|
3 Months Ended |
Mar. 31, 2024 |
Equity [Abstract] |
|
SHAREHOLDERS’ EQUITY |
10. SHAREHOLDERS’ EQUITY
The
Company had the right to sell up to $35 million of its Series B Preferred Stock using its preferred stock at-the-market facility (“ATM”).
This right terminated when the Company suspended the Preferred Stock dividends in December 2023. The Company also had the right to sell
up to $50 million of its common stock using a common stock ATM facility. This right also terminated when the Company suspended the Preferred
Stock dividends. The underwriters of the ATMs receive 3% of the gross proceeds actually received.
On
December 11, 2023, the Board of Directors suspended the monthly cash dividends for Series A Preferred Stock and Series B Preferred Stock
beginning with the payment scheduled for December 15, 2023 together with the remaining dividends that were declared. The suspension of
these dividends will defer approximately $1.3 million in cash dividend payments each month. During this suspension, dividends will continue
to accrue in arrears on the Series A and Series B Preferred Stock. The Board of Directors will regularly review and consider when the
suspension should be lifted.
During
the quarter ended March 31, 2024, no dividends were declared by the Board of Directors. At March 31, 2024, the Company owed
approximately $5.4
million for dividends that had previously been declared through February 2024 (but whose payment has been suspended), and also had
total undeclared dividends of approximately $1.3
million, which represents the accrued (but undeclared) dividends due to preferred shareholders of record on March 31, 2024.
Dividends in arrears that have not been declared by the Board of Directors are not recorded in the condensed consolidated balance
sheets.
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v3.24.1.1.u2
REVENUE
|
3 Months Ended |
Mar. 31, 2024 |
Revenue from Contract with Customer [Abstract] |
|
REVENUE |
11. REVENUE
Introduction
The
Company accounts for revenue in accordance with ASC 606, Revenue from Contracts with Customers. All revenue is recognized as our
performance obligations are satisfied. A performance obligation is a promise in a contract to transfer a distinct good or service to
a customer, and is the unit of account under ASC 606. The Company recognizes revenue when the revenue cycle management services begin
on the medical billing claims, which is generally upon receipt of the claim from the provider. For many services, the Company recognizes
revenue as a percentage of the amount the customer collects on the medical billing claims. The Company’s software is utilized at
the time the provider sees the patient, and the Company estimates the value of the consideration it will earn over the remaining contractual
period as our services are provided and recognizes the fees over the term; this estimation involves predicting the amounts our clients
will ultimately collect associated with the services they provided. Certain significant estimates, such as payment-to-charge ratios,
effective billing rates and the estimated contractual payment periods are required to measure revenue cycle management revenue under
the standard.
Most
of our current contracts with customers contain a single performance obligation. For contracts where we provide multiple services, such
as where we perform multiple ancillary services, each service represents its own performance obligation. The standalone selling prices
are based on the contractual price for the service.
We
apply the portfolio approach as permitted by ASC 606 as a practical expedient to contracts with similar characteristics and we use estimates
and assumptions when accounting for those portfolios. Our contracts generally include standard commercial payment terms. We have no significant
obligations for refunds, warranties or similar obligations and our revenue does not include taxes collected from our customers.
Disaggregation
of Revenue from Contracts with Customers
We
derive revenue from five primary sources: (1) technology-enabled business solutions, (2) professional services, (3) printing and mailing
services, (4) group purchasing services and (5) medical practice management services.
The
following table represents a disaggregation of revenue for the three months ended March 31, 2024 and 2023:
SCHEDULE OF DISAGGREGATION OF REVENUE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 17,283 | | |
$ | 19,495 | |
Professional services | |
| 4,422 | | |
| 6,560 | |
Printing and mailing services | |
| 861 | | |
| 713 | |
Group purchasing services | |
| 155 | | |
| 186 | |
Medical Practice Management: | |
| | | |
| | |
Medical practice management services | |
| 3,241 | | |
| 3,047 | |
Total | |
$ | 25,962 | | |
$ | 30,001 | |
Revenue | |
$ | 25,962 | | |
$ | 30,001 | |
Technology-enabled
business solutions:
Revenue
derived on an on-going basis from our technology-enabled solutions, which typically include revenue cycle management services, is billed
as a percentage of payments collected by our customers. The fee for our services often includes the ability to use our electronic health
records (“EHR”) and practice management software as well as revenue cycle management (“RCM”) as part of the bundled
fee. The Software-as-a-Service (“SaaS”) component is not a material portion of the contract compared to the stand-alone value
of RCM.
Technology-assisted
revenue cycle management services are the recurring process of submitting and following up on claims with health insurance companies
in order for the healthcare providers to receive payment for the services they rendered. The Company typically invoices customers on
a monthly basis based on the actual collections received by its customers and the agreed-upon rate in the sales contract. The fee for
these services typically includes use of practice management software and related tools (on a SaaS basis), electronic health records
(on a SaaS basis), medical billing services and use of mobile health solutions. We consider the services to be one performance obligation
since the promises are not distinct in the context of the contract. The performance obligation consists of a series of distinct services
that are substantially the same and have the same periodic pattern of transfer to our customers.
In
many cases, our clients may terminate their agreements with 90 days’ notice without cause, thereby limiting the term in which we
have enforceable rights and obligations, although this time period can vary between clients. Our payment terms are normally net 30 days.
Although our contracts typically have stated terms of one or more years, under ASC 606 our contracts are considered month-to-month and
accordingly, there is no financing component.
For
the majority of our revenue cycle management contracts, the total transaction price is variable because our obligation is to process
an unknown quantity of claims, as and when requested by our customers over the contract period. When a contract includes variable consideration,
we evaluate the estimate of the variable consideration to determine whether the estimate needs to be constrained; therefore, we include
variable consideration in the transaction price only to the extent that it is probable that a significant reversal of the amount of cumulative
revenue recognized will not occur when the uncertainty associated with variable consideration is subsequently resolved. Estimates to
determine variable consideration such as payment-to-charge ratios, effective billing rates, and the estimated contractual payment periods
are updated at each reporting date. Revenue is recognized over the performance period using the input method.
Our
proprietary, cloud-based practice management application automates the labor-intensive workflow of a medical office in a unified and
streamlined SaaS platform. The Company has a large number of clients who utilize the Company’s practice management software, electronic
health records software, patient experience management solutions, business intelligence software and/or robotic process automation software
on a SaaS basis, but who do not utilize the Company’s revenue cycle management services. SaaS fees may be fixed based on the number
of providers, or may be variable.
Our
digital health services, which began generating revenue in 2022, include chronic care management, where a care manager has remote visits
with patients with one or more chronic conditions under the supervision of a physician who is our client. The performance obligation
for chronic care management is satisfied at a point in time once the patient receives the remote visit. The digital health services also
include remote patient monitoring where our system monitors recordings from FDA approved internet connected devices. These devices record
patient trends and alert the physician to changes which might trigger the need for additional follow-up visits. The performance obligations
for remote patient monitoring are satisfied over time as the recordings are received and the patient receives the remote visit. The revenue
for chronic care management for the three months ended March 31, 2024 and 2023, was approximately $440,000 and $135,000, respectively.
The revenue for remote patient monitoring for the three months ended March 31, 2024 and 2023 was approximately $140,000 and $11,000,
respectively.
The
medical billing clearinghouse service takes claim information from customers, checks the claims for errors and sends this information
electronically to insurance companies. The Company invoices customers on a monthly basis based on the number of claims submitted and
the agreed-upon rate in the agreement. This service is provided to medical practices and providers to medical practices who are not revenue
cycle management customers. The performance obligation is satisfied once the relevant submissions are completed.
Additional
services such as coding and transcription are rendered in connection with the delivery of revenue cycle management and related medical
services. The Company invoices customers monthly, based on the actual amount of services performed at the agreed-upon rate in the contract.
These services are only offered to revenue cycle management customers. These services do not represent a material right because the services
are optional to the customer and customers electing these services are charged the same price for those services as if they were on a
standalone basis. Each individual coding or transcription transaction processed represents a performance obligation, which is satisfied
over time as that individual service is rendered.
Professional
services:
Our
professional services include an extensive set of services including EHR vendor-agnostic optimization and activation, project management,
IT transformation consulting, process improvement, training, education and staffing for large healthcare organizations including health
systems and hospitals. The performance obligation is satisfied over time using the input method. The revenue is recorded on a monthly
basis as the professional services are rendered. Unbilled revenue at March 31, 2024 and 2023 was approximately $47,000
and $100,000,
respectively.
Printing
and mailing services:
The
Company provides printing and mailing services for both revenue cycle management customers and a non-revenue cycle management customer,
and invoices on a monthly basis based on the number of prints, the agreed-upon rate per print and the postage incurred. The performance
obligation is satisfied once the printing and mailing is completed.
Group
purchasing services:
The
Company provides group purchasing services which enable medical providers to purchase various vaccines directly from selected pharmaceutical
companies at a discounted price. Currently, there are approximately 4,000 medical providers who are members of the program. Revenue is
recognized as the vaccine shipments are made to the medical providers. Fees from the pharmaceutical companies are paid either quarterly
or annually and the Company adjusts its revenue accrual at the time of payment. The Company makes significant judgments regarding the
variable consideration which we expect to be entitled to for the group purchasing services which includes the anticipated shipments to
the members enrolled in the program, anticipated volumes of purchases made by the members, and the changes in the number of members.
The amounts recorded are constrained by estimates of decreases in shipments and loss of members to avoid a significant revenue reversal
in the subsequent period. The only performance obligation is to provide the pharmaceutical companies with the medical providers who want
to become members in order to purchase vaccines. The performance obligation is satisfied once the medical provider agrees to purchase
a specific quantity of vaccines and the medical provider’s information is forwarded to the vaccine suppliers. The Company records
a contract asset for revenue earned and not paid as the ultimate payment is conditioned on achieving certain volume thresholds.
For
all of the above revenue streams other than group purchasing services and chronic care management, revenue is recognized over time, which
is typically one month or less, which closely matches the point in time that the customer simultaneously receives and consumes the benefits
provided by the Company. For the group purchasing services, revenue is recognized at a point in time. Each service is substantially the
same and has the same periodic pattern of transfer to the customer. Each of the services provided above is considered a separate performance
obligation.
There
were no unsatisfied performance obligations for contracts with an original duration greater than one year. The Company has elected to
utilize the practical expedient available with the guidance for contracts with an expected duration of one year or less.
Medical
practice management services:
The
Company also provides medical practice management services under long-term management service agreements to three medical practices.
We provide the medical practices with the nurses, administrative support, facilities, supplies, equipment, marketing, RCM,
accounting, and other non-clinical services needed to efficiently operate their practices. Revenue is recognized as the services are
provided to the medical practices. Revenue recorded in the condensed consolidated statements of operations represents the
reimbursement of costs paid by the Company for the practices and the management fee earned each month for managing the practice. The
management fee is based on either a fixed fee or a percentage of the net operating income.
The
Company assumes all financial risk for the performance of the managed medical practices. Revenue is impacted by the amount of the costs
incurred by the practices and their operating income. The gross billing of the practices is impacted by billing rates, changes in current
procedural terminology code reimbursement and collection trends which in turn impacts the management fee that the Company is entitled
to. Billing rates are reviewed at least annually and adjusted based on current insurer reimbursement practices. The performance obligation
is satisfied as the management services are provided.
Our
contracts for medical practice management services have approximately an additional 15 years remaining and are only cancellable
under very limited circumstances. The Company receives a management fee each month for managing the day-to-day business operations
of each medical group as a fixed fee or a percentage payment of the net operating income which is included in revenue in the
condensed consolidated statements of operations.
Our
medical practice management services obligations consist of a series of distinct services that are substantially the same and have the
same periodic pattern of transfer to our customers. Revenue is recognized over time, however for reporting and convenience purposes,
the management fee is computed at each month-end.
Information
about contract balances:
As
of March 31, 2024, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management performance
obligations outstanding was approximately $5.2
million. We expect to recognize substantially
all of the revenue for the remaining performance obligations over the next three months. Approximately $264,000
of the contract asset represents revenue earned,
not paid, from the group purchasing services.
Amounts
that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end
of each month when the services have been provided. The contract asset includes our right to payment for services already transferred
to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue
cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives
payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group
purchasing services.
Changes
in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle
management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional
and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced
when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. The opening and closing balances
of the Company’s accounts receivable, contract asset and deferred revenue are as follows:
SCHEDULE OF CHANGES IN ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE
| |
Accounts Receivable - Net | | |
Contract Asset | | |
Deferred Revenue (current) | | |
Deferred Revenue (long term) | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 11,888 | | |
$ | 5,094 | | |
$ | 1,380 | | |
$ | 256 | |
Increase, net | |
| 74 | | |
| 361 | | |
| 6 | | |
| 52 | |
Balance as of March 31, 2024 | |
$ | 11,962 | | |
$ | 5,455 | | |
$ | 1,386 | | |
$ | 308 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (127 | ) | |
| 619 | | |
| 8 | | |
| 8 | |
Balance as of March 31, 2023 | |
$ | 14,646 | | |
$ | 5,018 | | |
$ | 1,394 | | |
$ | 350 | |
Deferred
commissions:
Our
sales incentive plans include commissions payable to employees and third parties at the time of initial contract execution that are
capitalized as incremental costs to obtain a contract. The capitalized commissions are amortized over the period the related
services are transferred. As we do not offer commissions on contract renewals, we have determined the amortization period to be the
estimated client life, which is three years. Deferred commissions were approximately $488,000 and
$580,000 at
March 31, 2024 and 2023, respectively, and are included in the other assets amounts in the condensed consolidated balance sheets.
The amortization of deferred sales commissions during the three months ended March 31, 2024 and 2023 was approximately $90,000 and
$167,000,
respectively.
Trade
Accounts Receivable – Estimate of Credit Losses:
ASU
2016-13 requires the recognition of lifetime estimated credit losses expected to occur for trade accounts receivable. The guidance also
requires we pool assets with similar risk characteristics and consider current economic conditions when estimating losses. The adoption
of the ASU 2016-13 for trade accounts receivable was recorded as a charge to accumulated deficit of approximately $186,000
as of January 1, 2023.
At
adoption, we segmented the accounts receivable population into pools based on their risk assessment. Risks related to trade accounts
receivable are a customer’s inability to pay or bankruptcy. Each pool was defined by their internal credit assessment and business
size. The pools are aligned with management’s review of financial performance. For the three months ended March 31, 2024 and 2023,
no adjustment to the pools was necessary.
We
utilize a loss-rate method to measure the expected credit loss for each pool. The loss rate is calculated using a three-year lookback
period of write-offs and adjustments, divided by the revenue for each pool by aging category, net of customer payments during that period.
We consider current and future economic conditions, internal forecasts, customer collection experience and credit memos issued during
the current period when assessing loss rates. We reviewed these factors and concluded that no adjustments should be made to the historical
loss rate data for the current quarter. In addition, the Company uses specific account identification in determining the total allowance
for expected credit losses. Trade receivables are written off only after the Company has exhausted all collection efforts.
Changes
in the allowance for expected credit losses for trade accounts receivable are presented in the table below:
SCHEDULE OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 879 | | |
$ | 823 | |
Adoption of ASC 326 | |
| - | | |
| 186 | |
Provision | |
| 37 | | |
| 454 | |
Recoveries/adjustments | |
| 1 | | |
| 107 | |
Write-offs | |
| - | | |
| (691 | ) |
Ending balance | |
$ | 917 | | |
$ | 879 | |
|
X |
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- DefinitionThe entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.
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v3.24.1.1.u2
STOCK-BASED COMPENSATION
|
3 Months Ended |
Mar. 31, 2024 |
Share-Based Payment Arrangement [Abstract] |
|
STOCK-BASED COMPENSATION |
12. STOCK-BASED COMPENSATION
As
of March 31, 2024, 710,694
shares of common stock and 28,000
shares of Series B Preferred Stock are available
for grant. Permissible awards include incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock,
RSUs, performance stock and cash-settled awards and other stock-based awards in the discretion of the Compensation Committee of the Board
of Directors including unrestricted stock grants.
Certain
equity-based RSU agreements contain a provision in which the units shall immediately vest and become converted into common shares at
the rate of one share per RSU, immediately after a change in control, as defined in the award agreement.
Common
and preferred stock RSUs
In
February 2023, the Compensation Committee approved executive bonuses to be paid in shares of Series B Preferred Stock, with the
number of shares and the amount based on specified criteria being achieved during the year 2023. During October, the Compensation
Committee approved the issuance 10,000
of the above shares to one of the executives who retired. The remaining 24,000
shares were forfeited in 2024.
In
March 2024, the Compensation Committee approved executive bonuses to be paid in shares of Series B Preferred Stock with the number
of shares and the amount based on specified criteria being achieved during the year 2024. There were 34,000
shares awarded. These criteria will be evaluated in early 2025. For the three months ended March 31, 2024, a net benefit of
approximately $708,000
was recorded primarily related to prior year bonuses that had been accrued but were not awarded. Stock compensation expense recorded
is based on the value of the shares at the grant date and recognized over the service period. The portion of the stock compensation
expense to be used for the payment of withholding and payroll taxes is included in accrued compensation in the condensed
consolidated balance sheets. The balance of the stock compensation expense has been recorded as additional paid-in
capital.
The
following table summarizes the RSU transactions related to the common and preferred stock under the A&R Plan for the three months
ended March 31, 2024 and 2023:
DISCLOSURE
OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD
| |
Common Stock | | |
Series A Preferred Stock | | |
Series B Preferred Stock | |
Outstanding and unvested shares at January 1, 2024 | |
| 753,495 | | |
| - | | |
| 57,199 | |
Granted | |
| - | | |
| - | | |
| 34,000 | |
Vested | |
| (326,501 | ) | |
| - | | |
| (14,000 | ) |
Forfeited | |
| (217,115 | ) | |
| - | | |
| (24,000 | ) |
Outstanding and unvested shares at March 31, 2024 | |
| 209,879 | | |
| - | | |
| 53,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 546,851 | | |
| - | | |
| 62,000 | |
Vested | |
| (498,660 | ) | |
| - | | |
| (57,263 | ) |
Forfeited | |
| (19,975 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at March 31, 2023 | |
| 673,691 | | |
| - | | |
| 85,199 | |
The
liability for the 17,754
cash-settled awards and the liability for withheld taxes in connection with the equity awards was approximately $80,000
and $767,000
at March 31, 2024 and December 31, 2023, respectively, and is included in accrued compensation in the condensed consolidated balance
sheets. No amounts were paid in connection with cash-settled awards during both the three months ended March 31, 2024 and
2023.
Stock-based
compensation expense
The
following table summarizes the components of share-based compensation (benefit) expense for the three months ended March 31, 2024 and
2023:
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | (45 | ) | |
$ | 88 | |
General and administrative | |
| (696 | ) | |
| 605 | |
Research and development | |
| 54 | | |
| 37 | |
Selling and marketing | |
| (21 | ) | |
| 342 | |
Total stock-based compensation (benefit) expense | |
$ | (708 | ) | |
$ | 1,072 | |
|
X |
- DefinitionThe entire disclosure for share-based payment arrangement.
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v3.24.1.1.u2
INCOME TAXES
|
3 Months Ended |
Mar. 31, 2024 |
Income Tax Disclosure [Abstract] |
|
INCOME TAXES |
13. INCOME TAXES
The
income tax expense for the three months ended March 31, 2024 was approximately $39,000 comprised of current state tax expense of $30,000
and foreign tax expense of $9,000. There was no deferred income tax recorded. The income tax expense for the three months ended March
31, 2023 was approximately $65,000 comprised of a current state tax expense of $39,000 and a deferred tax expense of $26,000.
The
current income tax provision for the three months ended March 31, 2024 and 2023 primarily relates to state minimum taxes and foreign
income taxes. The deferred tax provision for the three months ended March 31, 2023 relates to the book and tax difference of amortization
on indefinite-lived intangibles, primarily goodwill. To the extent allowable, prior to January 1, 2024, the federal and state deferred
tax provision had been offset by the indefinite life net operating loss. As a result of the goodwill impairment charge recorded for the
year ended December 31, 2023, no deferred tax liability is required.
The
Company has incurred cumulative losses, which make realization of a deferred tax asset difficult to support in accordance with ASC 740.
Accordingly, a valuation allowance has been recorded against the federal and state deferred tax assets as of March 31, 2024 and December
31, 2023.
|
X |
- DefinitionThe entire disclosure for income tax.
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v3.24.1.1.u2
SEGMENT REPORTING
|
3 Months Ended |
Mar. 31, 2024 |
Segment Reporting [Abstract] |
|
SEGMENT REPORTING |
14. SEGMENT REPORTING
The
Company’s Chief Executive Officer and Executive Chairman jointly serve as the Chief Operating Decision Maker (“CODM”),
organize the Company, manage resource allocations and measure performance among two operating and reportable segments: (i) Healthcare
IT and (ii) Medical Practice Management.
The
Healthcare IT segment includes revenue cycle management, SaaS solutions and other services. The Medical Practice Management segment includes
the management of three medical practices. Each segment is considered a reporting unit. The CODM evaluates the financial performance
of the business units on the basis of revenue and direct operating costs excluding unallocated amounts that are mainly corporate overhead
costs. Our CODM does not evaluate operating segments using asset or liability information. The accounting policies of the segments are
the same as those disclosed in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 filed with the SEC
on March 21, 2024. The following table presents revenues, operating expenses and operating income (loss) by reportable segment:
SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2024 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 22,721 | | |
$ | 3,241 | | |
$ | - | | |
$ | 25,962 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 12,544 | | |
| 2,633 | | |
| - | | |
| 15,177 | |
Selling and marketing | |
| 1,760 | | |
| 10 | | |
| - | | |
| 1,770 | |
General and administrative | |
| 2,581 | | |
| 434 | | |
| 706 | | |
| 3,721 | |
Research and development | |
| 913 | | |
| - | | |
| - | | |
| 913 | |
Depreciation and amortization | |
| 3,845 | | |
| 85 | | |
| - | | |
| 3,930 | |
Loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Total operating expenses | |
| 21,965 | | |
| 3,162 | | |
| 706 | | |
| 25,833 | |
Operating income (loss) | |
$ | 756 | | |
$ | 79 | | |
$ | (706 | ) | |
$ | 129 | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 26,954 | | |
$ | 3,047 | | |
$ | - | | |
$ | 30,001 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,693 | | |
| 2,414 | | |
| - | | |
| 18,107 | |
Selling and marketing | |
| 2,604 | | |
| 8 | | |
| - | | |
| 2,612 | |
General and administrative | |
| 2,496 | | |
| 448 | | |
| 2,176 | | |
| 5,120 | |
Research and development | |
| 1,078 | | |
| - | | |
| - | | |
| 1,078 | |
Depreciation and amortization | |
| 2,949 | | |
| 89 | | |
| - | | |
| 3,038 | |
Net loss on lease terminations and unoccupied lease charges | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Total operating expenses | |
| 25,089 | | |
| 2,959 | | |
| 2,176 | | |
| 30,224 | |
Operating income (loss) | |
$ | 1,865 | | |
$ | 88 | | |
$ | (2,176 | ) | |
$ | (223 | ) |
|
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v3.24.1.1.u2
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
|
3 Months Ended |
Mar. 31, 2024 |
Accounting Policies [Abstract] |
|
Recent Accounting Pronouncements |
Recent
Accounting Pronouncements — From time to time, new accounting pronouncements are issued by the Financial
Accounting Standards Board (“FASB”) and are adopted by us as of the specified effective date. Unless otherwise
discussed, we believe that the impact of recently adopted and recently issued accounting pronouncements will not have a material
impact on our condensed consolidated financial position, results of operations and cash flows.
In
June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments.
The guidance in Accounting Standards Update (“ASU”) 2016-13 replaces the incurred loss impairment methodology under current
GAAP. The new impairment model requires immediate recognition of estimated credit losses expected to occur for most financial assets
and certain other instruments. It will apply to all entities. For trade receivables, loans and held-to-maturity debt securities, entities
will be required to estimate lifetime expected credit losses. This may result in the earlier recognition of credit losses. In November
2019, the FASB issued ASU No. 2019-10, which delayed this standard’s effective date for SEC smaller reporting companies to the fiscal
years beginning on or after December 15, 2022. The Company adopted this guidance on January 1, 2023 using a modified retrospective adoption
methodology, whereby the cumulative impact of all prior periods is recorded in accumulated deficit or other impacted balance sheet items
upon adoption. The impact to the accumulated deficit as of January 1, 2023 was a charge of approximately $186,000 and a corresponding
increase to the allowance for expected credit losses.
In
March 2023, the FASB issued ASU 2023-01, Leases (Topic 842): Common Control Arrangements – Issue 2. The amendments in this
update require that leasehold improvements associated with common control leases be: (1) amortized by the lessee over the useful life
of the leasehold improvements to the common control group as long as the lessee controls the use of the underlying asset through a lease
and (2) accounted for as a transfer between entities under common control through an adjustment to equity if, and when, the lessee no
longer controls the use of the underlying asset. The amendments in this update are effective for fiscal years beginning after December
15, 2023. There was no impact on the condensed consolidated financial statements as a result of this standard.
In
October 2023, the FASB issued ASU 2023-06, Disclosure Improvements: Codification Amendments in Response to the SEC’s Disclosure
Update and Simplification Initiative. This update amends the disclosure or presentation requirements related to various subtopics
in the FASB Accounting Standards Codification (the “Codification”). The new guidance is intended to align U.S. GAAP requirements
with those of the SEC and to facilitate the application of U.S. GAAP for all entities. The effective date for each amendment will be
the date on which the SEC’s removal of that related disclosure requirement from Regulation S-X or Regulation S-K becomes effective,
with early adoption prohibited. If by June 30, 2027 the SEC has not removed the applicable requirement from Regulation S-X or Regulation
S-K, the pending content of the associated amendment will be removed from the Codification and will not become effective.
In
November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280), Improvements to Reportable Disclosures. The amendments
in this update improve segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. The
amendments are effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after
December 15, 2024. Early adoption is permitted. The expected impact would only be to the financial statement disclosures.
In
December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740), Improvements to Income Tax Disclosures. The amendments in
this update enhance the transparency and decision usefulness of income tax disclosures primarily related to rate reconciliation and income
taxes paid information. The update also includes certain other amendments to improve the effectiveness of income tax disclosures. The
amendments are effective for annual periods beginning after December 15, 2024. Early adoption is permitted. The Company does not expect
this update to have a material impact on the condensed consolidated financial statements.
In
March 2024, the FASB issued ASU 2024-02, Codification Improvements – Amendments to Remove References to the Concepts Statements.
This update contains amendments to the Codification that remove references to various FASB Concepts Statements. This Codification updates
are for technical corrections such as conforming amendments, clarifications to guidance, simplifications to wording or the structure
of guidance and other minor improvements. The resulting amendments are referred to as Codification improvements. The amendments in this
update are effective for public business entities for fiscal years beginning after December 15, 2024. Early adoption is permitted. The
Company does not expect this update to have a material impact on the condensed consolidated financial statements.
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v3.24.1.1.u2
GOODWILL AND INTANGIBLE ASSETS-NET (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
SCHEDULE OF CHANGES TO THE CARRYING AMOUNT OF GOODWILL |
The
following is the summary of the carrying amount of goodwill for the three months ended March 31, 2024 and the year ended December 31,
2023:
SCHEDULE
OF CHANGES TO THE CARRYING AMOUNT OF GOODWILL
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning gross balance | |
$ | 19,186 | | |
$ | 61,186 | |
Impairment charges | |
| - | | |
| (42,000 | ) |
Ending gross balance | |
$ | 19,186 | | |
$ | 19,186 | |
|
SCHEDULE OF INTANGIBLE ASSETS |
Intangible
assets – net as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF INTANGIBLE ASSETS
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Contracts and relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 30,979 | | |
| 29,379 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other intangible assets | |
| 8,417 | | |
| 8,417 | |
Total intangible assets | |
| 88,229 | | |
| 86,629 | |
Less: Accumulated amortization | |
| 64,992 | | |
| 61,555 | |
Intangible assets - net | |
$ | 23,237 | | |
$ | 25,074 | |
|
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE |
As
of March 31, 2024, future amortization is scheduled to be expensed as follows:
SCHEDULE
OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 8,556 | |
2025 | |
| 8,915 | |
2026 | |
| 4,533 | |
2027 | |
| 483 | |
2028 | |
| 300 | |
Thereafter | |
| 450 | |
Total | |
$ | 23,237 | |
|
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v3.24.1.1.u2
NET LOSS PER COMMON SHARE (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Earnings Per Share [Abstract] |
|
SCHEDULE OF RECONCILIATION OF WEIGHTED-AVERAGE SHARES OUTSTANDING FOR BASIC AND DILUTED NET LOSS PER COMMON SHARE |
The
following table reconciles the weighted-average shares outstanding for basic and diluted net loss per share for the three months ended
March 31, 2024 and 2023:
SCHEDULE
OF RECONCILIATION OF WEIGHTED-AVERAGE SHARES OUTSTANDING FOR BASIC AND DILUTED NET LOSS PER COMMON SHARE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands, except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | |
Net loss attributable to common shareholders | |
$ | (246 | ) | |
$ | (4,332 | ) |
Weighted-average common shares used to compute basic and diluted loss per share | |
| 16,014,309 | | |
| 15,421,096 | |
Net loss attributable to common shareholders per share - basic and diluted | |
$ | (0.02 | ) | |
$ | (0.28 | ) |
|
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v3.24.1.1.u2
ACCRUED EXPENSES AND DEBT (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Accrued Expenses And Debt |
|
SCHEDULE OF ACCRUED EXPENSES |
Accrued
expenses as of March 31, 2024 and December 31, 2023 consist of the following:
SCHEDULE
OF ACCRUED EXPENSES
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
|
|
($ in thousands) |
|
Accrued expenses |
|
$ |
3,506 |
|
|
$ |
4,030 |
|
Payable to managed practices |
|
|
2,396 |
|
|
|
593 |
|
Taxes and other |
|
|
448 |
|
|
|
442 |
|
Total |
|
$ |
6,350 |
|
|
$ |
5,065 |
|
|
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v3.24.1.1.u2
LEASES (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Leases [Abstract] |
|
SCHEDULE OF LEASE EXPENSE |
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Operating lease cost | |
$ | 637 | | |
$ | 801 | |
Short-term lease cost | |
| 4 | | |
| - | |
Variable lease cost | |
| 5 | | |
| 5 | |
Total - net lease cost | |
$ | 646 | | |
$ | 806 | |
|
SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES |
Supplemental
balance sheet information related to leases is as follows:
SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,775 | | |
$ | 1,888 | |
Non-current operating lease liabilities | |
| 2,320 | | |
| 2,516 | |
Total operating lease liabilities | |
$ | 4,095 | | |
$ | 4,404 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 4,614 | | |
$ | 6,571 | |
Asset lease expense | |
| (509 | ) | |
| (2,152 | ) |
Foreign exchange gain/(loss) | |
| 2 | | |
| (54 | ) |
ROU assets, net | |
$ | 4,107 | | |
$ | 4,365 | |
Operating lease right-of-use assets | |
$ | 4,107 | | |
$ | 4,365 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 4.5 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 13.7 | % | |
| 13.3 | % |
Operating leases, Weighted average discount rate | |
| 13.7 | % | |
| 13.3 | % |
|
SCHEDULE OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES |
Supplemental
cash flow and other information related to leases is as follows:
SCHEDULE
OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 668 | | |
$ | 907 | |
| |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 249 | | |
$ | 287 | |
|
SCHEDULE OF MATURITIES OF LEASE LIABILITIES |
Maturities
of lease liabilities are as follows:
SCHEDULE
OF MATURITIES OF LEASE LIABILITIES
Operating leases - Years ending December 31, | |
($ in thousands) | |
2024 (nine months) | |
$ | 1,756 | |
2025 | |
| 1,350 | |
2026 | |
| 577 | |
2027 | |
| 453 | |
2028 | |
| 385 | |
Thereafter | |
| 1,429 | |
Total lease payments | |
| 5,950 | |
Less: imputed interest | |
| (1,855 | ) |
Total lease obligations | |
| 4,095 | |
Less: current obligations | |
| 1,775 | |
Long-term lease obligations | |
$ | 2,320 | |
|
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v3.24.1.1.u2
RESTRUCTURING COSTS (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Restructuring and Related Activities [Abstract] |
|
SCHEDULE OF LIABILITIES ASSOCIATED WITH RESTRUCTURING COSTS |
SCHEDULE OF LIABILITIES ASSOCIATED WITH RESTRUCTURING COSTS
| |
Severance and separation costs | | |
Equity awards acceleration costs | | |
Other exit related costs | | |
Total restructuring and other costs | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Additions | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Payments and other adjustments | |
| (202 | ) | |
| - | | |
| (26 | ) | |
| (228 | ) |
Balance as of March 31, 2024 | |
$ | 265 | | |
$ | - | | |
$ | - | | |
$ | 265 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Beginning balance | |
$ | - | | |
$ | - | | |
$ | - | | |
$ | - | |
Additions | |
| 439 | | |
| 170 | | |
| 36 | | |
| 645 | |
Payments and other adjustments | |
| (294 | ) | |
| (170 | ) | |
| (10 | ) | |
| (474 | ) |
Balance as of December 31, 2023 | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
Ending balance | |
$ | 145 | | |
$ | - | | |
$ | 26 | | |
$ | 171 | |
|
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v3.24.1.1.u2
REVENUE (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Revenue from Contract with Customer [Abstract] |
|
SCHEDULE OF DISAGGREGATION OF REVENUE |
The
following table represents a disaggregation of revenue for the three months ended March 31, 2024 and 2023:
SCHEDULE OF DISAGGREGATION OF REVENUE
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 17,283 | | |
$ | 19,495 | |
Professional services | |
| 4,422 | | |
| 6,560 | |
Printing and mailing services | |
| 861 | | |
| 713 | |
Group purchasing services | |
| 155 | | |
| 186 | |
Medical Practice Management: | |
| | | |
| | |
Medical practice management services | |
| 3,241 | | |
| 3,047 | |
Total | |
$ | 25,962 | | |
$ | 30,001 | |
Revenue | |
$ | 25,962 | | |
$ | 30,001 | |
|
SCHEDULE OF CHANGES IN ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE |
SCHEDULE OF CHANGES IN ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE
| |
Accounts Receivable - Net | | |
Contract Asset | | |
Deferred Revenue (current) | | |
Deferred Revenue (long term) | |
| |
($ in thousands) | |
Balance as of January 1, 2024 | |
$ | 11,888 | | |
$ | 5,094 | | |
$ | 1,380 | | |
$ | 256 | |
Increase, net | |
| 74 | | |
| 361 | | |
| 6 | | |
| 52 | |
Balance as of March 31, 2024 | |
$ | 11,962 | | |
$ | 5,455 | | |
$ | 1,386 | | |
$ | 308 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (127 | ) | |
| 619 | | |
| 8 | | |
| 8 | |
Balance as of March 31, 2023 | |
$ | 14,646 | | |
$ | 5,018 | | |
$ | 1,394 | | |
$ | 350 | |
|
SCHEDULE OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS |
Changes
in the allowance for expected credit losses for trade accounts receivable are presented in the table below:
SCHEDULE OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS
| |
Three Months Ended | | |
Year Ended | |
| |
March 31, 2024 | | |
December 31, 2023 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 879 | | |
$ | 823 | |
Adoption of ASC 326 | |
| - | | |
| 186 | |
Provision | |
| 37 | | |
| 454 | |
Recoveries/adjustments | |
| 1 | | |
| 107 | |
Write-offs | |
| - | | |
| (691 | ) |
Ending balance | |
$ | 917 | | |
$ | 879 | |
|
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v3.24.1.1.u2
STOCK-BASED COMPENSATION (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Share-Based Payment Arrangement [Abstract] |
|
DISCLOSURE OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD |
The
following table summarizes the RSU transactions related to the common and preferred stock under the A&R Plan for the three months
ended March 31, 2024 and 2023:
DISCLOSURE
OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD
| |
Common Stock | | |
Series A Preferred Stock | | |
Series B Preferred Stock | |
Outstanding and unvested shares at January 1, 2024 | |
| 753,495 | | |
| - | | |
| 57,199 | |
Granted | |
| - | | |
| - | | |
| 34,000 | |
Vested | |
| (326,501 | ) | |
| - | | |
| (14,000 | ) |
Forfeited | |
| (217,115 | ) | |
| - | | |
| (24,000 | ) |
Outstanding and unvested shares at March 31, 2024 | |
| 209,879 | | |
| - | | |
| 53,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 546,851 | | |
| - | | |
| 62,000 | |
Vested | |
| (498,660 | ) | |
| - | | |
| (57,263 | ) |
Forfeited | |
| (19,975 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at March 31, 2023 | |
| 673,691 | | |
| - | | |
| 85,199 | |
|
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS |
The
following table summarizes the components of share-based compensation (benefit) expense for the three months ended March 31, 2024 and
2023:
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
| |
2024 | | |
2023 | |
| |
Three Months Ended March 31, | |
| |
2024 | | |
2023 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | (45 | ) | |
$ | 88 | |
General and administrative | |
| (696 | ) | |
| 605 | |
Research and development | |
| 54 | | |
| 37 | |
Selling and marketing | |
| (21 | ) | |
| 342 | |
Total stock-based compensation (benefit) expense | |
$ | (708 | ) | |
$ | 1,072 | |
|
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v3.24.1.1.u2
SEGMENT REPORTING (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Segment Reporting [Abstract] |
|
SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT |
SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2024 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 22,721 | | |
$ | 3,241 | | |
$ | - | | |
$ | 25,962 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 12,544 | | |
| 2,633 | | |
| - | | |
| 15,177 | |
Selling and marketing | |
| 1,760 | | |
| 10 | | |
| - | | |
| 1,770 | |
General and administrative | |
| 2,581 | | |
| 434 | | |
| 706 | | |
| 3,721 | |
Research and development | |
| 913 | | |
| - | | |
| - | | |
| 913 | |
Depreciation and amortization | |
| 3,845 | | |
| 85 | | |
| - | | |
| 3,930 | |
Loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 322 | | |
| - | | |
| - | | |
| 322 | |
Total operating expenses | |
| 21,965 | | |
| 3,162 | | |
| 706 | | |
| 25,833 | |
Operating income (loss) | |
$ | 756 | | |
$ | 79 | | |
$ | (706 | ) | |
$ | 129 | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
| |
Three Months Ended March 31, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical Practice
Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 26,954 | | |
$ | 3,047 | | |
$ | - | | |
$ | 30,001 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,693 | | |
| 2,414 | | |
| - | | |
| 18,107 | |
Selling and marketing | |
| 2,604 | | |
| 8 | | |
| - | | |
| 2,612 | |
General and administrative | |
| 2,496 | | |
| 448 | | |
| 2,176 | | |
| 5,120 | |
Research and development | |
| 1,078 | | |
| - | | |
| - | | |
| 1,078 | |
Depreciation and amortization | |
| 2,949 | | |
| 89 | | |
| - | | |
| 3,038 | |
Net loss on lease terminations and unoccupied lease charges | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Net loss on lease terminations, unoccupied lease charges and restructuring costs | |
| 269 | | |
| - | | |
| - | | |
| 269 | |
Total operating expenses | |
| 25,089 | | |
| 2,959 | | |
| 2,176 | | |
| 30,224 | |
Operating income (loss) | |
$ | 1,865 | | |
$ | 88 | | |
$ | (2,176 | ) | |
$ | (223 | ) |
|
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v3.24.1.1.u2
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Details Narrative) - USD ($) $ in Thousands |
3 Months Ended |
12 Months Ended |
|
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Jan. 01, 2023 |
Accounting Policies [Abstract] |
|
|
|
|
Goodwill impairment charges |
|
|
$ 42,000
|
|
Net loss |
241
|
$ 401
|
48,700
|
|
Net decrease in cash |
807
|
$ (4,138)
|
9,000
|
|
Working capital |
474
|
|
(57)
|
|
Cash |
4,138
|
|
$ 3,331
|
|
Dividend suspended |
$ 1,300
|
|
|
|
Allowance for expected credit losses |
|
|
|
$ 186
|
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v3.24.1.1.u2
SCHEDULE OF INTANGIBLE ASSETS (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
$ 88,229
|
$ 86,629
|
Less: Accumulated amortization |
64,992
|
61,555
|
Intangible assets - net |
23,237
|
25,074
|
Customer Relationships [Member] |
|
|
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
47,597
|
47,597
|
Capitalized Software [Member] |
|
|
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
30,979
|
29,379
|
Noncompete Agreements [Member] |
|
|
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
1,236
|
1,236
|
Other Intangible Assets [Member] |
|
|
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
$ 8,417
|
$ 8,417
|
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v3.24.1.1.u2
GOODWILL AND INTANGIBLE ASSETS-NET (Details Narrative) - USD ($) $ in Thousands |
3 Months Ended |
12 Months Ended |
|
Mar. 31, 2024 |
Dec. 31, 2023 |
Dec. 31, 2023 |
Dec. 31, 2022 |
Indefinite-Lived Intangible Assets [Line Items] |
|
|
|
|
Goodwill |
$ 19,186
|
$ 19,186
|
$ 19,186
|
$ 61,186
|
Goodwill impairment charges |
|
|
42,000
|
|
Amortization expense |
3,400
|
|
2,500
|
|
Medical Practice Management Segment [Member] |
|
|
|
|
Indefinite-Lived Intangible Assets [Line Items] |
|
|
|
|
Goodwill |
$ 90
|
90
|
$ 90
|
|
Healthcare IT [Member] |
|
|
|
|
Indefinite-Lived Intangible Assets [Line Items] |
|
|
|
|
Goodwill impairment charges |
|
$ 42,000
|
|
|
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v3.24.1.1.u2
SCHEDULE OF RECONCILIATION OF WEIGHTED-AVERAGE SHARES OUTSTANDING FOR BASIC AND DILUTED NET LOSS PER COMMON SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands |
3 Months Ended |
12 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Earnings Per Share [Abstract] |
|
|
|
Net loss attributable to common shareholders |
$ (246)
|
$ (4,332)
|
$ (4,332)
|
Weighted-average common shares used to compute basic loss per share |
16,014,309
|
15,421,096
|
15,421,096
|
Weighted-average common shares used to compute diluted loss per share |
16,014,309
|
15,421,096
|
15,421,096
|
Net loss attributable to common shareholders per share - basic |
$ (0.02)
|
$ (0.28)
|
$ (0.28)
|
Net loss attributable to common shareholders per share - diluted |
$ (0.02)
|
$ (0.28)
|
$ (0.28)
|
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ACCRUED EXPENSES AND DEBT (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands |
|
3 Months Ended |
|
|
|
|
Aug. 31, 2023 |
Mar. 31, 2024 |
Sep. 30, 2018 |
Apr. 01, 2024 |
Dec. 31, 2023 |
Aug. 30, 2023 |
Feb. 28, 2023 |
Line of Credit Facility [Line Items] |
|
|
|
|
|
|
|
Lline of credit |
|
$ 9,000
|
|
|
$ 10,000
|
|
|
Line of credit, remaining borrowing base |
|
3,600
|
|
|
|
|
|
Line of credit facility, commitment fee amount |
|
100
|
|
|
|
|
|
Offshore bank accounts |
|
155
|
|
|
$ 255
|
|
|
Insurance Financing [Member] |
|
|
|
|
|
|
|
Line of Credit Facility [Line Items] |
|
|
|
|
|
|
|
Debt interest rate |
|
|
|
|
9.40%
|
|
|
SVB Debt Agreement [Member] |
|
|
|
|
|
|
|
Line of Credit Facility [Line Items] |
|
|
|
|
|
|
|
Upfront fees |
|
$ 50
|
$ 50
|
|
|
|
|
Warrants to purchase shares |
|
125,000
|
|
|
|
|
|
Payments for annual anniversary fee |
|
$ 50
|
|
|
|
|
|
Warrant strike price |
|
$ 3.92
|
|
|
|
|
|
Warrants exercise price |
|
$ 3.12
|
|
|
|
|
|
SVB Debt Agreement [Member] | Additional Warrant [Member] |
|
|
|
|
|
|
|
Line of Credit Facility [Line Items] |
|
|
|
|
|
|
|
Warrants to purchase shares |
|
|
28,489
|
|
|
|
|
Warrant strike price |
|
|
$ 5.26
|
|
|
|
|
Warrants exercise price |
|
|
$ 3.58
|
|
|
|
|
Warrants term |
|
|
5 years
|
|
|
|
|
SVB Credit Facility [Member] |
|
|
|
|
|
|
|
Line of Credit Facility [Line Items] |
|
|
|
|
|
|
|
Secured revolving line of credit percentage |
|
200.00%
|
|
|
|
|
|
Line of Credit Facility, Current Borrowing Capacity |
|
|
|
|
|
|
$ 25,000
|
Line of credit facility, interest rate |
2.00%
|
2.00%
|
|
1.50%
|
|
1.50%
|
|
Minimum liquidity ratio reduction amendments expiry date |
Mar. 31, 2024
|
|
|
|
|
|
|
Line of credit facility, commitment fee description |
|
There is also a fee of one-half of 1% annually for the unused portion of the credit line.
|
|
|
|
|
|
Percentage of shares offshore facilities |
|
65.00%
|
|
|
|
|
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SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Leases [Abstract] |
|
|
Operating lease right-of-use assets |
$ 4,107
|
$ 4,365
|
Current operating lease liabilities |
1,775
|
1,888
|
Non-current operating lease liabilities |
2,320
|
2,516
|
Total operating lease liabilities |
4,095
|
4,404
|
ROU assets |
4,614
|
6,571
|
Asset lease expense |
(509)
|
(2,152)
|
Foreign exchange gain/(loss) |
$ 2
|
$ (54)
|
Operating leases, Weighted average remaining lease term |
4 years 6 months
|
4 years 6 months
|
Operating leases, Weighted average discount rate |
13.70%
|
13.30%
|
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SCHEDULE OF MATURITIES OF LEASE LIABILITIES (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Leases [Abstract] |
|
|
2024 (nine months) |
$ 1,756
|
|
2025 |
1,350
|
|
2026 |
577
|
|
2027 |
453
|
|
2028 |
385
|
|
Thereafter |
1,429
|
|
Total lease payments |
5,950
|
|
Less: imputed interest |
(1,855)
|
|
Total lease obligations |
4,095
|
$ 4,404
|
Less: current obligations |
1,775
|
1,888
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$ 2,320
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$ 2,516
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v3.24.1.1.u2
COMMITMENTS AND CONTINGENCIES (Details Narrative) - USD ($)
|
|
3 Months Ended |
|
Dec. 22, 2023 |
Mar. 31, 2021 |
Apr. 01, 2024 |
Loss Contingencies [Line Items] |
|
|
|
Damages paid value |
|
$ 750,000
|
|
Claim damages |
|
288,750
|
|
Unpaid fees |
|
$ 21,698
|
|
Advance amount |
|
|
$ 200,000
|
Ramapo Anesthesiologists, PC [Member] |
|
|
|
Loss Contingencies [Line Items] |
|
|
|
Mitigation related costs |
$ 117,000
|
|
|
Ramapo Anesthesiologists, PC [Member] | Accrued Expenses [Member] |
|
|
|
Loss Contingencies [Line Items] |
|
|
|
Mitigation settlement payable |
$ 32,000
|
|
|
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v3.24.1.1.u2
Related PARTIES (Details Narrative) - USD ($) $ in Thousands |
|
|
1 Months Ended |
3 Months Ended |
12 Months Ended |
Feb. 12, 2024 |
Feb. 01, 2024 |
Jan. 31, 2024 |
Feb. 28, 2023 |
Jun. 30, 2022 |
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Net revenue |
|
|
|
|
|
$ 25,962
|
$ 30,001
|
|
Current assets - related party |
|
|
|
|
|
16
|
|
$ 16
|
Lease expense per month for temporary housing |
|
|
|
|
|
6,200
|
|
|
Operating lease, right-of-use asset |
|
|
|
|
|
4,107
|
|
4,365
|
Operating lease liability (current portion) |
|
|
|
|
|
1,775
|
|
1,888
|
Operating lease liability |
|
|
|
|
|
2,320
|
|
2,516
|
talkMD Clinicians [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Income taxes paid |
|
|
|
|
|
5,500
|
|
|
Executive Chairman [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Rent expense |
|
|
|
|
|
70
|
51
|
|
Operating lease upgradations |
|
|
|
|
|
227
|
502
|
|
Payments to related party |
|
|
|
|
|
|
|
330
|
Related Party [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Operating lease, right-of-use asset |
|
|
|
|
|
303
|
|
331
|
Operating lease liability (current portion) |
|
|
|
|
|
164
|
|
182
|
Operating lease liability |
|
|
|
|
|
133
|
|
142
|
Physician [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Net revenue |
|
|
|
|
|
24
|
$ 19
|
|
Receivable due from customer |
|
|
|
|
|
$ 8
|
|
$ 18
|
Former Non-Independent Directors [Member] | Consulting Agreement [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Compensation for statement of work per month |
|
$ 25
|
|
|
|
|
|
|
Investor relations services per month |
$ 8
|
|
|
|
|
|
|
|
Former Non-Independent Directors [Member] | Series B Preferred Stock [Member] | Consulting Agreement [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Shares issued for services |
|
|
14,000
|
14,000
|
10,000
|
|
|
|
Preferred stock dividend percentage |
|
|
|
|
8.75%
|
|
|
|
X |
- DefinitionAmount of expense for employee benefit and equity-based compensation.
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SCHEDULE OF DISAGGREGATION OF REVENUE (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Revenue |
$ 25,962
|
$ 30,001
|
Healthcare IT [Member] |
|
|
Revenue |
22,721
|
26,954
|
Healthcare IT [Member] | Technology-enabled Business Solutions [Member] |
|
|
Revenue |
17,283
|
19,495
|
Healthcare IT [Member] | Professional Services [Member] |
|
|
Revenue |
4,422
|
6,560
|
Healthcare IT [Member] | Printing and Mailing Services [Member] |
|
|
Revenue |
861
|
713
|
Healthcare IT [Member] | Group Purchasing Services [Member] |
|
|
Revenue |
155
|
186
|
Medical Practice Management [Member] |
|
|
Revenue |
$ 3,241
|
$ 3,047
|
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SCHEDULE OF CHANGES IN ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Revenue from Contract with Customer [Abstract] |
|
|
Accounts Receivable - Net, Opening |
$ 11,888
|
$ 14,773
|
Contract Assets, Opening |
5,094
|
4,399
|
Deferred Revenue (current), Opening |
1,380
|
1,386
|
Deferred Revenue (long term), Opening |
256
|
342
|
Accounts Receivable - Net, increase (decrease), net |
74
|
(127)
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Increase in Contract with Customer, Asset |
361
|
619
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Deferred Revenue (current), increase (decrease), net |
6
|
8
|
Deferred Revenue (long term), increase (decrease), net |
52
|
8
|
Accounts Receivable - Net, Closing |
11,962
|
14,646
|
Contract Assets, Closing |
5,455
|
5,018
|
Deferred Revenue (current), Closing |
1,386
|
1,394
|
Deferred Revenue (long term), Closing |
$ 308
|
$ 350
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REVENUE (Details Narrative) - USD ($) $ in Thousands |
3 Months Ended |
|
|
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Jan. 01, 2023 |
Revenue |
$ 25,962
|
$ 30,001
|
|
|
Revenue, Remaining Performance Obligation, Amount |
5,200
|
|
|
|
Amortization of Deferred Sales Commissions |
90
|
167
|
|
|
Accumulated deficit |
(74,722)
|
|
$ (74,481)
|
|
Trade Accounts Receivable [Member] | Accounting Standards Update 2016-13 [Member] |
|
|
|
|
Accumulated deficit |
|
|
|
$ 186
|
Other Noncurrent Assets [Member] |
|
|
|
|
Deferred commissions |
488
|
580
|
|
|
Chronic Care Management [Member] |
|
|
|
|
Revenue |
440
|
135
|
|
|
Remote Patient Monitoring [Member] |
|
|
|
|
Revenue |
140
|
11
|
|
|
Professional Services [Member] | Unbilled Revenues [Member] |
|
|
|
|
Revenue |
47
|
$ 100
|
|
|
Group Purchasing Services [Member] |
|
|
|
|
Contract with Customer, Asset, after Allowance for Credit Loss |
$ 264
|
|
|
|
X |
- DefinitionThe amount of expense recognized in the current period for the periodic realization of capitalized fees that were paid to salespeople, distributors, brokers, and agents at the time of the conclusion of the sale. As a noncash expense, this element is added back to net income when calculating cash provided by or used in operations using the indirect method.
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v3.24.1.1.u2
DISCLOSURE OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD (Details) - Restricted Stock Units (RSUs) [Member] - shares
|
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Series A Preferred Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested at beginning |
|
|
Granted |
|
|
Vested |
|
|
Forfeited |
|
|
Outstanding and unvested at ending |
|
|
Series B Preferred Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested at beginning |
57,199
|
80,462
|
Granted |
34,000
|
62,000
|
Vested |
(14,000)
|
(57,263)
|
Forfeited |
(24,000)
|
|
Outstanding and unvested at ending |
53,199
|
85,199
|
Common Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested at beginning |
753,495
|
645,475
|
Granted |
|
546,851
|
Vested |
(326,501)
|
(498,660)
|
Forfeited |
(217,115)
|
(19,975)
|
Outstanding and unvested at ending |
209,879
|
673,691
|
X |
- DefinitionThe number of equity-based payment instruments, excluding stock (or unit) options, that were forfeited during the reporting period.
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SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
Total stock-based compensation (benefit) expense |
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|
$ 1,072
|
Direct Operating Costs [Member] |
|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
Total stock-based compensation (benefit) expense |
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|
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General and Administrative Expense [Member] |
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|
605
|
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|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
Total stock-based compensation (benefit) expense |
54
|
37
|
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|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
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|
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1 Months Ended |
3 Months Ended |
Oct. 31, 2023 |
Mar. 31, 2024 |
Mar. 31, 2023 |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
Stock-based compensation (benefit) expense |
|
$ (708)
|
$ 1,072
|
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|
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|
|
Liability for cash settled amount |
|
$ 80
|
$ 767
|
Series B Preferred Stock [Member] |
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
Share-based payment award, number of shares issuance |
10,000
|
|
|
Share-based payment award, number of shares forfeited |
|
24,000
|
|
Share-based payment award, number of shares grant |
|
34,000
|
|
Stock-based compensation (benefit) expense |
|
$ 708
|
|
Restricted Stock Units (RSUs) [Member] | Common Stock [Member] |
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant |
|
710,694
|
|
Restricted Stock Units (RSUs) [Member] | Preferred Stock [Member] | Series B Preferred Stock [Member] |
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant |
|
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SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Segment Reporting Information [Line Items] |
|
|
Net revenue |
$ 25,962
|
$ 30,001
|
Direct operating costs |
15,177
|
18,107
|
Selling and marketing |
1,770
|
2,612
|
General and administrative |
3,721
|
5,120
|
Research and development |
913
|
1,078
|
Depreciation and amortization |
3,930
|
3,038
|
Net loss on lease terminations, unoccupied lease charges and restructuring costs |
322
|
269
|
Total operating expenses |
25,833
|
30,224
|
OPERATING INCOME (LOSS) |
129
|
(223)
|
Healthcare IT [Member] |
|
|
Segment Reporting Information [Line Items] |
|
|
Net revenue |
22,721
|
26,954
|
Direct operating costs |
12,544
|
15,693
|
Selling and marketing |
1,760
|
2,604
|
General and administrative |
2,581
|
2,496
|
Research and development |
913
|
1,078
|
Depreciation and amortization |
3,845
|
2,949
|
Net loss on lease terminations, unoccupied lease charges and restructuring costs |
322
|
269
|
Total operating expenses |
21,965
|
25,089
|
OPERATING INCOME (LOSS) |
756
|
1,865
|
Medical Practice Management [Member] |
|
|
Segment Reporting Information [Line Items] |
|
|
Net revenue |
3,241
|
3,047
|
Direct operating costs |
2,633
|
2,414
|
Selling and marketing |
10
|
8
|
General and administrative |
434
|
448
|
Research and development |
|
|
Depreciation and amortization |
85
|
89
|
Net loss on lease terminations, unoccupied lease charges and restructuring costs |
|
|
Total operating expenses |
3,162
|
2,959
|
OPERATING INCOME (LOSS) |
79
|
88
|
Unallocated Corporate Expenses [Member] |
|
|
Segment Reporting Information [Line Items] |
|
|
Net revenue |
|
|
Direct operating costs |
|
|
Selling and marketing |
|
|
General and administrative |
706
|
2,176
|
Research and development |
|
|
Depreciation and amortization |
|
|
Net loss on lease terminations, unoccupied lease charges and restructuring costs |
|
|
Total operating expenses |
706
|
2,176
|
OPERATING INCOME (LOSS) |
$ (706)
|
$ (2,176)
|
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