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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 September 30, 2023
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
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
October 27, 2023, the registrant had 15,873,120 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 2, 2023. 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 our 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 apply artificial intelligence effectively in driving value for our clients through
technology-based solutions; |
| | |
| ● | 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 and President,
all of which are critical to our ongoing operations, growing our business and integrating
of our newly acquired businesses; |
| | |
| ● | 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 & Trust Company, and other
future debt facilities; |
| | |
| ● | our
ability to pay our monthly preferred dividends to the holders of our Series A and Series
B preferred stock; |
| | |
| ● | 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 respond to the uncertainty resulting from the ongoing COVID-19 pandemic and the
impact it 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. Consolidated Financial Statements
CARECLOUD,
INC.
CONSOLIDATED
BALANCE SHEETS
($
in thousands, except share and per share amounts)
|
|
September
30, |
|
|
December
31, |
|
|
|
2023 |
|
|
2022 |
|
|
|
(Unaudited) |
|
|
|
|
ASSETS |
|
|
|
|
|
|
|
|
Current
assets: |
|
|
|
|
|
|
|
|
Cash |
|
$ |
6,406 |
|
|
$ |
12,299 |
|
Accounts
receivable - net |
|
|
12,310 |
|
|
|
14,773 |
|
Contract
asset |
|
|
4,948 |
|
|
|
4,399 |
|
Inventory |
|
|
478 |
|
|
|
381 |
|
Current
assets - related party |
|
|
50 |
|
|
|
16 |
|
Prepaid
expenses and other current assets |
|
|
3,299 |
|
|
|
2,785 |
|
Total
current assets |
|
|
27,491 |
|
|
|
34,653 |
|
Property
and equipment - net |
|
|
5,319 |
|
|
|
5,056 |
|
Operating
lease right-of-use assets |
|
|
4,491 |
|
|
|
4,921 |
|
Intangible
assets - net |
|
|
26,689 |
|
|
|
29,520 |
|
Goodwill |
|
|
61,186 |
|
|
|
61,186 |
|
Other
assets |
|
|
745 |
|
|
|
838 |
|
TOTAL
ASSETS |
|
$ |
125,921 |
|
|
$ |
136,174 |
|
LIABILITIES
AND SHAREHOLDERS’ EQUITY |
|
|
|
|
|
|
|
|
Current
liabilities: |
|
|
|
|
|
|
|
|
Accounts
payable |
|
$ |
6,243 |
|
|
$ |
5,681 |
|
Accrued
compensation |
|
|
3,118 |
|
|
|
4,248 |
|
Accrued
expenses |
|
|
4,629 |
|
|
|
4,432 |
|
Operating
lease liability (current portion) |
|
|
1,810 |
|
|
|
2,273 |
|
Deferred
revenue (current portion) |
|
|
1,527 |
|
|
|
1,386 |
|
Notes
payable (current portion) |
|
|
490 |
|
|
|
319 |
|
Dividend
payable |
|
|
4,125 |
|
|
|
4,059 |
|
Total
current liabilities |
|
|
21,942 |
|
|
|
22,398 |
|
Notes
payable |
|
|
10 |
|
|
|
13 |
|
Borrowings
under line of credit |
|
|
12,000 |
|
|
|
8,000 |
|
Operating
lease liability |
|
|
2,789 |
|
|
|
3,207 |
|
Deferred
revenue |
|
|
422 |
|
|
|
342 |
|
Deferred
tax liability |
|
|
606 |
|
|
|
525 |
|
Total
liabilities |
|
|
37,769 |
|
|
|
34,485 |
|
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 September 30, 2023 and
December 31, 2022. Series B, issued and outstanding 1,463,392 and 1,344,128 shares at September 30, 2023 and December 31, 2022, respectively |
|
|
6 |
|
|
|
6 |
|
Common
stock, $0.001 par value - authorized 35,000,000 shares. Issued 16,598,449 and 15,970,204 shares at September 30, 2023 and December
31, 2022, respectively. Outstanding 15,857,650 and 15,229,405 shares at September 30, 2023 and December 31, 2022, respectively |
|
|
17 |
|
|
|
16 |
|
Additional
paid-in capital |
|
|
123,872 |
|
|
|
130,987 |
|
Accumulated
deficit |
|
|
(30,789 |
) |
|
|
(25,621 |
) |
Accumulated
other comprehensive loss |
|
|
(4,292 |
) |
|
|
(3,037 |
) |
Less:
740,799 common shares held in treasury, at cost at September 30, 2023 and December 31, 2022 |
|
|
(662 |
) |
|
|
(662 |
) |
Total
shareholders’ equity |
|
|
88,152 |
|
|
|
101,689 |
|
TOTAL
LIABILITIES AND SHAREHOLDERS’ EQUITY |
|
$ |
125,921 |
|
|
$ |
136,174 |
|
See
notes to consolidated financial statements.
CARECLOUD,
INC.
CONSOLIDATED
STATEMENTS OF OPERATIONS (UNAUDITED)
($
in thousands, except share and per share amounts)
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended | | |
Nine
Months Ended | |
| |
September
30, | | |
September
30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
NET
REVENUE | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
OPERATING
EXPENSES: | |
| | | |
| | | |
| | | |
| | |
Direct
operating costs | |
| 18,260 | | |
| 20,406 | | |
| 53,843 | | |
| 64,866 | |
Selling
and marketing | |
| 2,337 | | |
| 2,504 | | |
| 7,529 | | |
| 7,314 | |
General
and administrative | |
| 5,482 | | |
| 6,500 | | |
| 16,518 | | |
| 18,479 | |
Research
and development | |
| 1,260 | | |
| 1,168 | | |
| 3,523 | | |
| 3,251 | |
Change
in contingent consideration | |
| - | | |
| (1,660 | ) | |
| - | | |
| (2,890 | ) |
Depreciation
and amortization | |
| 3,903 | | |
| 2,810 | | |
| 10,282 | | |
| 8,686 | |
Net
loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| 307 | | |
| 430 | | |
| 928 | |
Total
operating expenses | |
| 31,250 | | |
| 32,035 | | |
| 92,125 | | |
| 100,634 | |
OPERATING
(LOSS) INCOME | |
| (1,970 | ) | |
| 1,688 | | |
| (3,482 | ) | |
| 5,658 | |
OTHER: | |
| | | |
| | | |
| | | |
| | |
Interest
income | |
| 52 | | |
| 14 | | |
| 124 | | |
| 22 | |
Interest
expense | |
| (352 | ) | |
| (96 | ) | |
| (829 | ) | |
| (303 | ) |
Other
expense - net | |
| (422 | ) | |
| (495 | ) | |
| (591 | ) | |
| (300 | ) |
Income
tax provision | |
| 57 | | |
| 55 | | |
| 204 | | |
| 144 | |
NET
(LOSS) INCOME | |
$ | (2,749 | ) | |
$ | 1,056 | | |
$ | (4,982 | ) | |
$ | 4,933 | |
| |
| | | |
| | | |
| | | |
| | |
Preferred
stock dividend | |
| 3,916 | | |
| 3,849 | | |
| 11,757 | | |
| 11,662 | |
NET
LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS | |
$ | (6,665 | ) | |
$ | (2,793 | ) | |
$ | (16,739 | ) | |
$ | (6,729 | ) |
| |
| | | |
| | | |
| | | |
| | |
Net
loss per common share: basic and diluted | |
$ | (0.42 | ) | |
$ | (0.18 | ) | |
$ | (1.07 | ) | |
$ | (0.45 | ) |
Weighted-average
common shares used to compute basic and diluted loss per share | |
| 15,760,499 | | |
| 15,148,721 | | |
| 15,600,361 | | |
| 15,070,913 | |
See
notes to consolidated financial statements.
CARECLOUD,
INC.
CONSOLIDATED
STATEMENTS OF COMPREHENSIVE (LOSS) INCOME (UNAUDITED)
($
in thousands)
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended | | |
Nine
Months Ended | |
| |
September
30, | | |
September
30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
NET
(LOSS) INCOME | |
$ | (2,749 | ) | |
$ | 1,056 | | |
$ | (4,982 | ) | |
$ | 4,933 | |
OTHER
COMPREHENSIVE INCOME (LOSS), NET OF TAX | |
| | | |
| | | |
| | | |
| | |
Foreign
currency translation adjustment (a) | (a) |
| 362 | | |
| (537 | ) | |
| (1,255 | ) | |
| (1,782 | ) |
COMPREHENSIVE
(LOSS) INCOME | |
$ | (2,387 | ) | |
$ | 519 | | |
$ | (6,237 | ) | |
$ | 3,151 | |
See
notes to consolidated financial statements.
CARECLOUD,
INC.
CONSOLIDATED
STATEMENTS OF SHAREHOLDERS’ EQUITY (UNAUDITED)
FOR
THE THREE AND NINE MONTHS ENDED SEPTEMBER 30, 2023 AND SEPTEMBER 30, 2022
($
in thousands, except for number of shares)
| |
Shares | | |
Amount | | |
Shares | | |
Amount | | |
Shares | | |
Amount | | |
Capital | | |
Deficit | | |
Loss | | |
Stock | | |
Equity | |
| |
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, 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 | |
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
- April 1, 2023 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,445,392 | | |
$ | 1 | | |
| 16,333,407 | | |
$ | 16 | | |
$ | 129,678 | | |
$ | (26,208 | ) | |
$ | (4,748 | ) | |
$ | (662 | ) | |
$ | 98,082 | |
Net
loss | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (1,832 | ) | |
| - | | |
| - | | |
| (1,832 | ) |
Foreign
currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 94 | | |
| - | | |
| 94 | |
Issuance
of stock under the equity incentive plan | |
| - | | |
| - | | |
| 9,000 | | |
| - | | |
| 15,489 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based
compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,089 | | |
| - | | |
| - | | |
| - | | |
| 1,089 | |
Shares
issued for services | |
| - | | |
| - | | |
| - | | |
| - | | |
| 20,000 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Preferred
stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (3,910 | ) | |
| - | | |
| - | | |
| - | | |
| (3,910 | ) |
Balance
- June 30, 2023 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,454,392 | | |
$ | 1 | | |
| 16,368,896 | | |
$ | 16 | | |
$ | 126,857 | | |
$ | (28,040 | ) | |
$ | (4,654 | ) | |
$ | (662 | ) | |
$ | 93,523 | |
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance
- July 1, 2023 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,454,392 | | |
$ | 1 | | |
| 16,368,896 | | |
$ | 16 | | |
$ | 126,857 | | |
$ | (28,040 | ) | |
$ | (4,654 | ) | |
$ | (662 | ) | |
$ | 93,523 | |
Net
loss | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (2,749 | ) | |
| - | | |
| - | | |
| (2,749 | ) |
Foreign
currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 362 | | |
| - | | |
| 362 | |
Issuance
of stock under the equity incentive plan | |
| - | | |
| - | | |
| 9,000 | | |
| - | | |
| 229,553 | | |
| 1 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1 | |
Stock-based
compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 931 | | |
| - | | |
| - | | |
| - | | |
| 931 | |
Preferred
stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (3,916 | ) | |
| - | | |
| - | | |
| - | | |
| (3,916 | ) |
Balance
- September 30, 2023 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,463,392 | | |
$ | 1 | | |
| 16,598,449 | | |
$ | 17 | | |
$ | 123,872 | | |
$ | (30,789 | ) | |
$ | (4,292 | ) | |
$ | (662 | ) | |
$ | 88,152 | |
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance
- January 1, 2022 | |
| 5,299,227 | | |
$ | 5 | | |
| - | | |
$ | - | | |
| 15,657,641 | | |
$ | 16 | | |
$ | 131,379 | | |
$ | (31,053 | ) | |
$ | (1,754 | ) | |
$ | (662 | ) | |
$ | 97,931 | |
Net
income | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,140 | | |
| - | | |
| - | | |
| 1,140 | |
Foreign
currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (255 | ) | |
| - | | |
| (255 | ) |
Issuance
of stock under the equity incentive plan | |
| 22,319 | | |
| - | | |
| - | | |
| - | | |
| 145,809 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based
compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 887 | | |
| - | | |
| - | | |
| - | | |
| 887 | |
Redemption
of Series A Preferred Stock | |
| (800,000 | ) | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (20,000 | ) | |
| - | | |
| - | | |
| - | | |
| (20,000 | ) |
Issuance
of Series B Preferred Stock | |
| - | | |
| - | | |
| 1,150,372 | | |
| 1 | | |
| - | | |
| - | | |
| 26,637 | | |
| - | | |
| - | | |
| - | | |
| 26,638 | |
Stock
issuance costs | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (11 | ) | |
| - | | |
| - | | |
| - | | |
| (11 | ) |
Preferred
stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (4,037 | ) | |
| - | | |
| - | | |
| - | | |
| (4,037 | ) |
Balance
- March 31, 2022 | |
| 4,521,546 | | |
$ | 5 | | |
| 1,150,372 | | |
$ | 1 | | |
| 15,803,450 | | |
$ | 16 | | |
$ | 134,855 | | |
$ | (29,913 | ) | |
$ | (2,009 | ) | |
$ | (662 | ) | |
$ | 102,293 | |
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance
- April 1, 2022 | |
| 4,521,546 | | |
$ | 5 | | |
| 1,150,372 | | |
$ | 1 | | |
| 15,803,450 | | |
$ | 16 | | |
$ | 134,855 | | |
$ | (29,913 | ) | |
$ | (2,009 | ) | |
$ | (662 | ) | |
$ | 102,293 | |
Net
income | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 2,737 | | |
| - | | |
| - | | |
| 2,737 | |
Foreign
currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (990 | ) | |
| - | | |
| (990 | ) |
Issuance
of stock under the equity incentive plan | |
| 4,685 | | |
| - | | |
| 10,000 | | |
| - | | |
| 15,809 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based
compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,257 | | |
| - | | |
| - | | |
| - | | |
| 1,257 | |
Redemption
of Series A Preferred Stock | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (5 | ) | |
| - | | |
| - | | |
| - | | |
| (5 | ) |
Issuance
of Series B Preferred Stock | |
| - | | |
| - | | |
| 49,876 | | |
| - | | |
| - | | |
| - | | |
| 1,223 | | |
| - | | |
| - | | |
| - | | |
| 1,223 | |
Stock
issuance costs | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (10 | ) | |
| - | | |
| - | | |
| - | | |
| (10 | ) |
Preferred
stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (3,776 | ) | |
| - | | |
| - | | |
| - | | |
| (3,776 | ) |
Balance
- June 30, 2022 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,210,248 | | |
$ | 1 | | |
| 15,819,259 | | |
$ | 16 | | |
$ | 133,544 | | |
$ | (27,176 | ) | |
$ | (2,999 | ) | |
$ | (662 | ) | |
$ | 102,729 | |
| |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |
Balance
- July 1, 2022 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,210,248 | | |
$ | 1 | | |
| 15,819,259 | | |
$ | 16 | | |
$ | 133,544 | | |
$ | (27,176 | ) | |
$ | (2,999 | ) | |
$ | (662 | ) | |
$ | 102,729 | |
Balance
| |
| 4,526,231 | | |
$ | 5 | | |
| 1,210,248 | | |
$ | 1 | | |
| 15,819,259 | | |
$ | 16 | | |
$ | 133,544 | | |
$ | (27,176 | ) | |
$ | (2,999 | ) | |
$ | (662 | ) | |
$ | 102,729 | |
Net
income | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,056 | | |
| - | | |
| - | | |
| 1,056 | |
Net
income (loss) | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,056 | | |
| - | | |
| - | | |
| 1,056 | |
Foreign
currency translation adjustment | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (537 | ) | |
| - | | |
| (537 | ) |
Issuance
of stock under the equity incentive plan | |
| - | | |
| - | | |
| - | | |
| - | | |
| 132,676 | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | |
Stock-based
compensation, net of cash settlements | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| 1,017 | | |
| - | | |
| - | | |
| - | | |
| 1,017 | |
Issuance
of Series B Preferred Stock | |
| - | | |
| - | | |
| 98,968 | | |
| - | | |
| - | | |
| - | | |
| 2,419 | | |
| - | | |
| - | | |
| - | | |
| 2,419 | |
Stock
issuance costs | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (11 | ) | |
| - | | |
| - | | |
| - | | |
| (11 | ) |
Preferred
stock dividends | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| - | | |
| (3,849 | ) | |
| - | | |
| - | | |
| - | | |
| (3,849 | ) |
Balance
- September 30, 2022 | |
| 4,526,231 | | |
$ | 5 | | |
| 1,309,216 | | |
$ | 1 | | |
| 15,951,935 | | |
$ | 16 | | |
$ | 133,120 | | |
$ | (26,120 | ) | |
$ | (3,536 | ) | |
$ | (662 | ) | |
$ | 102,824 | |
Balance | |
| 4,526,231 | | |
$ | 5 | | |
| 1,309,216 | | |
$ | 1 | | |
| 15,951,935 | | |
$ | 16 | | |
$ | 133,120 | | |
$ | (26,120 | ) | |
$ | (3,536 | ) | |
$ | (662 | ) | |
$ | 102,824 | |
For
all periods presented, the preferred stock dividends were paid monthly at the rate of $2.75 and $2.19 for Series A and Series B, respectively,
per share per annum.
See
notes to consolidated financial statements.
CARECLOUD,
INC.
CONSOLIDATED
STATEMENTS OF CASH FLOWS (UNAUDITED)
FOR
THE NINE MONTHS ENDED SEPTEMBER 30, 2023 AND 2022
($
in thousands)
| |
2023 | | |
2022 | |
OPERATING
ACTIVITIES: | |
| | | |
| | |
Net
(loss) income | |
$ | (4,982 | ) | |
$ | 4,933 | |
Adjustments
to reconcile net (loss) income to net cash provided by operating activities: | |
| | | |
| | |
Depreciation
and amortization | |
| 10,672 | | |
| 9,120 | |
Lease
amortization | |
| 1,618 | | |
| 2,474 | |
Deferred
revenue | |
| 221 | | |
| 381 | |
Provision
for doubtful accounts | |
| 389 | | |
| 715 | |
Provision
for deferred income taxes | |
| 81 | | |
| 62 | |
Foreign
exchange loss | |
| 596 | | |
| 238 | |
Interest
accretion | |
| 493 | | |
| 460 | |
Stock-based
compensation expense | |
| 3,783 | | |
| 3,399 | |
Change
in contingent consideration | |
| - | | |
| (2,890 | ) |
Changes
in operating assets and liabilities: | |
| | | |
| | |
Accounts
receivable | |
| 1,889 | | |
| 10 | |
Contract
asset | |
| (549 | ) | |
| 318 | |
Inventory | |
| (97 | ) | |
| 85 | |
Other
assets | |
| (117 | ) | |
| 62 | |
Accounts
payable and other liabilities | |
| (2,276 | ) | |
| (4,264 | ) |
Net
cash provided by operating activities | |
| 11,721 | | |
| 15,103 | |
INVESTING
ACTIVITIES: | |
| | | |
| | |
Purchases
of property and equipment | |
| (2,687 | ) | |
| (2,156 | ) |
Capitalized
software | |
| (6,635 | ) | |
| (6,967 | ) |
Net
cash used in investing activities | |
| (9,322 | ) | |
| (9,123 | ) |
FINANCING
ACTIVITIES: | |
| | | |
| | |
Preferred
stock dividends paid | |
| (11,691 | ) | |
| (11,478 | ) |
Settlement
of tax withholding obligations on stock issued to employees | |
| (1,425 | ) | |
| (1,140 | ) |
Repayments
of notes payable | |
| (717 | ) | |
| (769 | ) |
Stock
issuance costs | |
| - | | |
| (32 | ) |
Proceeds
from issuance of Series B Preferred Stock, net of expenses | |
| 1,427 | | |
| 30,280 | |
Redemption
of Series A Preferred Stock | |
| - | | |
| (20,005 | ) |
Proceeds
from line of credit | |
| 14,700 | | |
| 17,500 | |
Repayment
of line of credit | |
| (10,700 | ) | |
| (25,500 | ) |
Net
cash used in financing activities | |
| (8,406 | ) | |
| (11,144 | ) |
EFFECT
OF EXCHANGE RATE CHANGES ON CASH | |
| 114 | | |
| (309 | ) |
NET
DECREASE IN CASH AND RESTRICTED CASH | |
| (5,893 | ) | |
| (5,473 | ) |
CASH
AND RESTRICTED CASH - Beginning of the period | |
| 12,299 | | |
| 10,340 | |
CASH
AND RESTRICTED CASH - End of the period | |
$ | 6,406 | | |
$ | 4,867 | |
SUPPLEMENTAL
NONCASH INVESTING AND FINANCING ACTIVITIES: | |
| | | |
| | |
Dividends
declared, not paid | |
$ | 4,125 | | |
$ | 4,040 | |
Purchase
of prepaid insurance with assumption of note | |
$ | 620 | | |
$ | 695 | |
SUPPLEMENTAL
INFORMATION - Cash paid during the period for: | |
| | | |
| | |
Income
taxes | |
$ | 131 | | |
$ | 128 | |
Interest | |
$ | 630 | | |
$ | 125 | |
See
notes to consolidated financial statements.
CARECLOUD,
INC.
NOTES
TO CONSOLIDATED FINANCIAL STATEMENTS
AS
OF AND FOR THE THREE AND NINE MONTHS ENDED SEPTEMBER 30, 2023
AND
2022 (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. During the second
quarter of 2023, the Company formed a wholly owned subsidiary, CareCloud ME Health Consultancy LLC, in the United Arab Emirates, which
has not yet begun operations.
2. BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
The
accompanying unaudited 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 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 September 30, 2023, the results of operations
for the three and nine months ended September 30, 2023 and 2022 and cash flows for the nine months ended September 30, 2023 and 2022.
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 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 consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated
financial statements for the year ended December 31, 2022, which are included in the Company’s Annual Report on Form 10-K, filed
with the SEC on March 2, 2023.
Significant
Accounting Policies — During the nine months ended September 30, 2023, there were no changes to the Company’s significant
accounting policies, other than the adoption of ASU 2016-13 discussed below, from its disclosures in the Annual Report on Form 10-K for
the year ended December 31, 2022, filed with the SEC on March 2, 2023.
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 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 delays 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 for the allowance related to accounts receivable was a charge
of approximately $186,000 and a corresponding increase to the allowance for doubtful accounts.
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. The Company does not expect this update to have a material impact on the consolidated financial statements.
3. GOODWILL AND INTANGIBLE ASSETS-NET
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. During the three months ended September 30, 2023, the Company experienced
a decline in its market capitalization as a result of a sustained decrease in the Company’s stock price. The Company considered
the sustained decrease to represent a triggering event requiring management to perform a goodwill impairment test as of August 31,
2023.
Based
on the results of the goodwill impairment test as of August 31, 2023 and updated to September 30, 2023 for purposes of the fiscal quarter,
it was concluded that goodwill was not impaired. The conclusion was based upon the value determined using the discounted cash flow
method as supported by the guideline company transactions method and the guideline public company method.
The
following is the summary of the carrying amount of goodwill for the nine months ended September 30, 2023 and the year ended December
31, 2022:
SCHEDULE OF INTANGIBLE ASSETS AND GOODWILL
| |
Nine
Months Ended | | |
Year
Ended | |
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Beginning gross
balance | |
$ | 61,186 | | |
$ | 61,186 | |
Acquisitions | |
| - | | |
| - | |
Ending gross balance | |
$ | 61,186 | | |
$ | 61,186 | |
Intangible
assets – net as of September 30, 2023 and December 31, 2022 consist of the following:
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Contracts and
relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 27,343 | | |
| 21,547 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other
intangible assets | |
| 8,417 | | |
| 8,415 | |
Total
intangible assets | |
| 84,593 | | |
| 78,795 | |
Less:
Accumulated amortization | |
| 57,904 | | |
| 49,275 | |
Intangible
assets - net | |
$ | 26,689 | | |
$ | 29,520 | |
Capitalized
software represents payroll and development costs incurred for internally developed software. Other intangible assets primarily represent
purchased intangibles. Amortization expense was approximately $8.8 million and $7.3 million for the nine months ended September 30, 2023
and 2022. The weighted-average amortization period is three years.
As
of September 30, 2023, future amortization is scheduled to be expensed as follows:
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years
ending December 31, | |
($
in thousands) | |
2023 (three months) | |
$ | 3,740 | |
2024 | |
| 10,960 | |
2025 | |
| 7,719 | |
2026 | |
| 3,220 | |
2027 | |
| 300 | |
Thereafter | |
| 750 | |
Total | |
$ | 26,689 | |
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 and nine months
ended September 30, 2023 and 2022:
SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands,
except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | | |
| | | |
| | |
Net
loss attributable to common shareholders | |
$ | (6,665 | ) | |
$ | (2,793 | ) | |
$ | (16,739 | ) | |
$ | (6,729 | ) |
Weighted-average
common shares used to compute basic and diluted loss per share | |
| 15,760,499 | | |
| 15,148,721 | | |
| 15,600,361 | | |
| 15,070,913 | |
Net
loss attributable to common shareholders per share - basic and diluted | |
$ | (0.42 | ) | |
$ | (0.18 | ) | |
$ | (1.07 | ) | |
$ | (0.45 | ) |
At
September 30, 2023, the 758,160 unvested equity restricted stock units (“RSUs”) as discussed in Note 11 have been excluded
from the above calculations as they were anti-dilutive. At September 30, 2022, the 480,526 unvested equity RSUs and 1,253,489 unexercised
warrants 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. DEBT
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 increased from the prime rate plus 1.50%
to the prime rate plus 2.00%.
The requirement for the minimum liquidity ratio was slightly reduced. The amendments expire March 31, 2024 and the credit facility
reverts to its previous terms.
As
of September 30, 2023 and December 31, 2022, there was $12
million and $8
million, respectively, of borrowings under the credit facility. Interest on the revolving line of credit is currently charged at the
prime rate plus 2.00%. 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 September 30, 2023, the remaining
borrowing base was approximately $3.3 million. During October 2023, $2 million of the outstanding credit line was repaid,
which similarly increased the borrowing base to approximately $5.3 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 September 30, 2023 and December 31, 2022, 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 September 30, 2023 and December 31,
2022, the Company held cash of approximately $71,000 and $1.8 million, 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 Notes — The Company financed certain vehicle purchases in the United States. The vehicle financing notes have six
year terms and were 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 8.56%.
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 consolidated balance sheets as of September 30, 2023 and December 31, 2022. 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 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 and nine months ended September 30, 2023, there were approximately $5,000 and $168,000, respectively,
of unoccupied lease charges for two of the Company’s facilities. During the three and nine months ended September 30, 2022, there
were approximately $257,000 and $786,000, respectively, of unoccupied lease charges. During the nine months ended September 30, 2022,
there was a gain on lease termination of approximately $105,000.
During
the nine months ended September 30, 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 $2,000 and $73,000 for the
three and nine months ended September 30, 2023, respectively, were incurred as a result of vacating the former premises. During the three
and nine months ended September 30, 2022, a facility lease was terminated in conjunction with the Company ceasing its document storage
services resulting in additional costs of approximately $51,000 and $248,000, respectively. This termination of lease resulted in additional
costs for the three and nine months ended September 30, 2023, of approximately $1,000 and $162,000, respectively. In addition, during
the nine months ended September 30, 2023, the Company paid approximately $27,000 to settle a claim regarding a lease termination in India.
These amounts are included in net loss on lease terminations and unoccupied lease charges in the consolidated statements of operations.
Lease
expense is included in direct operating costs, general and administrative expense, selling and marketing expense and research and development
expense in the consolidated statements of operations based on the nature of the expense. Our lease terms are determined taking into account
lease renewal options, the Company’s anticipated operating plans and leases that are on a month-to-month basis. The Company also
has some related party leases – see Note 8.
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Operating lease
cost | |
$ | 599 | | |
$ | 921 | | |
$ | 1,998 | | |
$ | 2,798 | |
Short-term lease cost | |
| - | | |
| 4 | | |
| - | | |
| 79 | |
Variable
lease cost | |
| 7 | | |
| 5 | | |
| 26 | | |
| 24 | |
Total
- net lease cost | |
$ | 606 | | |
$ | 930 | | |
$ | 2,024 | | |
$ | 2,901 | |
Short-term
lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2023 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
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,810 | | |
$ | 2,273 | |
Non-current operating lease liabilities | |
| 2,789 | | |
| 3,207 | |
Total operating lease liabilities | |
$ | 4,599 | | |
$ | 5,480 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 6,172 | | |
$ | 8,293 | |
Asset lease expense | |
| (1,618 | ) | |
| (3,286 | ) |
Foreign exchange loss | |
| (63 | ) | |
| (86 | ) |
ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 5.1 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 12.8 | % | |
| 7.9 | % |
Weighted average discount rate: Operating leases | |
| 12.8 | % | |
| 7.9 | % |
Supplemental
cash flow and other information related to leases is as follows:
SCHEDULE OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended
September 30, | | |
Nine
Months Ended
September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 802 | | |
$ | 1,228 | | |
$ | 2,463 | | |
$ | 3,598 | |
| |
| | | |
| | | |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 532 | | |
$ | 71 | | |
$ | 1,252 | | |
$ | 513 | |
Maturities
of lease liabilities are as follows:
SCHEDULE OF MATURITIES OF LEASE LIABILITIES
Operating leases - Years ending December 31, | |
($ in thousands) | |
2023 (three months) | |
$ | 708 | |
2024 | |
| 1,998 | |
2025 | |
| 1,263 | |
2026 | |
| 501 | |
2027 | |
| 374 | |
Thereafter | |
| 1,718 | |
Total lease payments | |
| 6,562 | |
Less: imputed interest | |
| (1,963 | ) |
Total lease obligations | |
| 4,599 | |
Less: current obligations | |
| (1,810 | ) |
Long-term lease obligations | |
$ | 2,789 | |
7. COMMITMENTS AND CONTINGENCIES
Legal
Proceedings — On December 9, 2022, an arbitrator rendered a decision in favor of MTBC Acquisition Corp. (“MAC”)
and dismissed the claims brought against MAC by Randolph Pain Relief and Wellness Center (“RPRWC”), determining that RPRWC
failed to prove any breach of the applicable billing services agreement and failed to prove that any alleged damages were due. The deadline
for RPRWC to file a summary action in Superior Court of New Jersey seeking to overturn the arbitrator’s decision was April 5, 2023
and no summary action was filed by such deadline. As such, the arbitrator’s decision dismissing RPRWC’s claims is final.
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
$36,000 and $5,000 for the three months ended September 30, 2023 and 2022, respectively, and $86,000 and $16,000 for the nine months
ended September 30, 2023 and 2022, respectively. As of both September 30, 2023, and December 31, 2022, the accounts receivable balance
due from this customer was approximately $13,000, and is included in accounts receivable - net in the consolidated balance sheets.
The
Company leases its corporate office in New Jersey, a temporary housing apartment for foreign visitors, a storage facility, its
operations center in Bagh, Pakistan and an apartment for temporary housing in Dubai, the UAE, from the Executive Chairman. The
related party rent expense for the three months ended September 30, 2023 and 2022 was approximately $69,000
and $49,000,
respectively, and was approximately $186,000
and $149,000
for the nine months ended September 30, 2023 and 2022, respectively, and is included in direct operating costs, general and
administrative expense, selling and marketing expense and research and development expense in the consolidated statements of
operations. During the nine months ended September 30, 2023 and 2022, the Company spent approximately $1.8
million and $633,000
to upgrade the related party leased facilities. During the nine months ended September 30, 2023 and 2022, the Company temporarily
advanced the Executive Chairman approximately $330,000
and $42,000,
respectively, 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 local individuals are allowed to purchase land in this region. Current
assets-related party in the 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 September 30, 2023 and December 31, 2022. Also at September 30, 2023, there is approximately $34,000
included in current assets-related party as a result of an advance to the Executive Chairman for the purchase of vacant land
surrounding the Bagh facility for the benefit of the Company. All amounts advanced were subsequently repaid
shortly after the advance was made. 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 September 30, 2023 is approximately $388,000 applicable to the related party leases. Included in the current and
non-current operating lease liability at September 30, 2023 is approximately $207,000 and $172,000, respectively, applicable to the related
party leases.
Included
in the ROU asset at December 31, 2022 is approximately $467,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at December 31, 2022 is approximately $158,000 and $301,000, 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 will receive 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 consolidated
statement of operations. All such shares of the Series B Preferred Stock are or will be 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 September 30, 2023.
9. SHAREHOLDERS’ EQUITY
The
Company has the right to sell up to $35 million of its Series B Preferred Stock using its preferred stock at-the-market facility (“ATM”).
The underwriter receives 3% of the gross proceeds. During the nine months ended September 30, 2023, the Company sold 59,773 shares of
Series B Preferred Stock and received net proceeds of approximately $1.4 million under this ATM facility. The Company also has the right
to sell up to $50 million of its common stock using a common stock ATM facility. The underwriters of the common stock ATM also receive
3% of the gross proceeds. During the nine months ended September 30, 2023, no shares of common stock were issued under this ATM.
During
the nine months ended September 30, 2022, the Company sold 1,299,216 shares of Series B Preferred Stock and received net proceeds of
approximately $30.3 million. This includes 198,406 shares sold under the Company’s ATM facility. On March 18, 2022, the Company
used a portion of these proceeds to redeem 800,000 shares of the Company’s 11% Series A Cumulative Redeemable Perpetual Preferred
Stock (“Series A Preferred Stock”) for $25.00 per share, plus all accrued and unpaid dividends to, but not including, the
redemption date.
10. 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 and nine months ended September 30, 2023 and 2022:
SCHEDULE
OF DISAGGREGATION OF REVENUE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 18,763 | | |
$ | 21,626 | | |
$ | 57,878 | | |
$ | 68,457 | |
Professional services | |
| 5,691 | | |
| 7,434 | | |
| 17,755 | | |
| 25,572 | |
Printing and mailing services | |
| 749 | | |
| 594 | | |
| 2,149 | | |
| 1,515 | |
Group purchasing services | |
| 389 | | |
| 310 | | |
| 749 | | |
| 602 | |
Medical Practice Management: | |
| | | |
| | | |
| | | |
| | |
Medical practice management services | |
| 3,688 | | |
| 3,759 | | |
| 10,112 | | |
| 10,146 | |
Total | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
Revenues | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
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.
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 mid-2022, include chronic care management, where a care manager conducts remote
visits with patients with one or more chronic conditions under the supervision of a physician who is our client. It also includes remote
patient monitoring where our system monitors recordings from FDA-approved internet connected devices. These devices record patient trends
and alerts the physician to changes which might trigger the need for additional follow-up visits. The performance obligation for chronic
care management is satisfied at a point in time once the patient receives the services. The performance obligation for remote patient
monitoring is satisfied over time as the patient receives the services. The revenue for these services for the three and nine months
ended September 30, 2023 was approximately $623,000 and $1.2 million, respectively. The revenue for these services was approximately
$24,000 and $30,000, for the three and nine months ended September 30, 2022, 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.
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, revenue is recognized over time, which is approximately one month,
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.
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 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 16 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 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 September 30, 2023, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management
performance obligations outstanding was approximately $4.6 million. We expect to recognize substantially all of the revenue for the remaining
performance obligations over the next three months. Approximately $331,000 of the contract asset represents revenue earned, not paid,
from the group purchasing services.
Amounts
that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end
of each month when the services have been provided. The contract asset includes our right to payment for services already transferred
to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue
cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives
payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group
purchasing services.
Changes
in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle
management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional
and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced
when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. The opening and closing balances
of the Company’s accounts receivable, contract asset and deferred revenue are as follows:
SCHEDULE
OF ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE
| |
Accounts
Receivable - Net | | |
Contract Asset | | |
Deferred Revenue (current) | | |
Deferred Revenue
(long term) | |
| |
($ in thousands) | |
Balance as of January 1, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (2,463 | ) | |
| 549 | | |
| 141 | | |
| 80 | |
Balance as of September 30, 2023 | |
$ | 12,310 | | |
$ | 4,948 | | |
$ | 1,527 | | |
$ | 422 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2022 | |
$ | 17,006 | | |
$ | 4,725 | | |
$ | 1,085 | | |
$ | 341 | |
(Decrease) increase, net | |
| (725 | ) | |
| (318 | ) | |
| 332 | | |
| 49 | |
Balance as of September 30, 2022 | |
$ | 16,281 | | |
$ | 4,407 | | |
$ | 1,417 | | |
$ | 390 | |
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 $543,000 and $692,000 at September 30, 2023 and 2022, respectively, and are included
in the other assets amounts in the consolidated balance sheets.
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 $186,000 as of January
1, 2023.
At
adoption, we segmented the accounts receivable population into pools based on their risk assessment. Risks related to trade accounts
receivable are a customer’s inability to pay or bankruptcy. Each pool was defined by their internal credit assessment and business
size. The pools are aligned with management’s review of financial performance. For the nine months ended September 30, 2023, no
adjustment to the pools was necessary.
We
utilize a loss-rate method to measure the expected credit loss for each pool. The loss rate is calculated using a three-year lookback
period of write-offs and adjustments, divided by the revenue for each pool by aging category, net of customer payments during that period.
We consider current and future economic conditions, internal forecasts, customer collection experience and credit memos issued during
the current period when assessing loss rates. We reviewed these factors and concluded that no adjustments should be made to the historical
loss rate data for the current quarter. In addition, the Company uses specific account identification in determining the total allowance
for expected credit losses. Trade receivables are written off only after the Company has exhausted all collection efforts.
Changes
in the allowance for expected credit losses for trade accounts receivable are presented in the table below:
SCHEDULE
OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS
| |
Nine Months Ended | | |
Year Ended | |
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 823 | | |
$ | 537 | |
Adoption of ASC 326 | |
| 186 | | |
| - | |
Provision | |
| 389 | | |
| 740 | |
Recoveries/adjustments | |
| 67 | | |
| 313 | |
Write-offs | |
| (468 | ) | |
| (767 | ) |
Ending balance | |
$ | 997 | | |
$ | 823 | |
11. STOCK-BASED COMPENSATION
During
2022, an additional 1,000,000 shares of common stock and 200,000 shares of Series B Preferred Stock were added to the Company’s
Amended and Restated 2014 Equity Incentive Plan (the “A&R Plan”) for future issuance. As of September 30, 2023, 500,427
shares of common stock and 38,000 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 2022, 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 2022. These shares were awarded in early 2023 based
on the achievement of the specified criteria.
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. For the three and nine months ended September
30, 2023, an expense of approximately $254,000 and $629,000, respectively, was recorded for these bonuses 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 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 nine months
ended September 30, 2023 and 2022:
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, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 1,056,453 | | |
| - | | |
| 62,000 | |
Vested | |
| (843,950 | ) | |
| - | | |
| (75,263 | ) |
Forfeited | |
| (58,388 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2023 | |
| 799,590 | | |
| - | | |
| 67,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2022 | |
| 418,039 | | |
| 34,000 | | |
| - | |
Granted | |
| 625,252 | | |
| - | | |
| 80,000 | |
Vested | |
| (426,299 | ) | |
| (34,000 | ) | |
| (10,000 | ) |
Forfeited | |
| (55,616 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2022 | |
| 561,376 | | |
| - | | |
| 70,000 | |
The
liability for the 41,430 cash-settled awards and the liability for withheld taxes in connection with the equity awards was approximately
$577,000 and $1.0 million at September 30, 2023 and December 31, 2022, respectively, and is included in accrued compensation in the consolidated
balance sheets. During the nine months ended September 30, 2022, approximately $13,000 was paid in connection with the cash-settled awards.
No amounts were paid in connection with cash-settled awards during the nine months ended September 30, 2023.
Stock-based
compensation expense
The
following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2023
and 2022:
SCHEDULE
OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
Stock-based compensation included in the | |
Three Months Ended September
30, | | |
Nine Months Ended September 30, | |
consolidated statements of operations: | |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | 271 | | |
$ | 247 | | |
$ | 659 | | |
$ | 665 | |
General and administrative | |
| 771 | | |
| 703 | | |
| 2,225 | | |
| 1,848 | |
Research and development | |
| 26 | | |
| 82 | | |
| 105 | | |
| 225 | |
Selling and marketing | |
| 141 | | |
| 296 | | |
| 794 | | |
| 661 | |
Total stock-based compensation expense | |
$ | 1,209 | | |
$ | 1,328 | | |
$ | 3,783 | | |
$ | 3,399 | |
12. INCOME TAXES
The
income tax expense for the three months ended September 30, 2023 was approximately $57,000 comprised of a current tax expense of $30,000,
a deferred tax expense of $17,000 and a foreign tax of $10,000. The income tax expense for the nine months ended September 30, 2023 was
approximately $204,000 comprised of a current tax expense of $94,000, a deferred tax expense of $81,000 and a foreign tax of $29,000.
The
income tax expense for the three months ended September 30, 2022 was approximately $55,000 comprised of a current tax expense of $20,000
and a deferred tax expense of $35,000. The income tax expense for the nine months ended September 30, 2022 was approximately $144,000
comprised of a current tax expense of $82,000 and a deferred tax expense of $62,000.
The
current income tax provision for the nine months ended September 30, 2023 and 2022 primarily relates to state minimum taxes and foreign
income taxes. The deferred tax provision for the three and nine months ended September 30, 2023 and 2022 relates to the book and tax
difference of amortization on indefinite-lived intangibles, primarily goodwill. To the extent allowable, the federal deferred tax provision
has been offset by the indefinite life net operating loss.
During
2022, it was determined that for the states that follow the federal rules regarding indefinite life net operating losses, the offset
to the state deferred tax liability was approximately $45,000. This amount was recorded as a deferred tax benefit during the second quarter
of 2022. Subsequently, the state deferred tax liability has been offset against the state net operating loss to the extent allowable.
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 September 30, 2023 and December
31, 2022.
13.
FAIR VALUE OF FINANCIAL INSTRUMENTS
The
fair values of assets and liabilities required to be measured at fair value are categorized based upon the level of judgement associated
with the inputs used to measure their value in one of the following three categories:
Level
1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities. We held no Level 1 financial instruments
at September 30, 2023 or December 31, 2022.
Level
2: Quoted prices for similar instruments in active markets with inputs that are observable, either directly or indirectly. Our Level
2 financial instruments include notes payable which are carried at cost and approximate fair value since the interest rates being charged
approximate market rates.
Level
3: Unobservable inputs are significant to the fair value of the asset or liability, and include situations where there is little, if
any, market activity for the asset or liability. Our Level 3 instruments include the fair value of contingent consideration related to
completed acquisitions. The fair value at September 30, 2022 is based on discounted cash flow analysis reflecting the likelihood of achieving
specified performance measure or events and captures the contractual nature of the contingencies, the passage of time and the associated
discount rate. As of September 30, 2022, the contingent consideration was valued using a Monte Carlo simulation model. There was no contingent
consideration recorded at September 30, 2023 or December 31, 2022 as the earn-out period ended November 30, 2022 and no amounts were
determined payable to the seller as they did not meet the contractual terms.
The
following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value
using significant unobservable inputs (Level 3):
SCHEDULE
OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION
| |
Fair Value Measurement
at Reporting Date Using Significant
Unobservable Inputs, Level 3 | |
| |
Nine Months Ended
September 30, | |
| |
2023 | | |
2022 | |
| |
($ in thousands) | |
Balance - January 1, | |
$ | - | | |
$ | 3,090 | |
Acquisitions | |
| - | | |
| - | |
Change in fair value | |
| - | | |
| (2,890 | ) |
Payments | |
| - | | |
| - | |
Balance - September 30, | |
$ | - | | |
$ | 200 | |
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, 2022 filed with the SEC
on March 2, 2023. 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 | |
| |
Nine Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate Expenses | | |
Total | |
Net revenue | |
$ | 78,531 | | |
$ | 10,112 | | |
$ | - | | |
$ | 88,643 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 46,003 | | |
| 7,840 | | |
| - | | |
| 53,843 | |
Selling and marketing | |
| 7,503 | | |
| 26 | | |
| - | | |
| 7,529 | |
General and administrative | |
| 8,466 | | |
| 1,362 | | |
| 6,690 | | |
| 16,518 | |
Research and development | |
| 3,523 | | |
| - | | |
| - | | |
| 3,523 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 10,013 | | |
| 269 | | |
| - | | |
| 10,282 | |
Loss on lease terminations and unoccupied lease charges | |
| 430 | | |
| - | | |
| - | | |
| 430 | |
Total operating expenses | |
| 75,938 | | |
| 9,497 | | |
| 6,690 | | |
| 92,125 | |
Operating income (loss) | |
$ | 2,593 | | |
$ | 615 | | |
$ | (6,690 | ) | |
$ | (3,482 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 25,592 | | |
$ | 3,688 | | |
$ | - | | |
$ | 29,280 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,369 | | |
| 2,891 | | |
| - | | |
| 18,260 | |
Selling and marketing | |
| 2,329 | | |
| 8 | | |
| - | | |
| 2,337 | |
General and administrative | |
| 2,719 | | |
| 466 | | |
| 2,297 | | |
| 5,482 | |
Research and development | |
| 1,260 | | |
| - | | |
| - | | |
| 1,260 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 3,814 | | |
| 89 | | |
| - | | |
| 3,903 | |
Loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| - | | |
| - | | |
| 8 | |
Total operating expenses | |
| 25,499 | | |
| 3,454 | | |
| 2,297 | | |
| 31,250 | |
Operating income (loss) | |
$ | 93 | | |
$ | 234 | | |
$ | (2,297 | ) | |
$ | (1,970 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Nine Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 96,146 | | |
$ | 10,146 | | |
$ | - | | |
$ | 106,292 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 56,878 | | |
| 7,988 | | |
| - | | |
| 64,866 | |
Selling and marketing | |
| 7,293 | | |
| 21 | | |
| - | | |
| 7,314 | |
General and administrative | |
| 10,213 | | |
| 1,312 | | |
| 6,954 | | |
| 18,479 | |
Research and development | |
| 3,251 | | |
| - | | |
| - | | |
| 3,251 | |
Change in contingent consideration | |
| (2,890 | ) | |
| - | | |
| - | | |
| (2,890 | ) |
Depreciation and amortization | |
| 8,420 | | |
| 266 | | |
| - | | |
| 8,686 | |
Net loss on lease terminations and unoccupied lease charges | |
| 928 | | |
| - | | |
| - | | |
| 928 | |
Total operating expenses | |
| 84,093 | | |
| 9,587 | | |
| 6,954 | | |
| 100,634 | |
Operating income (loss) | |
$ | 12,053 | | |
$ | 559 | | |
$ | (6,954 | ) | |
$ | 5,658 | |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 29,964 | | |
$ | 3,759 | | |
$ | - | | |
$ | 33,723 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 17,582 | | |
| 2,824 | | |
| - | | |
| 20,406 | |
Selling and marketing | |
| 2,496 | | |
| 8 | | |
| - | | |
| 2,504 | |
General and administrative | |
| 3,231 | | |
| 455 | | |
| 2,814 | | |
| 6,500 | |
Research and development | |
| 1,168 | | |
| - | | |
| - | | |
| 1,168 | |
Change in contingent consideration | |
| (1,660 | ) | |
| - | | |
| - | | |
| (1,660 | ) |
Depreciation and amortization | |
| 2,721 | | |
| 89 | | |
| - | | |
| 2,810 | |
Net loss on lease terminations and unoccupied lease charges | |
| 307 | | |
| - | | |
| - | | |
| 307 | |
Total operating expenses | |
| 25,845 | | |
| 3,376 | | |
| 2,814 | | |
| 32,035 | |
Operating income (loss) | |
$ | 4,119 | | |
$ | 383 | | |
$ | (2,814 | ) | |
$ | 1,688 | |
15. SUBSEQUENT
EVENTS
During
October 2023, the Company committed and began to effectively align resources with business priorities and improve profitability through
a reduction in its work force. A majority of the impacted employees will exit the Company in the fourth quarter of 2023.
Also
during October 2023, the Executive Chairman was advanced approximately $30,000
for the purchase of land surrounding the Bagh facility for the benefit of the Company. (See Note 8). This amount was
repaid within the month.
Item
2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The
following is a discussion of our consolidated financial condition and results of operations for the three and nine months ended September
30, 2023 and 2022, and other factors that are expected to affect our prospective financial condition. The following discussion and analysis
should be read together with our 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, 2022, filed with the SEC on March 2, 2023.
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.
COVID-19
Update
In
response to the COVID-19 pandemic, we implemented a business continuity plan to respond quickly and provide ongoing guidance so that
we could continue offering our clients uninterrupted products, services and support while also protecting our employees. We believe these
actions have been successful and that the pandemic, and our responses, have not significantly affected our financial results for the
nine months ended September 30, 2023.
Refer
to Part I, Item 1A. Risk Factors, Risks Related to Our Business in the Company’s Annual Report on Form 10-K filed with the SEC
on March 2, 2023 for further discussion of the potential impact of the COVID-19 pandemic on our business.
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 September 30, 2023 and December 31, 2022, the Company held cash of approximately $71,000
and $1.8 million, 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 September 30, 2023, the Company 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. 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 record (“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 (“RCM”) 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 (“EHR”), 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 (“PM”) 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; |
| ○ | Patient
Experience Management (“PXM”) 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. |
Our
professional services solutions can be categorized as follows:
| ● | 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 450 experienced health industry experts
throughout the United States. These experts are supported by our highly educated and specialized offshore workforce of approximately
3,500 team members that are approximately 13% 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, UAE and Sri Lanka together accounted for approximately 13% and 12% of total expenses for
the nine months ended September 30, 2023 and 2022, respectively. A significant portion of those foreign expenses were personnel-related
costs (approximately 77% and 80% for the nine months ended September 30, 2023 and 2022, 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, UAE 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:
|
● |
Income
tax expense 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 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; |
|
● |
Net
loss on lease terminations and unoccupied lease charges; and |
|
● |
Change
in contingent consideration. |
Set
forth below is a presentation of our adjusted EBITDA for the three and nine months ended September 30, 2023 and 2022:
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Net revenue | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
| |
| | | |
| | | |
| | | |
| | |
GAAP net (loss) income | |
| (2,749 | ) | |
| 1,056 | | |
| (4,982 | ) | |
| 4,933 | |
| |
| | | |
| | | |
| | | |
| | |
Provision for income taxes | |
| 57 | | |
| 55 | | |
| 204 | | |
| 144 | |
Net interest expense | |
| 300 | | |
| 82 | | |
| 705 | | |
| 281 | |
Foreign exchange loss / other expense | |
| 426 | | |
| 523 | | |
| 609 | | |
| 359 | |
Stock-based compensation expense | |
| 1,209 | | |
| 1,328 | | |
| 3,783 | | |
| 3,399 | |
Depreciation and amortization | |
| 3,903 | | |
| 2,810 | | |
| 10,282 | | |
| 8,686 | |
Transaction and integration costs | |
| 91 | | |
| 316 | | |
| 270 | | |
| 724 | |
Net loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| 307 | | |
| 430 | | |
| 928 | |
Change in contingent consideration | |
| - | | |
| (1,660 | ) | |
| - | | |
| (2,890 | ) |
Adjusted EBITDA | |
$ | 3,245 | | |
$ | 4,817 | | |
$ | 11,301 | | |
$ | 16,564 | |
Adjusted
operating income and adjusted operating margin exclude the following elements that are included in GAAP operating (loss) income:
|
● |
Stock-based
compensation 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 and unoccupied lease charges; and |
|
● |
Change
in contingent consideration. |
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 and nine months ended September 30, 2023 and 2022:
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Net revenue | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
| |
| | | |
| | | |
| | | |
| | |
GAAP net (loss) income | |
| (2,749 | ) | |
| 1,056 | | |
| (4,982 | ) | |
| 4,933 | |
Provision for income taxes | |
| 57 | | |
| 55 | | |
| 204 | | |
| 144 | |
Net interest expense | |
| 300 | | |
| 82 | | |
| 705 | | |
| 281 | |
Other expense - net | |
| 422 | | |
| 495 | | |
| 591 | | |
| 300 | |
GAAP operating (loss) income | |
| (1,970 | ) | |
| 1,688 | | |
| (3,482 | ) | |
| 5,658 | |
GAAP operating margin | |
| (6.7 | %) | |
| 5.0 | % | |
| (3.9 | %) | |
| 5.3 | % |
| |
| | | |
| | | |
| | | |
| | |
Stock-based compensation expense | |
| 1,209 | | |
| 1,328 | | |
| 3,783 | | |
| 3,399 | |
Amortization of purchased intangible assets | |
| 1,201 | | |
| 1,428 | | |
| 3,775 | | |
| 4,884 | |
Transaction and integration costs | |
| 91 | | |
| 316 | | |
| 270 | | |
| 724 | |
Net loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| 307 | | |
| 430 | | |
| 928 | |
Change in contingent consideration | |
| - | | |
| (1,660 | ) | |
| - | | |
| (2,890 | ) |
Non-GAAP adjusted operating income | |
$ | 539 | | |
$ | 3,407 | | |
$ | 4,776 | | |
$ | 12,703 | |
Non-GAAP adjusted operating margin | |
| 1.8 | % | |
| 10.1 | % | |
| 5.4 | % | |
| 12.0 | % |
Adjusted
net income and adjusted net income per share exclude the following elements which are included in GAAP net (loss) income:
|
● |
Foreign
currency gains and losses and other non-operating expenditures; |
|
● |
Stock-based
compensation 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 and unoccupied lease charges; |
|
● |
Change
in contingent consideration; and |
|
● |
Income
tax expense 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) income to non-GAAP adjusted net income for the three and nine months ended September 30, 2023 and 2022:
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
GAAP net (loss) income | |
$ | (2,749 | ) | |
$ | 1,056 | | |
$ | (4,982 | ) | |
$ | 4,933 | |
| |
| | | |
| | | |
| | | |
| | |
Foreign exchange loss / other expense | |
| 426 | | |
| 523 | | |
| 609 | | |
| 359 | |
Stock-based compensation expense | |
| 1,209 | | |
| 1,328 | | |
| 3,783 | | |
| 3,399 | |
Amortization of purchased intangible assets | |
| 1,201 | | |
| 1,428 | | |
| 3,775 | | |
| 4,884 | |
Transaction and integration costs | |
| 91 | | |
| 316 | | |
| 270 | | |
| 724 | |
Net loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| 307 | | |
| 430 | | |
| 928 | |
Change in contingent consideration | |
| - | | |
| (1,660 | ) | |
| - | | |
| (2,890 | ) |
Income tax expense related to goodwill | |
| 17 | | |
| 35 | | |
| 81 | | |
| 61 | |
Non-GAAP adjusted net income | |
$ | 203 | | |
$ | 3,333 | | |
$ | 3,966 | | |
$ | 12,398 | |
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 September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
GAAP net loss attributable to common shareholders, per share | |
$ | (0.42 | ) | |
$ | (0.18 | ) | |
$ | (1.07 | ) | |
$ | (0.45 | ) |
Impact of preferred stock dividend | |
| 0.25 | | |
| 0.25 | | |
| 0.76 | | |
| 0.78 | |
Net (loss) income per end-of-period share | |
| (0.17 | ) | |
| 0.07 | | |
| (0.31 | ) | |
| 0.33 | |
| |
| | | |
| | | |
| | | |
| | |
Foreign exchange loss / other expense | |
| 0.02 | | |
| 0.03 | | |
| 0.04 | | |
| 0.02 | |
Stock-based compensation expense | |
| 0.08 | | |
| 0.09 | | |
| 0.24 | | |
| 0.23 | |
Amortization of purchased intangible assets | |
| 0.07 | | |
| 0.09 | | |
| 0.23 | | |
| 0.31 | |
Transaction and integration costs | |
| 0.01 | | |
| 0.02 | | |
| 0.02 | | |
| 0.05 | |
Net loss on lease terminations and unoccupied lease charges | |
| 0.00 | | |
| 0.02 | | |
| 0.03 | | |
| 0.06 | |
Change in contingent consideration | |
| 0.00 | | |
| (0.11 | ) | |
| 0.00 | | |
| (0.19 | ) |
Income tax expense related to goodwill | |
| 0.00 | | |
| 0.00 | | |
| 0.00 | | |
| 0.00 | |
Non-GAAP adjusted earnings per share | |
$ | 0.01 | | |
$ | 0.21 | | |
$ | 0.25 | | |
$ | 0.81 | |
| |
| | | |
| | | |
| | | |
| | |
End-of-period common shares | |
| 15,857,650 | | |
| 15,211,136 | | |
| 15,857,650 | | |
| 15,211,136 | |
In-the-money warrants and outstanding unvested RSUs | |
| 758,160 | | |
| 605,526 | | |
| 758,160 | | |
| 605,526 | |
Total fully diluted shares | |
| 16,615,810 | | |
| 15,816,662 | | |
| 16,615,810 | | |
| 15,816,662 | |
Non-GAAP adjusted diluted earnings per share | |
$ | 0.01 | | |
$ | 0.21 | | |
$ | 0.24 | | |
$ | 0.78 | |
For
purposes of determining non-GAAP adjusted earnings per share, the Company used the number of common shares outstanding at the end of
September 30, 2023 and 2022. 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 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 September 30, 2023 and 2022, 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 64% of our revenues during both the three months ended September 30, 2023 and 2022, and 65% and 64% for the nine months
ended September 30, 2023 and 2022, respectively. Other healthcare IT services, including printing and mailing operations, group purchasing
and professional services, represented approximately 23% and 25% of revenues for the three months ended September 30, 2023 and 2022,
respectively, and 23% and 26% for the nine months ended September 30, 2023 and 2022, respectively.
We
earned approximately 13% and 12% of our revenue from medical practice management services during the three and nine months ended September
30, 2023, respectively, and approximately 11% and 10% during the three and nine months ended September 30, 2022, 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 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.
Change
in Contingent Consideration. Contingent consideration represents the portion of consideration payable to the sellers of some of our
acquisitions, the amount of which is based on the achievement of defined performance measures contained in the purchase agreements. Contingent
consideration is adjusted to fair value at the end of each reporting period.
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 and Unoccupied Lease Charges. 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. One of the leases that had unoccupied space ended
in February 2023. The Company was able to turn back to the landlord one of the other unused facilities effective January 1, 2022.
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 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 September 30, 2023 and December 31, 2022.
Critical
Accounting Policies and Estimates
The
critical accounting policies and estimates used in the preparation of our consolidated financial statements that we believe affect our
more significant judgments and estimates used in the preparation of our 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, 2022.
Capitalized
Software Costs:
As
of September 30, 2023 and December 31, 2022, the carrying amounts of internally-developed capitalized software in use was $17.6 million
and $16.6 million, respectively. The increase in the capitalized software costs represents the continued investment in proprietary technology.
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, 2022, filed with the SEC on March 2, 2023.
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 September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
Net revenue | |
| 100.0 | % | |
| 100.0 | % | |
| 100.0 | % | |
| 100.0 | % |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 62.4 | % | |
| 60.5 | % | |
| 60.7 | % | |
| 61.0 | % |
Selling and marketing | |
| 8.0 | % | |
| 7.4 | % | |
| 8.5 | % | |
| 6.9 | % |
General and administrative | |
| 18.7 | % | |
| 19.3 | % | |
| 18.6 | % | |
| 17.4 | % |
Research and development | |
| 4.3 | % | |
| 3.5 | % | |
| 4.0 | % | |
| 3.1 | % |
Change in contingent consideration | |
| 0.0 | % | |
| (4.9 | %) | |
| 0.0 | % | |
| (2.7 | %) |
Depreciation and amortization | |
| 13.3 | % | |
| 8.3 | % | |
| 11.6 | % | |
| 8.2 | % |
Net loss on lease terminations and unoccupied lease charges | |
| 0.0 | % | |
| 0.9 | % | |
| 0.5 | % | |
| 0.9 | % |
Total operating expenses | |
| 106.7 | % | |
| 95.0 | % | |
| 103.9 | % | |
| 94.8 | % |
| |
| | | |
| | | |
| | | |
| | |
Operating (loss) income | |
| (6.7 | %) | |
| 5.0 | % | |
| (3.9 | %) | |
| 5.2 | % |
| |
| | | |
| | | |
| | | |
| | |
Interest expense - net | |
| 1.0 | % | |
| 0.2 | % | |
| 0.8 | % | |
| 0.3 | % |
Other expense - net | |
| (1.4 | %) | |
| (1.5 | %) | |
| (0.7 | %) | |
| (0.3 | %) |
(Loss) income before provision for income taxes | |
| (9.1 | %) | |
| 3.3 | % | |
| (5.4 | %) | |
| 4.6 | % |
Income tax provision | |
| 0.2 | % | |
| 0.2 | % | |
| 0.2 | % | |
| 0.1 | % |
Net (loss) income | |
| (9.3 | %) | |
| 3.1 | % | |
| (5.6 | %) | |
| 4.5 | % |
Comparison
of the three and nine months ended September 30, 2023 and 2022:
| |
Three Months Ended
September 30, | | |
Change | | |
Nine
Months Ended
September 30, | | |
Change | |
| |
2023 | | |
2022 | | |
Amount | | |
Percent | | |
2023 | | |
2022 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Net revenue | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | (4,443 | ) | |
| (13 | %) | |
$ | 88,643 | | |
$ | 106,292 | | |
$ | (17,649 | ) | |
| (17 | %) |
Net
Revenue. Net revenue of $29.3 million and $88.6 million for the three and nine months ended September 30, 2023, respectively, decreased
by $4.4 million or 13% and $17.6 million or 17% from net revenue of $33.7 million and $106.3 million for the three and nine months ended
September 30, 2022, respectively. Revenue for the three and nine months ended September 30, 2023 includes $18.8 million and $57.9 million
relating to technology-enabled business solutions, $5.7 million and $17.8 million related to professional services and $3.7 million and
$10.1 million for medical practice management services, respectively.
There
was a $1.7 million and $7.8 million decrease in project-based professional services revenue for the three and nine months ended September
30, 2023 compared to the same periods in the prior year. The 2023 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 September 30, 2023 and 2022 was $0.7 million and $3.0 million, respectively. Revenue from these
customers for the nine months ended September 30, 2023 was $2.7 million, accounting for approximately $8.0 million of the decline in
revenue. Revenue from these customers is expected to be approximately $0.3 million for the remainder of 2023. (Refer to Forward-Looking
Statements disclosure on page 2 of this Form 10-Q.)
| |
Three Months Ended
September 30, | | |
Change | | |
Nine
Months Ended
September
30, | | |
Change | |
| |
2023 | | |
2022 | | |
Amount | | |
Percent | | |
2023 | | |
2022 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Direct operating costs | |
$ | 18,260 | | |
$ | 20,406 | | |
$ | (2,146 | ) | |
| (11 | %) | |
$ | 53,843 | | |
$ | 64,866 | | |
$ | (11,023 | ) | |
| (17 | %) |
Selling and marketing | |
| 2,337 | | |
| 2,504 | | |
| (167 | ) | |
| (7 | %) | |
| 7,529 | | |
| 7,314 | | |
| 215 | | |
| 3 | % |
General and administrative | |
| 5,482 | | |
| 6,500 | | |
| (1,018 | ) | |
| (16 | %) | |
| 16,518 | | |
| 18,479 | | |
| (1,961 | ) | |
| (11 | %) |
Research and development | |
| 1,260 | | |
| 1,168 | | |
| 92 | | |
| 8 | % | |
| 3,523 | | |
| 3,251 | | |
| 272 | | |
| 8 | % |
Change in contingent consideration | |
| - | | |
| (1,660 | ) | |
| 1,660 | | |
| 100 | % | |
| - | | |
| (2,890 | ) | |
| 2,890 | | |
| 100 | % |
Depreciation | |
| 493 | | |
| 474 | | |
| 19 | | |
| 4 | % | |
| 1,496 | | |
| 1,405 | | |
| 91 | | |
| 6 | % |
Amortization | |
| 3,410 | | |
| 2,336 | | |
| 1,074 | | |
| 46 | % | |
| 8,786 | | |
| 7,281 | | |
| 1,505 | | |
| 21 | % |
Net loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| 307 | | |
| (299 | ) | |
| (97 | %) | |
| 430 | | |
| 928 | | |
| (498 | ) | |
| (54 | %) |
Total operating expenses | |
$ | 31,250 | | |
$ | 32,035 | | |
$ | (785 | ) | |
| (2 | %) | |
$ | 92,125 | | |
$ | 100,634 | | |
$ | (8,509 | ) | |
| (8 | %) |
Direct
Operating Costs. Direct operating costs of $18.3 million and $53.8 million for the three and nine months ended September 30,
2023, respectively, decreased by $2.1 million or 11% and $11.0 million or 17% compared to direct operating costs of $20.4 million
and $64.9 million for the three and nine months ended September 30, 2022, respectively. During the three and nine months ended
September 30, 2023, salary costs decreased by $1.4 million and $7.4 million, outsourcing and processing costs decreased by $762,000
and $3.0 million and other costs such as medical supplies, vaccines, rent and consultancy fees decreased by $142,000 and $736,000,
respectively. The decrease in the salary costs was due to the decrease in the Pakistan exchange rate, a decrease in the U.S.
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 nine months ended September 30, 2023.
Selling
and Marketing Expense. Selling and marketing expense of $2.3 million and $7.5 million for the three and nine months ended September
30, 2023, respectively, decreased by $167,000 or 7% and increased by $215,000 or 3% from selling and marketing expense of $2.5 million
and $7.3 million for the three and nine months ended September 30, 2022, respectively. The decrease for the three months ended September 30, 2023 was due
to lower spending on selling and marketing activities.
General
and Administrative Expense. General and administrative expense of $5.5 million and $16.5 million for the three and nine months
ended September 30, 2023, respectively, decreased by $1.0 million or 16% and $2.0 million or 11% compared to general and
administrative expense of $6.5 million and $18.5 million for the three and nine months ended September 30, 2022, respectively.
During the three and nine months ended September 30, 2023, salary costs decreased by $292,000 and $1.4 million, computer expenses
decreased by $89,000 and $314,000 and provision for doubtful accounts decreased by $48,000 and $327,000, respectively. The decrease
in salary costs was due to lower headcount and a favorable change in foreign exchange rates. 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 $1.3 million and $3.5 million for the three and nine months ended
September 30, 2023, respectively, increased by approximately $92,000 or 8% and $272,000 or 8% from research and development expense
of $1.2 million and $3.3 million for the three and nine months ended September 30, 2022, respectively. The increase was due to the
redeployment of employees performing functions that were previously classified as direct operating costs to functions classified as
research and development expense which was offset by a decrease in the U.S. headcount. During the nine months ended September 30,
2023 and 2022, the Company capitalized approximately $6.6 million and $7.0 million, respectively, of development costs in connection
with its internal-use software.
Change
in Contingent Consideration. There was no change in contingent consideration during the nine months ended September 30, 2023 as the
balance of contingent consideration was $0 at December 31, 2022. The change of $1.7 million and $2.9 million for the three and nine months
ended September 30, 2022, respectively, reflected the estimated decrease in the fair value of the contingent consideration from the medSR
acquisition.
Depreciation.
Depreciation of $493,000 and $1.5 million for the three and nine months ended September 30, 2023, respectively, increased by $19,000
or 4% and $91,000 or 6% from the depreciation of $474,000 and $1.4 million for the three and nine months ended September 30, 2022, respectively.
Amortization
Expense. Amortization expense of $3.4 million and $8.8 million for the three and nine months ended September 30, 2023, respectively,
increased by $1.1 million or 46% and $1.5 million or 21% from amortization expense of $2.3 million and $7.3 million for the three and
nine months ended September 30, 2022, respectively. The increase in amortization expense was due to placing certain internal-use software
into production and commencing amortization on that balance.
Net
Loss on Lease Terminations and Unoccupied Lease Charges. Net loss on lease terminations represents the write-off of leasehold improvements
and gains or losses as the result of lease terminations. During the nine months ended September 30, 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 $2,000 and $73,000 for the three and nine months ended September 30, 2023, respectively, 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 and nine months ended September 30, 2023, of $1,000
and $162,000, respectively. In addition, during the nine months ended September 30, 2023, the Company paid $27,000 to settle a claim
regarding a lease termination in India. 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. The Company was able to turn back to the landlord one of the unused
facilities effective January 1, 2022. Unoccupied lease charges for the three and nine months ended September 30, 2023 were $5,000 and
$168,000, respectively. During the three and nine months ended September 30, 2022, there were $257,000 and $786,000, respectively, of
unoccupied lease charges.
| |
Three Months Ended
September 30, | | |
Change | | |
Nine
Months Ended
September
30, | | |
Change | |
| |
2023 | | |
2022 | | |
Amount | | |
Percent | | |
2023 | | |
2022 | | |
Amount | | |
Percent | |
| |
($ in thousands) | |
Interest income | |
$ | 52 | | |
$ | 14 | | |
$ | 38 | | |
| 271 | % | |
$ | 124 | | |
$ | 22 | | |
$ | 102 | | |
| 464 | % |
Interest expense | |
| (352 | ) | |
| (96 | ) | |
| (256 | ) | |
| (267 | %) | |
| (829 | ) | |
| (303 | ) | |
| (526 | ) | |
| (174 | %) |
Other expense - net | |
| (422 | ) | |
| (495 | ) | |
| 73 | | |
| 15 | % | |
| (591 | ) | |
| (300 | ) | |
| (291 | ) | |
| (97 | %) |
Income tax provision | |
| 57 | | |
| 55 | | |
| 2 | | |
| 4 | % | |
| 204 | | |
| 144 | | |
| 60 | | |
| 42 | % |
Interest
Income. Interest income of $52,000 and $124,000 for the three and nine months ended September 30, 2023, respectively, increased by
$38,000 and $102,000 from interest income of $14,000 and $22,000 for the three and nine months ended September 30, 2022, respectively.
The interest income represents interest earned on temporary cash investments, which increased due to rising interest rates and late fees
from customers.
Interest
Expense. Interest expense of $352,000 and $829,000 for the three and nine months ended September 30, 2023, respectively, increased
by $256,000 and $526,000 from interest expense of $96,000 and $303,000 for the three and nine months ended September 30, 2022, respectively.
The increase in interest expense was due to the increased use of the line of credit. Interest expense includes the amortization of deferred
financing costs, which was $114,000 and $92,000 during the nine months ended September 30, 2023 and 2022, respectively.
Other
Expense – net. Other expense – net was $422,000 and $591,000 for the three and nine months ended September 30, 2023,
respectively, compared to other expense – net of $495,000 and $300,000 for the three and nine months ended September 30, 2022,
respectively. 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 consolidated statements of operations.
Income
Tax Provision. The provision for income taxes was $57,000 and $204,000 for the three and nine months ended September 30, 2023, respectively,
compared to the provision for income taxes of $55,000 and $144,000 for the three and nine months ended September 30, 2022, respectively.
As a result of the Company having certain net operating losses with an indefinite life under the current federal tax rules, the federal
deferred tax liability was offset against the federal net operating loss to the extent allowable in 2023 and 2022. During 2022, it was
determined that for the states that follow the federal rules regarding indefinite life net operating losses, the offset to the state
deferred tax liability was $45,000. This amount was recorded during the second quarter of 2022. Subsequently, the state deferred tax
liability has been offset against state net operating losses to the extent allowable.
The
current income tax expense for the three and nine months ended September 30, 2023 was approximately $40,000 and $123,000, respectively,
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 September 30, 2023 and December 31, 2022.
Liquidity
and Capital Resources
As
of September 30, 2023, the Company had total cash of $6.4 million and net working capital of $5.5 million. For the three and nine months
ended September 30, 2023, cash provided by operations was $4.3 million and $11.7 million, respectively, offset by cash used in investing
and financing activities of $5.8 million and $17.7 million, respectively, resulting in a decrease in cash of $1.3 million and $5.9 million,
respectively, after accounting for the effect of $0.2 million and $0.1 million, respectively, of exchange rate changes.
The
Company is currently looking at various ways to increase its revenue through organic growth via its current salesforce, which would generate
additional gross margin with no change to operating expenses. A number of clients have signed up for the new CareCloud Wellness offering,
and as this volume ramps up, it will generate additional margin. There is also significant effort being expended in increasing the professional
services business, where clients are charged “cost-plus,” generating additional margin. Concurrently, the Company is reviewing
its expenses and capital expenditures and has begun and will continue to reduce spending in non-critical areas, to reduce cash usage
even without additional revenue.
Additional
funding, if necessary, could come from the sale of the Company’s three public securities, i.e., sales of its common stock or one
or both of its two series of Nasdaq-listed preferred stock. There are active “at-the-market” facilities to sell common stock
and Series B preferred stock, and the Company can sell shares utilizing its existing shelf registration facility. Further, additional
capital could be obtained from the Company’s credit line since the amount drawn is less than the borrowing base and the Company
is in compliance with all covenants. Accordingly, we believe our cash on hand, our cash flows from operations and our ability to raise
capital, if necessary, will be sufficient to fund our operations for the next 12 months and beyond.
The
Company has a revolving line of credit, and as of September 30, 2023, there was $12 million outstanding of which $2 million was repaid
in early October 2023. As of September 30, 2023, the unused borrowing base was approximately $3.3 million. During the nine months ended
September 30, 2023, the Company sold 59,773 shares of 8.75% Series B Preferred Stock and raised $1.4 million in net proceeds after fees
and expenses.
The
following table summarizes our cash flows for the periods presented:
| |
Three Months Ended
September 30, | | |
Nine Months Ended
September 30, | | |
Change | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | | |
Amount | | |
Percent | |
| |
($ in thousands) | | |
| |
Net cash provided by operating activities | |
$ | 4,313 | | |
$ | 6,977 | | |
$ | 11,721 | | |
$ | 15,103 | | |
$ | (3,382 | ) | |
| (22 | %) |
Net cash used in investing activities | |
| (3,245 | ) | |
| (3,496 | ) | |
| (9,322 | ) | |
| (9,123 | ) | |
| (199 | ) | |
| (2 | %) |
Net cash used in financing activities | |
| (2,581 | ) | |
| (9,047 | ) | |
| (8,406 | ) | |
| (11,144 | ) | |
| 2,738 | | |
| 25 | % |
Effect of exchange rate changes on cash | |
| 253 | | |
| 213 | | |
| 114 | | |
| (309 | ) | |
| 423 | | |
| 137 | % |
Net decrease in cash and restricted cash | |
$ | (1,260 | ) | |
$ | (5,353 | ) | |
$ | (5,893 | ) | |
$ | (5,473 | ) | |
$ | (420 | ) | |
| (8 | %) |
The
loss before income taxes was $2.7 million and $4.8 million for the three and nine months ended September 30, 2023, respectively, which
included $3.9 million and $10.3 million of non-cash depreciation and amortization, respectively. The income before income taxes was $1.1
million and $5.1 million for the three and nine months ended September 30, 2022, respectively, which included $2.8 million and $8.7 million
of non-cash depreciation and amortization, respectively.
Operating
Activities
Net
cash provided by operating activities was $11.7 million and $15.1 million during the nine months ended September 30, 2023 and 2022, respectively.
This decrease was primarily the result of the decrease in net income of $9.9 million which included the following changes in non-cash
items: an increase in depreciation and amortization of $1.6 million and an increase in stock-based compensation of $384,000. The decrease
in the net income was partially offset by the change in accounts receivable which decreased by $1.9 million for the nine months ended
September 30, 2023, compared with a decrease of $10,000 for the nine months ended September 30, 2022. Accounts payable, accrued compensation
and accrued expenses decreased by $2.3 million during the nine months ended September 30, 2023, compared with a decrease of $4.3 million
for the nine months ended September 30, 2022. The contract asset increased by $867,000 during the nine months ended September 30, 2023
compared to the prior period.
Investing
Activities
Net
cash used in investing activities was $9.3 million and $9.1 million for the nine months ended September 30, 2023 and 2022, respectively.
Capital expenditures were $2.7 million and $2.1 million for the nine months ended September 30, 2023 and 2022, respectively. The capital
expenditures for the nine months ended September 30, 2023 and 2022 primarily represented computer equipment purchased and leasehold improvements
for the Pakistan Offices. Software development costs of $6.6 million and $7.0 million for the nine months ended September 30, 2023 and
2022, 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 $8.4 million and $11.1 million during the nine months ended September 30, 2023 and 2022, respectively.
Cash used in financing activities during the nine months ended September 30, 2023 included $11.7 million of preferred stock dividends,
$717,000 of repayments for debt obligations and $1.4 million of tax withholding obligations paid in connection with stock awards issued
to employees. During the nine months ended September 30, 2023, the Company sold 59,773 shares of Series B Preferred Stock and received
net proceeds of approximately $1.4 million. Cash used in financing activities during the nine months ended September 30, 2022 included
$11.5 million of preferred stock dividends, $769,000 of repayments for debt obligations and $1.1 million of tax withholding obligations
paid in connection with stock awards issued to employees. During the nine months ended September 30, 2022, the Company received net proceeds
from the sale of Series B Preferred Stock of $30.3 million of which $20.0 million was used to redeem 800,000 shares of Series A Preferred
Stock. Net proceeds and repayments on the line of credit were $4.0 million and $8.0 million, respectively, for the nine months ended
September 30, 2023 and 2022, respectively.
Contractual
Obligations and Commitments
We
have contractual obligations under our line of credit. We were in compliance with all covenants as of September 30, 2023. 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, 2022, filed with the SEC on March 2, 2023.
Off-Balance
Sheet Arrangements
As
of September 30, 2023, and 2022, 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 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 September 30, 2023 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 September 30, 2023, our Chief Executive Officer and 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 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 2, 2023, 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, Use of Proceeds, and Issuer Purchases of Equity Securities
Not
applicable.
Item
3. Defaults Upon Senior Securities
Not
applicable.
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:
November 2, 2023 |
|
|
|
|
By: |
/s/
Lawrence J. Steenvoorden |
|
|
Lawrence
J. Steenvoorden |
|
|
Chief
Financial Officer |
|
|
Date:
November 2, 2023 |
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: |
|
|
November
2, 2023 |
|
|
Exhibit
31.2
CERTIFICATION
OF PRINCIPAL FINANCIAL OFFICER
PURSUANT
TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002
I,
Lawrence J. Steenvoorden, 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/
Lawrence J. Steenvoorden |
|
|
Lawrence
J. Steenvoorden |
|
|
Chief
Financial Officer (Principal Financial Officer) |
|
|
|
Dated: |
|
|
November
2, 2023 |
|
|
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 September 30, 2023 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: |
|
|
November
2, 2023 |
|
|
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, Lawrence J. Steenvoorden, 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 September 30, 2023 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/
Lawrence J. Steenvoorden |
|
|
Lawrence
J. Steenvoorden |
|
|
Chief
Financial Officer (Principal Financial Officer) |
|
|
|
Dated: |
|
|
November
2, 2023 |
|
|
v3.23.3
Cover - shares
|
9 Months Ended |
|
Sep. 30, 2023 |
Oct. 27, 2023 |
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|
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|
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|
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Entity Registrant Name |
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|
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|
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|
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|
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|
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|
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|
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|
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v3.23.3
Consolidated Balance Sheets - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
Current assets: |
|
|
Cash |
$ 6,406
|
$ 12,299
|
Accounts receivable - net |
12,310
|
14,773
|
Contract asset |
4,948
|
4,399
|
Inventory |
478
|
381
|
Prepaid expenses and other current assets |
3,299
|
2,785
|
Total current assets |
27,491
|
34,653
|
Property and equipment - net |
5,319
|
5,056
|
Operating lease right-of-use assets |
4,491
|
4,921
|
Intangible assets - net |
26,689
|
29,520
|
Goodwill |
61,186
|
61,186
|
Other assets |
745
|
838
|
TOTAL ASSETS |
125,921
|
136,174
|
Current liabilities: |
|
|
Accounts payable |
6,243
|
5,681
|
Accrued compensation |
3,118
|
4,248
|
Accrued expenses |
4,629
|
4,432
|
Operating lease liability (current portion) |
1,810
|
2,273
|
Deferred revenue (current portion) |
1,527
|
1,386
|
Notes payable (current portion) |
490
|
319
|
Dividend payable |
4,125
|
4,059
|
Total current liabilities |
21,942
|
22,398
|
Notes payable |
10
|
13
|
Borrowings under line of credit |
12,000
|
8,000
|
Operating lease liability |
2,789
|
3,207
|
Deferred revenue |
422
|
342
|
Deferred tax liability |
606
|
525
|
Total liabilities |
37,769
|
34,485
|
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 September 30, 2023 and December 31, 2022. Series B, issued and outstanding 1,463,392 and 1,344,128 shares at September 30, 2023 and December 31, 2022, respectively |
6
|
6
|
Common stock, $0.001 par value - authorized 35,000,000 shares. Issued 16,598,449 and 15,970,204 shares at September 30, 2023 and December 31, 2022, respectively. Outstanding 15,857,650 and 15,229,405 shares at September 30, 2023 and December 31, 2022, respectively |
17
|
16
|
Additional paid-in capital |
123,872
|
130,987
|
Accumulated deficit |
(30,789)
|
(25,621)
|
Accumulated other comprehensive loss |
(4,292)
|
(3,037)
|
Less: 740,799 common shares held in treasury, at cost at September 30, 2023 and December 31, 2022 |
(662)
|
(662)
|
Total shareholders’ equity |
88,152
|
101,689
|
TOTAL LIABILITIES AND SHAREHOLDERS’ EQUITY |
125,921
|
136,174
|
Related Party [Member] |
|
|
Current assets: |
|
|
Current assets - related party |
$ 50
|
$ 16
|
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v3.23.3
Consolidated Balance Sheets (Parenthetical) - $ / shares
|
Sep. 30, 2023 |
Dec. 31, 2022 |
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 |
16,598,449
|
15,970,204
|
Common stock, shares, outstanding |
15,857,650
|
15,229,405
|
Treasury stock, 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 |
1,463,392
|
1,344,128
|
Preferred stock, shares outstanding |
1,463,392
|
1,344,128
|
X |
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v3.23.3
Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Income Statement [Abstract] |
|
|
|
|
NET REVENUE |
$ 29,280
|
$ 33,723
|
$ 88,643
|
$ 106,292
|
OPERATING EXPENSES: |
|
|
|
|
Direct operating costs |
18,260
|
20,406
|
53,843
|
64,866
|
Selling and marketing |
2,337
|
2,504
|
7,529
|
7,314
|
General and administrative |
5,482
|
6,500
|
16,518
|
18,479
|
Research and development |
1,260
|
1,168
|
3,523
|
3,251
|
Change in contingent consideration |
|
(1,660)
|
|
(2,890)
|
Depreciation and amortization |
3,903
|
2,810
|
10,282
|
8,686
|
Net loss on lease terminations and unoccupied lease charges |
8
|
307
|
430
|
928
|
Total operating expenses |
31,250
|
32,035
|
92,125
|
100,634
|
OPERATING (LOSS) INCOME |
(1,970)
|
1,688
|
(3,482)
|
5,658
|
OTHER: |
|
|
|
|
Interest income |
52
|
14
|
124
|
22
|
Interest expense |
(352)
|
(96)
|
(829)
|
(303)
|
Other expense - net |
(422)
|
(495)
|
(591)
|
(300)
|
(LOSS) INCOME BEFORE PROVISION FOR INCOME TAXES |
(2,692)
|
1,111
|
(4,778)
|
5,077
|
Income tax provision |
57
|
55
|
204
|
144
|
NET (LOSS) INCOME |
(2,749)
|
1,056
|
(4,982)
|
4,933
|
Preferred stock dividend |
3,916
|
3,849
|
11,757
|
11,662
|
NET LOSS ATTRIBUTABLE TO COMMON SHAREHOLDERS |
$ (6,665)
|
$ (2,793)
|
$ (16,739)
|
$ (6,729)
|
Net loss per common share: basic |
$ (0.42)
|
$ (0.18)
|
$ (1.07)
|
$ (0.45)
|
Net loss per common share: diluted |
$ (0.42)
|
$ (0.18)
|
$ (1.07)
|
$ (0.45)
|
Weighted-average common shares used to compute basic loss per share |
15,760,499
|
15,148,721
|
15,600,361
|
15,070,913
|
Weighted-average common shares used to compute diluted loss per share |
15,760,499
|
15,148,721
|
15,600,361
|
15,070,913
|
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v3.23.3
Consolidated Statements of Comprehensive (Loss) Income (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Income Statement [Abstract] |
|
|
|
|
|
NET (LOSS) INCOME |
|
$ (2,749)
|
$ 1,056
|
$ (4,982)
|
$ 4,933
|
OTHER COMPREHENSIVE INCOME (LOSS), NET OF TAX |
|
|
|
|
|
Foreign currency translation adjustment (a) |
[1] |
362
|
(537)
|
(1,255)
|
(1,782)
|
COMPREHENSIVE (LOSS) INCOME |
|
$ (2,387)
|
$ 519
|
$ (6,237)
|
$ 3,151
|
|
|
X |
- DefinitionAmount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income, attributable to parent entity. Excludes changes in equity resulting from investments by owners and distributions to owners.
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v3.23.3
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, 2021 |
|
$ 5
|
|
$ 16
|
$ 131,379
|
$ (31,053)
|
$ (1,754)
|
$ (662)
|
$ 97,931
|
|
Balance, shares at Dec. 31, 2021 |
|
5,299,227
|
|
15,657,641
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
1,140
|
|
|
1,140
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
(255)
|
|
(255)
|
|
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
22,319
|
|
145,809
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
|
887
|
|
|
|
887
|
|
Issuance of Series B Preferred Stock |
|
|
$ 1
|
|
26,637
|
|
|
|
26,638
|
|
Issuance of Series B Preferred Stock, shares |
|
|
1,150,372
|
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
(4,037)
|
|
|
|
(4,037)
|
|
Redemption of Series A Preferred Stock |
|
|
|
|
(20,000)
|
|
|
|
(20,000)
|
|
Redemption of series A preferred stock, shares |
|
(800,000)
|
|
|
|
|
|
|
|
|
Stock issuance costs |
|
|
|
|
(11)
|
|
|
|
(11)
|
|
Balance at Mar. 31, 2022 |
|
$ 5
|
$ 1
|
$ 16
|
134,855
|
(29,913)
|
(2,009)
|
(662)
|
102,293
|
|
Balance, shares at Mar. 31, 2022 |
|
4,521,546
|
1,150,372
|
15,803,450
|
|
|
|
|
|
|
Balance at Dec. 31, 2021 |
|
$ 5
|
|
$ 16
|
131,379
|
(31,053)
|
(1,754)
|
(662)
|
97,931
|
|
Balance, shares at Dec. 31, 2021 |
|
5,299,227
|
|
15,657,641
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
|
|
|
4,933
|
|
Foreign currency translation adjustment |
[1] |
|
|
|
|
|
|
|
(1,782)
|
|
Preferred stock dividends |
|
|
|
|
|
|
|
|
(11,662)
|
|
Balance at Sep. 30, 2022 |
|
$ 5
|
$ 1
|
$ 16
|
133,120
|
(26,120)
|
(3,536)
|
(662)
|
102,824
|
|
Balance, shares at Sep. 30, 2022 |
|
4,526,231
|
1,309,216
|
15,951,935
|
|
|
|
|
|
|
Balance at Dec. 31, 2021 |
|
$ 5
|
|
$ 16
|
131,379
|
(31,053)
|
(1,754)
|
(662)
|
97,931
|
|
Balance, shares at Dec. 31, 2021 |
|
5,299,227
|
|
15,657,641
|
|
|
|
|
|
|
Cumulative effect of adopting ASC 326 |
|
|
|
|
|
|
|
|
|
|
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
|
|
|
|
|
|
|
Balance at Mar. 31, 2022 |
|
$ 5
|
$ 1
|
$ 16
|
134,855
|
(29,913)
|
(2,009)
|
(662)
|
102,293
|
|
Balance, shares at Mar. 31, 2022 |
|
4,521,546
|
1,150,372
|
15,803,450
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
2,737
|
|
|
2,737
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
(990)
|
|
(990)
|
|
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
4,685
|
10,000
|
15,809
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
|
1,257
|
|
|
|
1,257
|
|
Issuance of Series B Preferred Stock |
|
|
|
|
1,223
|
|
|
|
1,223
|
|
Issuance of Series B Preferred Stock, shares |
|
|
49,876
|
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
(3,776)
|
|
|
|
(3,776)
|
|
Redemption of Series A Preferred Stock |
|
|
|
|
(5)
|
|
|
|
(5)
|
|
Stock issuance costs |
|
|
|
|
(10)
|
|
|
|
(10)
|
|
Balance at Jun. 30, 2022 |
|
$ 5
|
$ 1
|
$ 16
|
133,544
|
(27,176)
|
(2,999)
|
(662)
|
102,729
|
|
Balance, shares at Jun. 30, 2022 |
|
4,526,231
|
1,210,248
|
15,819,259
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
1,056
|
|
|
1,056
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
(537)
|
|
(537)
|
[1] |
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
|
|
132,676
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
|
1,017
|
|
|
|
1,017
|
|
Issuance of Series B Preferred Stock |
|
|
|
|
2,419
|
|
|
|
2,419
|
|
Issuance of Series B Preferred Stock, shares |
|
|
98,968
|
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
(3,849)
|
|
|
|
(3,849)
|
|
Stock issuance costs |
|
|
|
|
(11)
|
|
|
|
(11)
|
|
Balance at Sep. 30, 2022 |
|
$ 5
|
$ 1
|
$ 16
|
133,120
|
(26,120)
|
(3,536)
|
(662)
|
102,824
|
|
Balance, shares at Sep. 30, 2022 |
|
4,526,231
|
1,309,216
|
15,951,935
|
|
|
|
|
|
|
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, shares |
|
4,526,231
|
1,344,128
|
15,970,204
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
(401)
|
|
|
(401)
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
(1,711)
|
|
(1,711)
|
|
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
|
|
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
|
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
(3,931)
|
|
|
|
(3,931)
|
|
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
|
|
|
|
|
|
|
Cumulative effect of adopting ASC 326 |
|
|
|
|
|
|
|
|
(186)
|
|
Net income (loss) |
|
|
|
|
|
|
|
|
(4,982)
|
|
Foreign currency translation adjustment |
[1] |
|
|
|
|
|
|
|
(1,255)
|
|
Issuance of Series B Preferred Stock, shares |
|
|
59,773
|
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
|
|
|
|
(11,757)
|
|
Balance at Sep. 30, 2023 |
|
$ 5
|
$ 1
|
$ 17
|
123,872
|
(30,789)
|
(4,292)
|
(662)
|
88,152
|
|
Balance, shares at Sep. 30, 2023 |
|
4,526,231
|
1,463,392
|
16,598,449
|
|
|
|
|
|
|
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
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
(1,832)
|
|
|
(1,832)
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
94
|
|
94
|
|
Issuance of stock under the equity incentive plan |
|
|
|
|
|
|
|
|
|
|
Issuance of stock under the equity incentive plan, shares |
|
|
9,000
|
15,489
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
|
1,089
|
|
|
|
1,089
|
|
Shares issued for services |
|
|
|
|
|
|
|
|
|
|
Shares issued for services, shares |
|
|
|
20,000
|
|
|
|
|
|
|
Preferred stock dividends |
|
|
|
|
(3,910)
|
|
|
|
(3,910)
|
|
Balance at Jun. 30, 2023 |
|
$ 5
|
$ 1
|
$ 16
|
126,857
|
(28,040)
|
(4,654)
|
(662)
|
93,523
|
|
Balance, shares at Jun. 30, 2023 |
|
4,526,231
|
1,454,392
|
16,368,896
|
|
|
|
|
|
|
Net income (loss) |
|
|
|
|
|
(2,749)
|
|
|
(2,749)
|
|
Foreign currency translation adjustment |
|
|
|
|
|
|
362
|
|
362
|
[1] |
Issuance of stock under the equity incentive plan |
|
|
|
$ 1
|
|
|
|
|
1
|
|
Issuance of stock under the equity incentive plan, shares |
|
|
9,000
|
229,553
|
|
|
|
|
|
|
Stock-based compensation, net of cash settlements |
|
|
|
|
931
|
|
|
|
931
|
|
Preferred stock dividends |
|
|
|
|
(3,916)
|
|
|
|
(3,916)
|
|
Balance at Sep. 30, 2023 |
|
$ 5
|
$ 1
|
$ 17
|
$ 123,872
|
$ (30,789)
|
$ (4,292)
|
$ (662)
|
$ 88,152
|
|
Balance, shares at Sep. 30, 2023 |
|
4,526,231
|
1,463,392
|
16,598,449
|
|
|
|
|
|
|
|
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v3.23.3
Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
12 Months Ended |
Sep. 30, 2023 |
Mar. 31, 2023 |
Sep. 30, 2022 |
Mar. 31, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Dec. 31, 2022 |
OPERATING ACTIVITIES: |
|
|
|
|
|
|
|
Net (loss) income |
$ (2,749)
|
$ (401)
|
$ 1,056
|
$ 1,140
|
$ (4,982)
|
$ 4,933
|
|
Adjustments to reconcile net (loss) income to net cash provided by operating activities: |
|
|
|
|
|
|
|
Depreciation and amortization |
|
|
|
|
10,672
|
9,120
|
|
Lease amortization |
|
|
|
|
1,618
|
2,474
|
|
Deferred revenue |
|
|
|
|
221
|
381
|
|
Provision for doubtful accounts |
|
|
|
|
389
|
715
|
$ 740
|
Provision for deferred income taxes |
|
|
|
|
81
|
62
|
|
Foreign exchange loss |
|
|
|
|
596
|
238
|
|
Interest accretion |
|
|
|
|
493
|
460
|
|
Stock-based compensation expense |
1,209
|
|
1,328
|
|
3,783
|
3,399
|
|
Change in contingent consideration |
|
|
(1,660)
|
|
|
(2,890)
|
|
Changes in operating assets and liabilities: |
|
|
|
|
|
|
|
Accounts receivable |
|
|
|
|
1,889
|
10
|
|
Contract asset |
|
|
|
|
(549)
|
318
|
|
Inventory |
|
|
|
|
(97)
|
85
|
|
Other assets |
|
|
|
|
(117)
|
62
|
|
Accounts payable and other liabilities |
|
|
|
|
(2,276)
|
(4,264)
|
|
Net cash provided by operating activities |
|
|
|
|
11,721
|
15,103
|
|
INVESTING ACTIVITIES: |
|
|
|
|
|
|
|
Purchases of property and equipment |
|
|
|
|
(2,687)
|
(2,156)
|
|
Capitalized software |
|
|
|
|
(6,635)
|
(6,967)
|
|
Net cash used in investing activities |
|
|
|
|
(9,322)
|
(9,123)
|
|
FINANCING ACTIVITIES: |
|
|
|
|
|
|
|
Preferred stock dividends paid |
|
|
|
|
(11,691)
|
(11,478)
|
|
Settlement of tax withholding obligations on stock issued to employees |
|
|
|
|
(1,425)
|
(1,140)
|
|
Repayments of notes payable |
|
|
|
|
(717)
|
(769)
|
|
Stock issuance costs |
|
|
|
|
|
(32)
|
|
Proceeds from issuance of Series B Preferred Stock, net of expenses |
|
|
|
|
1,427
|
30,280
|
|
Redemption of Series A Preferred Stock |
|
|
|
|
|
(20,005)
|
|
Proceeds from line of credit |
|
|
|
|
14,700
|
17,500
|
|
Repayment of line of credit |
|
|
|
|
(10,700)
|
(25,500)
|
|
Net cash used in financing activities |
|
|
|
|
(8,406)
|
(11,144)
|
|
EFFECT OF EXCHANGE RATE CHANGES ON CASH |
|
|
|
|
114
|
(309)
|
|
NET DECREASE IN CASH AND RESTRICTED CASH |
|
|
|
|
(5,893)
|
(5,473)
|
|
CASH AND RESTRICTED CASH - Beginning of the period |
|
$ 12,299
|
|
$ 10,340
|
12,299
|
10,340
|
10,340
|
CASH AND RESTRICTED CASH - End of the period |
6,406
|
|
4,867
|
|
6,406
|
4,867
|
12,299
|
SUPPLEMENTAL NONCASH INVESTING AND FINANCING ACTIVITIES: |
|
|
|
|
|
|
|
Dividends declared, not paid |
$ 4,125
|
|
$ 4,040
|
|
4,125
|
4,040
|
$ 4,059
|
Purchase of prepaid insurance with assumption of note |
|
|
|
|
620
|
695
|
|
SUPPLEMENTAL INFORMATION - Cash paid during the period for: |
|
|
|
|
|
|
|
Income taxes |
|
|
|
|
131
|
128
|
|
Interest |
|
|
|
|
$ 630
|
$ 125
|
|
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v3.23.3
ORGANIZATION AND BUSINESS
|
9 Months Ended |
Sep. 30, 2023 |
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. During the second
quarter of 2023, the Company formed a wholly owned subsidiary, CareCloud ME Health Consultancy LLC, in the United Arab Emirates, which
has not yet begun operations.
|
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v3.23.3
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
|
9 Months Ended |
Sep. 30, 2023 |
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 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 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 September 30, 2023, the results of operations
for the three and nine months ended September 30, 2023 and 2022 and cash flows for the nine months ended September 30, 2023 and 2022.
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 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 consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated
financial statements for the year ended December 31, 2022, which are included in the Company’s Annual Report on Form 10-K, filed
with the SEC on March 2, 2023.
Significant
Accounting Policies — During the nine months ended September 30, 2023, there were no changes to the Company’s significant
accounting policies, other than the adoption of ASU 2016-13 discussed below, from its disclosures in the Annual Report on Form 10-K for
the year ended December 31, 2022, filed with the SEC on March 2, 2023.
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 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 delays 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 for the allowance related to accounts receivable was a charge
of approximately $186,000 and a corresponding increase to the allowance for doubtful accounts.
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. The Company does not expect this update to have a material impact on the consolidated financial statements.
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v3.23.3
GOODWILL AND INTANGIBLE ASSETS-NET
|
9 Months Ended |
Sep. 30, 2023 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
GOODWILL AND INTANGIBLE ASSETS-NET |
3. GOODWILL AND INTANGIBLE ASSETS-NET
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. During the three months ended September 30, 2023, the Company experienced
a decline in its market capitalization as a result of a sustained decrease in the Company’s stock price. The Company considered
the sustained decrease to represent a triggering event requiring management to perform a goodwill impairment test as of August 31,
2023.
Based
on the results of the goodwill impairment test as of August 31, 2023 and updated to September 30, 2023 for purposes of the fiscal quarter,
it was concluded that goodwill was not impaired. The conclusion was based upon the value determined using the discounted cash flow
method as supported by the guideline company transactions method and the guideline public company method.
The
following is the summary of the carrying amount of goodwill for the nine months ended September 30, 2023 and the year ended December
31, 2022:
SCHEDULE OF INTANGIBLE ASSETS AND GOODWILL
| |
Nine
Months Ended | | |
Year
Ended | |
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Beginning gross
balance | |
$ | 61,186 | | |
$ | 61,186 | |
Acquisitions | |
| - | | |
| - | |
Ending gross balance | |
$ | 61,186 | | |
$ | 61,186 | |
Intangible
assets – net as of September 30, 2023 and December 31, 2022 consist of the following:
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Contracts and
relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 27,343 | | |
| 21,547 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other
intangible assets | |
| 8,417 | | |
| 8,415 | |
Total
intangible assets | |
| 84,593 | | |
| 78,795 | |
Less:
Accumulated amortization | |
| 57,904 | | |
| 49,275 | |
Intangible
assets - net | |
$ | 26,689 | | |
$ | 29,520 | |
Capitalized
software represents payroll and development costs incurred for internally developed software. Other intangible assets primarily represent
purchased intangibles. Amortization expense was approximately $8.8 million and $7.3 million for the nine months ended September 30, 2023
and 2022. The weighted-average amortization period is three years.
As
of September 30, 2023, future amortization is scheduled to be expensed as follows:
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years
ending December 31, | |
($
in thousands) | |
2023 (three months) | |
$ | 3,740 | |
2024 | |
| 10,960 | |
2025 | |
| 7,719 | |
2026 | |
| 3,220 | |
2027 | |
| 300 | |
Thereafter | |
| 750 | |
Total | |
$ | 26,689 | |
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v3.23.3
NET LOSS PER COMMON SHARE
|
9 Months Ended |
Sep. 30, 2023 |
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 and nine months
ended September 30, 2023 and 2022:
SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands,
except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | | |
| | | |
| | |
Net
loss attributable to common shareholders | |
$ | (6,665 | ) | |
$ | (2,793 | ) | |
$ | (16,739 | ) | |
$ | (6,729 | ) |
Weighted-average
common shares used to compute basic and diluted loss per share | |
| 15,760,499 | | |
| 15,148,721 | | |
| 15,600,361 | | |
| 15,070,913 | |
Net
loss attributable to common shareholders per share - basic and diluted | |
$ | (0.42 | ) | |
$ | (0.18 | ) | |
$ | (1.07 | ) | |
$ | (0.45 | ) |
At
September 30, 2023, the 758,160 unvested equity restricted stock units (“RSUs”) as discussed in Note 11 have been excluded
from the above calculations as they were anti-dilutive. At September 30, 2022, the 480,526 unvested equity RSUs and 1,253,489 unexercised
warrants 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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v3.23.3
DEBT
|
9 Months Ended |
Sep. 30, 2023 |
Debt Disclosure [Abstract] |
|
DEBT |
5. DEBT
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 increased from the prime rate plus 1.50%
to the prime rate plus 2.00%.
The requirement for the minimum liquidity ratio was slightly reduced. The amendments expire March 31, 2024 and the credit facility
reverts to its previous terms.
As
of September 30, 2023 and December 31, 2022, there was $12
million and $8
million, respectively, of borrowings under the credit facility. Interest on the revolving line of credit is currently charged at the
prime rate plus 2.00%. 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 September 30, 2023, the remaining
borrowing base was approximately $3.3 million. During October 2023, $2 million of the outstanding credit line was repaid,
which similarly increased the borrowing base to approximately $5.3 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 September 30, 2023 and December 31, 2022, 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 September 30, 2023 and December 31,
2022, the Company held cash of approximately $71,000 and $1.8 million, 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 Notes — The Company financed certain vehicle purchases in the United States. The vehicle financing notes have six
year terms and were 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 8.56%.
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v3.23.3
LEASES
|
9 Months Ended |
Sep. 30, 2023 |
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 consolidated balance sheets as of September 30, 2023 and December 31, 2022. 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 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 and nine months ended September 30, 2023, there were approximately $5,000 and $168,000, respectively,
of unoccupied lease charges for two of the Company’s facilities. During the three and nine months ended September 30, 2022, there
were approximately $257,000 and $786,000, respectively, of unoccupied lease charges. During the nine months ended September 30, 2022,
there was a gain on lease termination of approximately $105,000.
During
the nine months ended September 30, 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 $2,000 and $73,000 for the
three and nine months ended September 30, 2023, respectively, were incurred as a result of vacating the former premises. During the three
and nine months ended September 30, 2022, a facility lease was terminated in conjunction with the Company ceasing its document storage
services resulting in additional costs of approximately $51,000 and $248,000, respectively. This termination of lease resulted in additional
costs for the three and nine months ended September 30, 2023, of approximately $1,000 and $162,000, respectively. In addition, during
the nine months ended September 30, 2023, the Company paid approximately $27,000 to settle a claim regarding a lease termination in India.
These amounts are included in net loss on lease terminations and unoccupied lease charges in the consolidated statements of operations.
Lease
expense is included in direct operating costs, general and administrative expense, selling and marketing expense and research and development
expense in the consolidated statements of operations based on the nature of the expense. Our lease terms are determined taking into account
lease renewal options, the Company’s anticipated operating plans and leases that are on a month-to-month basis. The Company also
has some related party leases – see Note 8.
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Operating lease
cost | |
$ | 599 | | |
$ | 921 | | |
$ | 1,998 | | |
$ | 2,798 | |
Short-term lease cost | |
| - | | |
| 4 | | |
| - | | |
| 79 | |
Variable
lease cost | |
| 7 | | |
| 5 | | |
| 26 | | |
| 24 | |
Total
- net lease cost | |
$ | 606 | | |
$ | 930 | | |
$ | 2,024 | | |
$ | 2,901 | |
Short-term
lease cost represents leases that were not capitalized as the lease term as of the later of January 1, 2023 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
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,810 | | |
$ | 2,273 | |
Non-current operating lease liabilities | |
| 2,789 | | |
| 3,207 | |
Total operating lease liabilities | |
$ | 4,599 | | |
$ | 5,480 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 6,172 | | |
$ | 8,293 | |
Asset lease expense | |
| (1,618 | ) | |
| (3,286 | ) |
Foreign exchange loss | |
| (63 | ) | |
| (86 | ) |
ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 5.1 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 12.8 | % | |
| 7.9 | % |
Weighted average discount rate: Operating leases | |
| 12.8 | % | |
| 7.9 | % |
Supplemental
cash flow and other information related to leases is as follows:
SCHEDULE OF SUPPLEMENTAL CASH FLOW AND OTHER INFORMATION RELATED TO LEASES
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended
September 30, | | |
Nine
Months Ended
September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 802 | | |
$ | 1,228 | | |
$ | 2,463 | | |
$ | 3,598 | |
| |
| | | |
| | | |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 532 | | |
$ | 71 | | |
$ | 1,252 | | |
$ | 513 | |
Maturities
of lease liabilities are as follows:
SCHEDULE OF MATURITIES OF LEASE LIABILITIES
Operating leases - Years ending December 31, | |
($ in thousands) | |
2023 (three months) | |
$ | 708 | |
2024 | |
| 1,998 | |
2025 | |
| 1,263 | |
2026 | |
| 501 | |
2027 | |
| 374 | |
Thereafter | |
| 1,718 | |
Total lease payments | |
| 6,562 | |
Less: imputed interest | |
| (1,963 | ) |
Total lease obligations | |
| 4,599 | |
Less: current obligations | |
| (1,810 | ) |
Long-term lease obligations | |
$ | 2,789 | |
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v3.23.3
COMMITMENTS AND CONTINGENCIES
|
9 Months Ended |
Sep. 30, 2023 |
Commitments and Contingencies Disclosure [Abstract] |
|
COMMITMENTS AND CONTINGENCIES |
7. COMMITMENTS AND CONTINGENCIES
Legal
Proceedings — On December 9, 2022, an arbitrator rendered a decision in favor of MTBC Acquisition Corp. (“MAC”)
and dismissed the claims brought against MAC by Randolph Pain Relief and Wellness Center (“RPRWC”), determining that RPRWC
failed to prove any breach of the applicable billing services agreement and failed to prove that any alleged damages were due. The deadline
for RPRWC to file a summary action in Superior Court of New Jersey seeking to overturn the arbitrator’s decision was April 5, 2023
and no summary action was filed by such deadline. As such, the arbitrator’s decision dismissing RPRWC’s claims is final.
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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v3.23.3
RELATED PARTIES
|
9 Months Ended |
Sep. 30, 2023 |
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
$36,000 and $5,000 for the three months ended September 30, 2023 and 2022, respectively, and $86,000 and $16,000 for the nine months
ended September 30, 2023 and 2022, respectively. As of both September 30, 2023, and December 31, 2022, the accounts receivable balance
due from this customer was approximately $13,000, and is included in accounts receivable - net in the consolidated balance sheets.
The
Company leases its corporate office in New Jersey, a temporary housing apartment for foreign visitors, a storage facility, its
operations center in Bagh, Pakistan and an apartment for temporary housing in Dubai, the UAE, from the Executive Chairman. The
related party rent expense for the three months ended September 30, 2023 and 2022 was approximately $69,000
and $49,000,
respectively, and was approximately $186,000
and $149,000
for the nine months ended September 30, 2023 and 2022, respectively, and is included in direct operating costs, general and
administrative expense, selling and marketing expense and research and development expense in the consolidated statements of
operations. During the nine months ended September 30, 2023 and 2022, the Company spent approximately $1.8
million and $633,000
to upgrade the related party leased facilities. During the nine months ended September 30, 2023 and 2022, the Company temporarily
advanced the Executive Chairman approximately $330,000
and $42,000,
respectively, 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 local individuals are allowed to purchase land in this region. Current
assets-related party in the 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 September 30, 2023 and December 31, 2022. Also at September 30, 2023, there is approximately $34,000
included in current assets-related party as a result of an advance to the Executive Chairman for the purchase of vacant land
surrounding the Bagh facility for the benefit of the Company. All amounts advanced were subsequently repaid
shortly after the advance was made. 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 September 30, 2023 is approximately $388,000 applicable to the related party leases. Included in the current and
non-current operating lease liability at September 30, 2023 is approximately $207,000 and $172,000, respectively, applicable to the related
party leases.
Included
in the ROU asset at December 31, 2022 is approximately $467,000 applicable to the related party leases. Included in the current and non-current
operating lease liability at December 31, 2022 is approximately $158,000 and $301,000, 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 will receive 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 consolidated
statement of operations. All such shares of the Series B Preferred Stock are or will be 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 September 30, 2023.
|
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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v3.23.3
SHAREHOLDERS’ EQUITY
|
9 Months Ended |
Sep. 30, 2023 |
Equity [Abstract] |
|
SHAREHOLDERS’ EQUITY |
9. SHAREHOLDERS’ EQUITY
The
Company has the right to sell up to $35 million of its Series B Preferred Stock using its preferred stock at-the-market facility (“ATM”).
The underwriter receives 3% of the gross proceeds. During the nine months ended September 30, 2023, the Company sold 59,773 shares of
Series B Preferred Stock and received net proceeds of approximately $1.4 million under this ATM facility. The Company also has the right
to sell up to $50 million of its common stock using a common stock ATM facility. The underwriters of the common stock ATM also receive
3% of the gross proceeds. During the nine months ended September 30, 2023, no shares of common stock were issued under this ATM.
During
the nine months ended September 30, 2022, the Company sold 1,299,216 shares of Series B Preferred Stock and received net proceeds of
approximately $30.3 million. This includes 198,406 shares sold under the Company’s ATM facility. On March 18, 2022, the Company
used a portion of these proceeds to redeem 800,000 shares of the Company’s 11% Series A Cumulative Redeemable Perpetual Preferred
Stock (“Series A Preferred Stock”) for $25.00 per share, plus all accrued and unpaid dividends to, but not including, the
redemption date.
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- DefinitionThe entire disclosure for equity.
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v3.23.3
REVENUE
|
9 Months Ended |
Sep. 30, 2023 |
Revenue from Contract with Customer [Abstract] |
|
REVENUE |
10. 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 and nine months ended September 30, 2023 and 2022:
SCHEDULE
OF DISAGGREGATION OF REVENUE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 18,763 | | |
$ | 21,626 | | |
$ | 57,878 | | |
$ | 68,457 | |
Professional services | |
| 5,691 | | |
| 7,434 | | |
| 17,755 | | |
| 25,572 | |
Printing and mailing services | |
| 749 | | |
| 594 | | |
| 2,149 | | |
| 1,515 | |
Group purchasing services | |
| 389 | | |
| 310 | | |
| 749 | | |
| 602 | |
Medical Practice Management: | |
| | | |
| | | |
| | | |
| | |
Medical practice management services | |
| 3,688 | | |
| 3,759 | | |
| 10,112 | | |
| 10,146 | |
Total | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
Revenues | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
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.
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 mid-2022, include chronic care management, where a care manager conducts remote
visits with patients with one or more chronic conditions under the supervision of a physician who is our client. It also includes remote
patient monitoring where our system monitors recordings from FDA-approved internet connected devices. These devices record patient trends
and alerts the physician to changes which might trigger the need for additional follow-up visits. The performance obligation for chronic
care management is satisfied at a point in time once the patient receives the services. The performance obligation for remote patient
monitoring is satisfied over time as the patient receives the services. The revenue for these services for the three and nine months
ended September 30, 2023 was approximately $623,000 and $1.2 million, respectively. The revenue for these services was approximately
$24,000 and $30,000, for the three and nine months ended September 30, 2022, 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.
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, revenue is recognized over time, which is approximately one month,
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.
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 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 16 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 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 September 30, 2023, the estimated revenue expected to be recognized in the future related to the remaining revenue cycle management
performance obligations outstanding was approximately $4.6 million. We expect to recognize substantially all of the revenue for the remaining
performance obligations over the next three months. Approximately $331,000 of the contract asset represents revenue earned, not paid,
from the group purchasing services.
Amounts
that we are entitled to collect under the applicable contract are recorded as accounts receivable. Invoicing is performed at the end
of each month when the services have been provided. The contract asset includes our right to payment for services already transferred
to a customer when the right to payment is conditional on something other than the passage of time. For example, contracts for revenue
cycle management services where we recognize revenue over time but do not have a contractual right to payment until the customer receives
payment of their claim from the insurance provider. The contract asset also includes the revenue accrued, not received, for the group
purchasing services.
Changes
in the contract asset are recorded as adjustments to net revenue. The changes primarily result from providing services to revenue cycle
management customers that result in additional consideration and are offset by our right to payment for services becoming unconditional
and changes in the revenue accrued for the group purchasing services. The contract asset for our group purchasing services is reduced
when we receive payments from vaccine manufacturers and is increased for revenue earned, not received. The opening and closing balances
of the Company’s accounts receivable, contract asset and deferred revenue are as follows:
SCHEDULE
OF ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE
| |
Accounts
Receivable - Net | | |
Contract Asset | | |
Deferred Revenue (current) | | |
Deferred Revenue
(long term) | |
| |
($ in thousands) | |
Balance as of January 1, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (2,463 | ) | |
| 549 | | |
| 141 | | |
| 80 | |
Balance as of September 30, 2023 | |
$ | 12,310 | | |
$ | 4,948 | | |
$ | 1,527 | | |
$ | 422 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2022 | |
$ | 17,006 | | |
$ | 4,725 | | |
$ | 1,085 | | |
$ | 341 | |
(Decrease) increase, net | |
| (725 | ) | |
| (318 | ) | |
| 332 | | |
| 49 | |
Balance as of September 30, 2022 | |
$ | 16,281 | | |
$ | 4,407 | | |
$ | 1,417 | | |
$ | 390 | |
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 $543,000 and $692,000 at September 30, 2023 and 2022, respectively, and are included
in the other assets amounts in the consolidated balance sheets.
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 $186,000 as of January
1, 2023.
At
adoption, we segmented the accounts receivable population into pools based on their risk assessment. Risks related to trade accounts
receivable are a customer’s inability to pay or bankruptcy. Each pool was defined by their internal credit assessment and business
size. The pools are aligned with management’s review of financial performance. For the nine months ended September 30, 2023, no
adjustment to the pools was necessary.
We
utilize a loss-rate method to measure the expected credit loss for each pool. The loss rate is calculated using a three-year lookback
period of write-offs and adjustments, divided by the revenue for each pool by aging category, net of customer payments during that period.
We consider current and future economic conditions, internal forecasts, customer collection experience and credit memos issued during
the current period when assessing loss rates. We reviewed these factors and concluded that no adjustments should be made to the historical
loss rate data for the current quarter. In addition, the Company uses specific account identification in determining the total allowance
for expected credit losses. Trade receivables are written off only after the Company has exhausted all collection efforts.
Changes
in the allowance for expected credit losses for trade accounts receivable are presented in the table below:
SCHEDULE
OF TRADE ALLOWANCE FOR DOUBTFUL ACCOUNTS
| |
Nine Months Ended | | |
Year Ended | |
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 823 | | |
$ | 537 | |
Adoption of ASC 326 | |
| 186 | | |
| - | |
Provision | |
| 389 | | |
| 740 | |
Recoveries/adjustments | |
| 67 | | |
| 313 | |
Write-offs | |
| (468 | ) | |
| (767 | ) |
Ending balance | |
$ | 997 | | |
$ | 823 | |
|
X |
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v3.23.3
STOCK-BASED COMPENSATION
|
9 Months Ended |
Sep. 30, 2023 |
Share-Based Payment Arrangement [Abstract] |
|
STOCK-BASED COMPENSATION |
11. STOCK-BASED COMPENSATION
During
2022, an additional 1,000,000 shares of common stock and 200,000 shares of Series B Preferred Stock were added to the Company’s
Amended and Restated 2014 Equity Incentive Plan (the “A&R Plan”) for future issuance. As of September 30, 2023, 500,427
shares of common stock and 38,000 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 2022, 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 2022. These shares were awarded in early 2023 based
on the achievement of the specified criteria.
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. For the three and nine months ended September
30, 2023, an expense of approximately $254,000 and $629,000, respectively, was recorded for these bonuses 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 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 nine months
ended September 30, 2023 and 2022:
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, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 1,056,453 | | |
| - | | |
| 62,000 | |
Vested | |
| (843,950 | ) | |
| - | | |
| (75,263 | ) |
Forfeited | |
| (58,388 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2023 | |
| 799,590 | | |
| - | | |
| 67,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2022 | |
| 418,039 | | |
| 34,000 | | |
| - | |
Granted | |
| 625,252 | | |
| - | | |
| 80,000 | |
Vested | |
| (426,299 | ) | |
| (34,000 | ) | |
| (10,000 | ) |
Forfeited | |
| (55,616 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2022 | |
| 561,376 | | |
| - | | |
| 70,000 | |
The
liability for the 41,430 cash-settled awards and the liability for withheld taxes in connection with the equity awards was approximately
$577,000 and $1.0 million at September 30, 2023 and December 31, 2022, respectively, and is included in accrued compensation in the consolidated
balance sheets. During the nine months ended September 30, 2022, approximately $13,000 was paid in connection with the cash-settled awards.
No amounts were paid in connection with cash-settled awards during the nine months ended September 30, 2023.
Stock-based
compensation expense
The
following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2023
and 2022:
SCHEDULE
OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
Stock-based compensation included in the | |
Three Months Ended September
30, | | |
Nine Months Ended September 30, | |
consolidated statements of operations: | |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | 271 | | |
$ | 247 | | |
$ | 659 | | |
$ | 665 | |
General and administrative | |
| 771 | | |
| 703 | | |
| 2,225 | | |
| 1,848 | |
Research and development | |
| 26 | | |
| 82 | | |
| 105 | | |
| 225 | |
Selling and marketing | |
| 141 | | |
| 296 | | |
| 794 | | |
| 661 | |
Total stock-based compensation expense | |
$ | 1,209 | | |
$ | 1,328 | | |
$ | 3,783 | | |
$ | 3,399 | |
|
X |
- DefinitionThe entire disclosure for share-based payment arrangement.
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v3.23.3
INCOME TAXES
|
9 Months Ended |
Sep. 30, 2023 |
Income Tax Disclosure [Abstract] |
|
INCOME TAXES |
12. INCOME TAXES
The
income tax expense for the three months ended September 30, 2023 was approximately $57,000 comprised of a current tax expense of $30,000,
a deferred tax expense of $17,000 and a foreign tax of $10,000. The income tax expense for the nine months ended September 30, 2023 was
approximately $204,000 comprised of a current tax expense of $94,000, a deferred tax expense of $81,000 and a foreign tax of $29,000.
The
income tax expense for the three months ended September 30, 2022 was approximately $55,000 comprised of a current tax expense of $20,000
and a deferred tax expense of $35,000. The income tax expense for the nine months ended September 30, 2022 was approximately $144,000
comprised of a current tax expense of $82,000 and a deferred tax expense of $62,000.
The
current income tax provision for the nine months ended September 30, 2023 and 2022 primarily relates to state minimum taxes and foreign
income taxes. The deferred tax provision for the three and nine months ended September 30, 2023 and 2022 relates to the book and tax
difference of amortization on indefinite-lived intangibles, primarily goodwill. To the extent allowable, the federal deferred tax provision
has been offset by the indefinite life net operating loss.
During
2022, it was determined that for the states that follow the federal rules regarding indefinite life net operating losses, the offset
to the state deferred tax liability was approximately $45,000. This amount was recorded as a deferred tax benefit during the second quarter
of 2022. Subsequently, the state deferred tax liability has been offset against the state net operating loss to the extent allowable.
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 September 30, 2023 and December
31, 2022.
|
X |
- DefinitionThe entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.
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v3.23.3
FAIR VALUE OF FINANCIAL INSTRUMENTS
|
9 Months Ended |
Sep. 30, 2023 |
Fair Value Disclosures [Abstract] |
|
FAIR VALUE OF FINANCIAL INSTRUMENTS |
13.
FAIR VALUE OF FINANCIAL INSTRUMENTS
The
fair values of assets and liabilities required to be measured at fair value are categorized based upon the level of judgement associated
with the inputs used to measure their value in one of the following three categories:
Level
1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities. We held no Level 1 financial instruments
at September 30, 2023 or December 31, 2022.
Level
2: Quoted prices for similar instruments in active markets with inputs that are observable, either directly or indirectly. Our Level
2 financial instruments include notes payable which are carried at cost and approximate fair value since the interest rates being charged
approximate market rates.
Level
3: Unobservable inputs are significant to the fair value of the asset or liability, and include situations where there is little, if
any, market activity for the asset or liability. Our Level 3 instruments include the fair value of contingent consideration related to
completed acquisitions. The fair value at September 30, 2022 is based on discounted cash flow analysis reflecting the likelihood of achieving
specified performance measure or events and captures the contractual nature of the contingencies, the passage of time and the associated
discount rate. As of September 30, 2022, the contingent consideration was valued using a Monte Carlo simulation model. There was no contingent
consideration recorded at September 30, 2023 or December 31, 2022 as the earn-out period ended November 30, 2022 and no amounts were
determined payable to the seller as they did not meet the contractual terms.
The
following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value
using significant unobservable inputs (Level 3):
SCHEDULE
OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION
| |
Fair Value Measurement
at Reporting Date Using Significant
Unobservable Inputs, Level 3 | |
| |
Nine Months Ended
September 30, | |
| |
2023 | | |
2022 | |
| |
($ in thousands) | |
Balance - January 1, | |
$ | - | | |
$ | 3,090 | |
Acquisitions | |
| - | | |
| - | |
Change in fair value | |
| - | | |
| (2,890 | ) |
Payments | |
| - | | |
| - | |
Balance - September 30, | |
$ | - | | |
$ | 200 | |
|
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- DefinitionThe entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.
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v3.23.3
SEGMENT REPORTING
|
9 Months Ended |
Sep. 30, 2023 |
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, 2022 filed with the SEC
on March 2, 2023. 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 | |
| |
Nine Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate Expenses | | |
Total | |
Net revenue | |
$ | 78,531 | | |
$ | 10,112 | | |
$ | - | | |
$ | 88,643 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 46,003 | | |
| 7,840 | | |
| - | | |
| 53,843 | |
Selling and marketing | |
| 7,503 | | |
| 26 | | |
| - | | |
| 7,529 | |
General and administrative | |
| 8,466 | | |
| 1,362 | | |
| 6,690 | | |
| 16,518 | |
Research and development | |
| 3,523 | | |
| - | | |
| - | | |
| 3,523 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 10,013 | | |
| 269 | | |
| - | | |
| 10,282 | |
Loss on lease terminations and unoccupied lease charges | |
| 430 | | |
| - | | |
| - | | |
| 430 | |
Total operating expenses | |
| 75,938 | | |
| 9,497 | | |
| 6,690 | | |
| 92,125 | |
Operating income (loss) | |
$ | 2,593 | | |
$ | 615 | | |
$ | (6,690 | ) | |
$ | (3,482 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 25,592 | | |
$ | 3,688 | | |
$ | - | | |
$ | 29,280 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,369 | | |
| 2,891 | | |
| - | | |
| 18,260 | |
Selling and marketing | |
| 2,329 | | |
| 8 | | |
| - | | |
| 2,337 | |
General and administrative | |
| 2,719 | | |
| 466 | | |
| 2,297 | | |
| 5,482 | |
Research and development | |
| 1,260 | | |
| - | | |
| - | | |
| 1,260 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 3,814 | | |
| 89 | | |
| - | | |
| 3,903 | |
Loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| - | | |
| - | | |
| 8 | |
Total operating expenses | |
| 25,499 | | |
| 3,454 | | |
| 2,297 | | |
| 31,250 | |
Operating income (loss) | |
$ | 93 | | |
$ | 234 | | |
$ | (2,297 | ) | |
$ | (1,970 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Nine Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 96,146 | | |
$ | 10,146 | | |
$ | - | | |
$ | 106,292 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 56,878 | | |
| 7,988 | | |
| - | | |
| 64,866 | |
Selling and marketing | |
| 7,293 | | |
| 21 | | |
| - | | |
| 7,314 | |
General and administrative | |
| 10,213 | | |
| 1,312 | | |
| 6,954 | | |
| 18,479 | |
Research and development | |
| 3,251 | | |
| - | | |
| - | | |
| 3,251 | |
Change in contingent consideration | |
| (2,890 | ) | |
| - | | |
| - | | |
| (2,890 | ) |
Depreciation and amortization | |
| 8,420 | | |
| 266 | | |
| - | | |
| 8,686 | |
Net loss on lease terminations and unoccupied lease charges | |
| 928 | | |
| - | | |
| - | | |
| 928 | |
Total operating expenses | |
| 84,093 | | |
| 9,587 | | |
| 6,954 | | |
| 100,634 | |
Operating income (loss) | |
$ | 12,053 | | |
$ | 559 | | |
$ | (6,954 | ) | |
$ | 5,658 | |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 29,964 | | |
$ | 3,759 | | |
$ | - | | |
$ | 33,723 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 17,582 | | |
| 2,824 | | |
| - | | |
| 20,406 | |
Selling and marketing | |
| 2,496 | | |
| 8 | | |
| - | | |
| 2,504 | |
General and administrative | |
| 3,231 | | |
| 455 | | |
| 2,814 | | |
| 6,500 | |
Research and development | |
| 1,168 | | |
| - | | |
| - | | |
| 1,168 | |
Change in contingent consideration | |
| (1,660 | ) | |
| - | | |
| - | | |
| (1,660 | ) |
Depreciation and amortization | |
| 2,721 | | |
| 89 | | |
| - | | |
| 2,810 | |
Net loss on lease terminations and unoccupied lease charges | |
| 307 | | |
| - | | |
| - | | |
| 307 | |
Total operating expenses | |
| 25,845 | | |
| 3,376 | | |
| 2,814 | | |
| 32,035 | |
Operating income (loss) | |
$ | 4,119 | | |
$ | 383 | | |
$ | (2,814 | ) | |
$ | 1,688 | |
|
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v3.23.3
SUBSEQUENT EVENTS
|
9 Months Ended |
Sep. 30, 2023 |
Subsequent Events [Abstract] |
|
SUBSEQUENT EVENTS |
15. SUBSEQUENT
EVENTS
During
October 2023, the Company committed and began to effectively align resources with business priorities and improve profitability through
a reduction in its work force. A majority of the impacted employees will exit the Company in the fourth quarter of 2023.
Also
during October 2023, the Executive Chairman was advanced approximately $30,000
for the purchase of land surrounding the Bagh facility for the benefit of the Company. (See Note 8). This amount was
repaid within the month.
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v3.23.3
BASIS OF PRESENTATION AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
|
9 Months Ended |
Sep. 30, 2023 |
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 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 delays 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 for the allowance related to accounts receivable was a charge
of approximately $186,000 and a corresponding increase to the allowance for doubtful accounts.
In
March 2023, the FASB issued ASU 2023-01, Leases (Topic 842): Common Control Arrangements – Issue 2. The amendments in this
update require that leasehold improvements associated with common control leases be: (1) amortized by the lessee over the useful life
of the leasehold improvements to the common control group as long as the lessee controls the use of the underlying asset through a lease
and (2) accounted for as a transfer between entities under common control through an adjustment to equity if, and when, the lessee no
longer controls the use of the underlying asset. The amendments in this update are effective for fiscal years beginning after December
15, 2023. The Company does not expect this update to have a material impact on the consolidated financial statements.
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v3.23.3
GOODWILL AND INTANGIBLE ASSETS-NET (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
SCHEDULE OF INTANGIBLE ASSETS AND GOODWILL |
The
following is the summary of the carrying amount of goodwill for the nine months ended September 30, 2023 and the year ended December
31, 2022:
SCHEDULE OF INTANGIBLE ASSETS AND GOODWILL
| |
Nine
Months Ended | | |
Year
Ended | |
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Beginning gross
balance | |
$ | 61,186 | | |
$ | 61,186 | |
Acquisitions | |
| - | | |
| - | |
Ending gross balance | |
$ | 61,186 | | |
$ | 61,186 | |
|
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS |
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS
| |
September
30, 2023 | | |
December
31, 2022 | |
| |
($ in thousands) | |
Contracts and
relationships acquired | |
$ | 47,597 | | |
$ | 47,597 | |
Capitalized software | |
| 27,343 | | |
| 21,547 | |
Non-compete agreements | |
| 1,236 | | |
| 1,236 | |
Other
intangible assets | |
| 8,417 | | |
| 8,415 | |
Total
intangible assets | |
| 84,593 | | |
| 78,795 | |
Less:
Accumulated amortization | |
| 57,904 | | |
| 49,275 | |
Intangible
assets - net | |
$ | 26,689 | | |
$ | 29,520 | |
|
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE |
As
of September 30, 2023, future amortization is scheduled to be expensed as follows:
SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS, FUTURE AMORTIZATION EXPENSE
Years
ending December 31, | |
($
in thousands) | |
2023 (three months) | |
$ | 3,740 | |
2024 | |
| 10,960 | |
2025 | |
| 7,719 | |
2026 | |
| 3,220 | |
2027 | |
| 300 | |
Thereafter | |
| 750 | |
Total | |
$ | 26,689 | |
|
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v3.23.3
NET LOSS PER COMMON SHARE (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
Earnings Per Share [Abstract] |
|
SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED |
The
following table reconciles the weighted-average shares outstanding for basic and diluted net loss per share for the three and nine months
ended September 30, 2023 and 2022:
SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands,
except share and per share amounts) | |
Basic and Diluted: | |
| | | |
| | | |
| | | |
| | |
Net
loss attributable to common shareholders | |
$ | (6,665 | ) | |
$ | (2,793 | ) | |
$ | (16,739 | ) | |
$ | (6,729 | ) |
Weighted-average
common shares used to compute basic and diluted loss per share | |
| 15,760,499 | | |
| 15,148,721 | | |
| 15,600,361 | | |
| 15,070,913 | |
Net
loss attributable to common shareholders per share - basic and diluted | |
$ | (0.42 | ) | |
$ | (0.18 | ) | |
$ | (1.07 | ) | |
$ | (0.45 | ) |
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v3.23.3
LEASES (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
Leases [Abstract] |
|
SCHEDULE OF LEASE EXPENSE |
The
components of lease expense were as follows:
SCHEDULE OF LEASE EXPENSE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three
Months Ended September 30, | | |
Nine
Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Operating lease
cost | |
$ | 599 | | |
$ | 921 | | |
$ | 1,998 | | |
$ | 2,798 | |
Short-term lease cost | |
| - | | |
| 4 | | |
| - | | |
| 79 | |
Variable
lease cost | |
| 7 | | |
| 5 | | |
| 26 | | |
| 24 | |
Total
- net lease cost | |
$ | 606 | | |
$ | 930 | | |
$ | 2,024 | | |
$ | 2,901 | |
|
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
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Operating leases: | |
| | | |
| | |
Operating lease ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Current operating lease liabilities | |
$ | 1,810 | | |
$ | 2,273 | |
Non-current operating lease liabilities | |
| 2,789 | | |
| 3,207 | |
Total operating lease liabilities | |
$ | 4,599 | | |
$ | 5,480 | |
| |
| | | |
| | |
Operating leases: | |
| | | |
| | |
ROU assets | |
$ | 6,172 | | |
$ | 8,293 | |
Asset lease expense | |
| (1,618 | ) | |
| (3,286 | ) |
Foreign exchange loss | |
| (63 | ) | |
| (86 | ) |
ROU assets, net | |
$ | 4,491 | | |
$ | 4,921 | |
| |
| | | |
| | |
Weighted average remaining lease term (in years): | |
| | | |
| | |
Operating leases | |
| 4.5 | | |
| 5.1 | |
Weighted average discount rate: | |
| | | |
| | |
Operating leases | |
| 12.8 | % | |
| 7.9 | % |
Weighted average discount rate: Operating leases | |
| 12.8 | % | |
| 7.9 | % |
|
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
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended
September 30, | | |
Nine
Months Ended
September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Cash paid for amounts included in the measurement of lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating cash flows from operating leases | |
$ | 802 | | |
$ | 1,228 | | |
$ | 2,463 | | |
$ | 3,598 | |
| |
| | | |
| | | |
| | | |
| | |
ROU assets obtained in exchange for lease liabilities: | |
| | | |
| | | |
| | | |
| | |
Operating leases, excluding impairments and terminations | |
$ | 532 | | |
$ | 71 | | |
$ | 1,252 | | |
$ | 513 | |
|
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) | |
2023 (three months) | |
$ | 708 | |
2024 | |
| 1,998 | |
2025 | |
| 1,263 | |
2026 | |
| 501 | |
2027 | |
| 374 | |
Thereafter | |
| 1,718 | |
Total lease payments | |
| 6,562 | |
Less: imputed interest | |
| (1,963 | ) |
Total lease obligations | |
| 4,599 | |
Less: current obligations | |
| (1,810 | ) |
Long-term lease obligations | |
$ | 2,789 | |
|
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v3.23.3
REVENUE (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
Revenue from Contract with Customer [Abstract] |
|
SCHEDULE OF DISAGGREGATION OF REVENUE |
The
following table represents a disaggregation of revenue for the three and nine months ended September 30, 2023 and 2022:
SCHEDULE
OF DISAGGREGATION OF REVENUE
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
Three Months Ended September 30, | | |
Nine Months Ended September 30, | |
| |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Healthcare IT: | |
| | | |
| | | |
| | | |
| | |
Technology-enabled business solutions | |
$ | 18,763 | | |
$ | 21,626 | | |
$ | 57,878 | | |
$ | 68,457 | |
Professional services | |
| 5,691 | | |
| 7,434 | | |
| 17,755 | | |
| 25,572 | |
Printing and mailing services | |
| 749 | | |
| 594 | | |
| 2,149 | | |
| 1,515 | |
Group purchasing services | |
| 389 | | |
| 310 | | |
| 749 | | |
| 602 | |
Medical Practice Management: | |
| | | |
| | | |
| | | |
| | |
Medical practice management services | |
| 3,688 | | |
| 3,759 | | |
| 10,112 | | |
| 10,146 | |
Total | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
Revenues | |
$ | 29,280 | | |
$ | 33,723 | | |
$ | 88,643 | | |
$ | 106,292 | |
|
SCHEDULE OF ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE |
SCHEDULE
OF 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, 2023 | |
$ | 14,773 | | |
$ | 4,399 | | |
$ | 1,386 | | |
$ | 342 | |
(Decrease) increase, net | |
| (2,463 | ) | |
| 549 | | |
| 141 | | |
| 80 | |
Balance as of September 30, 2023 | |
$ | 12,310 | | |
$ | 4,948 | | |
$ | 1,527 | | |
$ | 422 | |
| |
| | | |
| | | |
| | | |
| | |
Balance as of January 1, 2022 | |
$ | 17,006 | | |
$ | 4,725 | | |
$ | 1,085 | | |
$ | 341 | |
(Decrease) increase, net | |
| (725 | ) | |
| (318 | ) | |
| 332 | | |
| 49 | |
Balance as of September 30, 2022 | |
$ | 16,281 | | |
$ | 4,407 | | |
$ | 1,417 | | |
$ | 390 | |
|
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
| |
Nine Months Ended | | |
Year Ended | |
| |
September 30, 2023 | | |
December 31, 2022 | |
| |
($ in thousands) | |
Beginning balance | |
$ | 823 | | |
$ | 537 | |
Adoption of ASC 326 | |
| 186 | | |
| - | |
Provision | |
| 389 | | |
| 740 | |
Recoveries/adjustments | |
| 67 | | |
| 313 | |
Write-offs | |
| (468 | ) | |
| (767 | ) |
Ending balance | |
$ | 997 | | |
$ | 823 | |
|
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v3.23.3
STOCK-BASED COMPENSATION (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
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 nine months
ended September 30, 2023 and 2022:
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, 2023 | |
| 645,475 | | |
| - | | |
| 80,462 | |
Granted | |
| 1,056,453 | | |
| - | | |
| 62,000 | |
Vested | |
| (843,950 | ) | |
| - | | |
| (75,263 | ) |
Forfeited | |
| (58,388 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2023 | |
| 799,590 | | |
| - | | |
| 67,199 | |
| |
| | | |
| | | |
| | |
Outstanding and unvested shares at January 1, 2022 | |
| 418,039 | | |
| 34,000 | | |
| - | |
Granted | |
| 625,252 | | |
| - | | |
| 80,000 | |
Vested | |
| (426,299 | ) | |
| (34,000 | ) | |
| (10,000 | ) |
Forfeited | |
| (55,616 | ) | |
| - | | |
| - | |
Outstanding and unvested shares at September 30, 2022 | |
| 561,376 | | |
| - | | |
| 70,000 | |
|
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS |
The
following table summarizes the components of share-based compensation expense for the three and nine months ended September 30, 2023
and 2022:
SCHEDULE
OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS
Stock-based compensation included in the | |
Three Months Ended September
30, | | |
Nine Months Ended September 30, | |
consolidated statements of operations: | |
2023 | | |
2022 | | |
2023 | | |
2022 | |
| |
($ in thousands) | |
Direct operating costs | |
$ | 271 | | |
$ | 247 | | |
$ | 659 | | |
$ | 665 | |
General and administrative | |
| 771 | | |
| 703 | | |
| 2,225 | | |
| 1,848 | |
Research and development | |
| 26 | | |
| 82 | | |
| 105 | | |
| 225 | |
Selling and marketing | |
| 141 | | |
| 296 | | |
| 794 | | |
| 661 | |
Total stock-based compensation expense | |
$ | 1,209 | | |
$ | 1,328 | | |
$ | 3,783 | | |
$ | 3,399 | |
|
X |
- DefinitionTabular disclosure of share-based payment arrangement.
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v3.23.3
FAIR VALUE OF FINANCIAL INSTRUMENTS (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
Fair Value Disclosures [Abstract] |
|
SCHEDULE OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION |
The
following table provides a reconciliation of the beginning and ending balances for the contingent consideration measured at fair value
using significant unobservable inputs (Level 3):
SCHEDULE
OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION
| |
Fair Value Measurement
at Reporting Date Using Significant
Unobservable Inputs, Level 3 | |
| |
Nine Months Ended
September 30, | |
| |
2023 | | |
2022 | |
| |
($ in thousands) | |
Balance - January 1, | |
$ | - | | |
$ | 3,090 | |
Acquisitions | |
| - | | |
| - | |
Change in fair value | |
| - | | |
| (2,890 | ) |
Payments | |
| - | | |
| - | |
Balance - September 30, | |
$ | - | | |
$ | 200 | |
|
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v3.23.3
SEGMENT REPORTING (Tables)
|
9 Months Ended |
Sep. 30, 2023 |
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 | |
| |
Nine Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate Expenses | | |
Total | |
Net revenue | |
$ | 78,531 | | |
$ | 10,112 | | |
$ | - | | |
$ | 88,643 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 46,003 | | |
| 7,840 | | |
| - | | |
| 53,843 | |
Selling and marketing | |
| 7,503 | | |
| 26 | | |
| - | | |
| 7,529 | |
General and administrative | |
| 8,466 | | |
| 1,362 | | |
| 6,690 | | |
| 16,518 | |
Research and development | |
| 3,523 | | |
| - | | |
| - | | |
| 3,523 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 10,013 | | |
| 269 | | |
| - | | |
| 10,282 | |
Loss on lease terminations and unoccupied lease charges | |
| 430 | | |
| - | | |
| - | | |
| 430 | |
Total operating expenses | |
| 75,938 | | |
| 9,497 | | |
| 6,690 | | |
| 92,125 | |
Operating income (loss) | |
$ | 2,593 | | |
$ | 615 | | |
$ | (6,690 | ) | |
$ | (3,482 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2023 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 25,592 | | |
$ | 3,688 | | |
$ | - | | |
$ | 29,280 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 15,369 | | |
| 2,891 | | |
| - | | |
| 18,260 | |
Selling and marketing | |
| 2,329 | | |
| 8 | | |
| - | | |
| 2,337 | |
General and administrative | |
| 2,719 | | |
| 466 | | |
| 2,297 | | |
| 5,482 | |
Research and development | |
| 1,260 | | |
| - | | |
| - | | |
| 1,260 | |
Change
in contingent consideration | |
| | | |
| | | |
| | | |
| | |
Depreciation and amortization | |
| 3,814 | | |
| 89 | | |
| - | | |
| 3,903 | |
Loss on lease terminations and unoccupied lease charges | |
| 8 | | |
| - | | |
| - | | |
| 8 | |
Total operating expenses | |
| 25,499 | | |
| 3,454 | | |
| 2,297 | | |
| 31,250 | |
Operating income (loss) | |
$ | 93 | | |
$ | 234 | | |
$ | (2,297 | ) | |
$ | (1,970 | ) |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Nine Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 96,146 | | |
$ | 10,146 | | |
$ | - | | |
$ | 106,292 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 56,878 | | |
| 7,988 | | |
| - | | |
| 64,866 | |
Selling and marketing | |
| 7,293 | | |
| 21 | | |
| - | | |
| 7,314 | |
General and administrative | |
| 10,213 | | |
| 1,312 | | |
| 6,954 | | |
| 18,479 | |
Research and development | |
| 3,251 | | |
| - | | |
| - | | |
| 3,251 | |
Change in contingent consideration | |
| (2,890 | ) | |
| - | | |
| - | | |
| (2,890 | ) |
Depreciation and amortization | |
| 8,420 | | |
| 266 | | |
| - | | |
| 8,686 | |
Net loss on lease terminations and unoccupied lease charges | |
| 928 | | |
| - | | |
| - | | |
| 928 | |
Total operating expenses | |
| 84,093 | | |
| 9,587 | | |
| 6,954 | | |
| 100,634 | |
Operating income (loss) | |
$ | 12,053 | | |
$ | 559 | | |
$ | (6,954 | ) | |
$ | 5,658 | |
| |
Healthcare
IT | | |
Medical
Practice
Management | | |
Unallocated
Corporate
Expenses | | |
Total | |
| |
Three Months Ended September 30, 2022 | |
| |
($ in thousands) | |
| |
Healthcare IT | | |
Medical
Practice Management | | |
Unallocated Corporate
Expenses | | |
Total | |
Net revenue | |
$ | 29,964 | | |
$ | 3,759 | | |
$ | - | | |
$ | 33,723 | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
Direct operating costs | |
| 17,582 | | |
| 2,824 | | |
| - | | |
| 20,406 | |
Selling and marketing | |
| 2,496 | | |
| 8 | | |
| - | | |
| 2,504 | |
General and administrative | |
| 3,231 | | |
| 455 | | |
| 2,814 | | |
| 6,500 | |
Research and development | |
| 1,168 | | |
| - | | |
| - | | |
| 1,168 | |
Change in contingent consideration | |
| (1,660 | ) | |
| - | | |
| - | | |
| (1,660 | ) |
Depreciation and amortization | |
| 2,721 | | |
| 89 | | |
| - | | |
| 2,810 | |
Net loss on lease terminations and unoccupied lease charges | |
| 307 | | |
| - | | |
| - | | |
| 307 | |
Total operating expenses | |
| 25,845 | | |
| 3,376 | | |
| 2,814 | | |
| 32,035 | |
Operating income (loss) | |
$ | 4,119 | | |
$ | 383 | | |
$ | (2,814 | ) | |
$ | 1,688 | |
|
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SCHEDULE OF FINITE-LIVED INTANGIBLE ASSETS (Details) - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
Finite-Lived Intangible Assets [Line Items] |
|
|
Total intangible assets |
$ 84,593
|
$ 78,795
|
Less: Accumulated amortization |
57,904
|
49,275
|
Intangible assets - net |
26,689
|
29,520
|
Contracts and Relationships Acquired [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 |
27,343
|
21,547
|
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
|
$ 8,415
|
X |
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v3.23.3
SCHEDULE OF LOSSES PER SHARE, BASIC AND DILUTED (Details) - USD ($) $ / shares in Units, $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Earnings Per Share [Abstract] |
|
|
|
|
Net loss attributable to common shareholders |
$ (6,665)
|
$ (2,793)
|
$ (16,739)
|
$ (6,729)
|
Weighted-average common shares used to compute basic loss per share |
15,760,499
|
15,148,721
|
15,600,361
|
15,070,913
|
Weighted-average common shares used to compute diluted loss per share |
15,760,499
|
15,148,721
|
15,600,361
|
15,070,913
|
Net loss attributable to common shareholders per share - basic |
$ (0.42)
|
$ (0.18)
|
$ (1.07)
|
$ (0.45)
|
Net loss attributable to common shareholders per share - diluted |
$ (0.42)
|
$ (0.18)
|
$ (1.07)
|
$ (0.45)
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v3.23.3
DEBT (Details Narrative) - USD ($)
|
|
1 Months Ended |
3 Months Ended |
9 Months Ended |
|
|
Aug. 31, 2023 |
Oct. 31, 2023 |
Sep. 30, 2018 |
Sep. 30, 2023 |
Feb. 28, 2023 |
Dec. 31, 2022 |
Debt Instrument [Line Items] |
|
|
|
|
|
|
Maturity date |
|
|
|
October 31, 2025
|
|
|
Long-term line of credit |
|
|
|
$ 12,000,000
|
|
$ 8,000,000
|
Remaining borrowing base |
|
|
|
3,300,000
|
|
|
Line of credit facility, commitment fee amount |
|
|
|
100,000
|
|
|
Offshore bank accounts |
|
|
|
$ 71,000
|
|
$ 1,800,000
|
Vehicle Financing Notes [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Vehicle financing in United States |
|
|
|
six
year
|
|
|
Insurance Financing [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Debt interest rate |
|
|
|
8.56%
|
|
|
SVB Debt Agreement [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Upfront fees |
|
|
$ 50,000
|
$ 50,000
|
|
|
Class of Warrant or Right, Number of Securities Called by Warrants or Rights |
|
|
|
125,000
|
|
|
Payments for annual anniversary fee |
|
|
|
$ 50,000
|
|
|
Warrant strike price |
|
|
|
$ 3.92
|
|
|
Warrants term |
|
|
|
5 years
|
|
|
Warrants exercise price |
|
|
|
$ 3.12
|
|
|
SVB Debt Agreement [Member] | Additional Warrant [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Class of Warrant or Right, Number of Securities Called by Warrants or Rights |
|
|
28,489
|
|
|
|
Warrant strike price |
|
|
$ 5.26
|
|
|
|
Warrants exercise price |
|
|
$ 3.58
|
|
|
|
Warrant expiration date |
|
|
September 2023
|
|
|
|
Subsequent Event [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Repayment of outstanding line of credit |
|
$ 2,000,000
|
|
|
|
|
Remaining borrowing base |
|
$ 5,300,000
|
|
|
|
|
SVB Credit Facility [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Secured revolving line of credit percentage |
|
|
|
200.00%
|
|
|
Line of credit, current borrowing capacity |
|
|
|
|
$ 25,000,000
|
|
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%
|
|
|
SVB Credit Facility [Member] | Prime Rate [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Line of credit facility, interest rate at the period end above prime rate |
|
|
|
2.00%
|
|
|
SVB Credit Facility [Member] | Prime Rate [Member] | Minimum [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Line of credit facility, interest rate at the period end above prime rate |
1.50%
|
|
|
|
|
|
SVB Credit Facility [Member] | Prime Rate [Member] | Maximum [Member] |
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
Line of credit facility, interest rate at the period end above prime rate |
2.00%
|
|
|
|
|
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v3.23.3
SCHEDULE OF SUPPLEMENTAL BALANCE SHEET INFORMATION RELATED TO LEASES (Details) - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
Leases [Abstract] |
|
|
Operating lease ROU assets, net |
$ 4,491
|
$ 4,921
|
Current operating lease liabilities |
1,810
|
2,273
|
Non-current operating lease liabilities |
2,789
|
3,207
|
Total operating lease liabilities |
4,599
|
5,480
|
ROU assets |
6,172
|
8,293
|
Asset lease expense |
(1,618)
|
(3,286)
|
Foreign exchange loss |
(63)
|
(86)
|
ROU assets, net |
$ 4,491
|
$ 4,921
|
Weighted average remaining lease term: Operating leases |
4 years 6 months
|
5 years 1 month 6 days
|
Weighted average discount rate: Operating leases |
12.80%
|
7.90%
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v3.23.3
SCHEDULE OF MATURITIES OF LEASE LIABILITIES (Details) - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
Leases [Abstract] |
|
|
2023 (three months) |
$ 708
|
|
2024 |
1,998
|
|
2025 |
1,263
|
|
2026 |
501
|
|
2027 |
374
|
|
Thereafter |
1,718
|
|
Total lease payments |
6,562
|
|
Less: imputed interest |
(1,963)
|
|
Total operating lease liabilities |
4,599
|
$ 5,480
|
Less: current obligations |
(1,810)
|
(2,273)
|
Long-term lease obligations |
$ 2,789
|
$ 3,207
|
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v3.23.3
LEASES (Details Narrative) - USD ($)
|
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Leases [Abstract] |
|
|
|
|
Lease term, description |
|
|
Leases with a term
of less than 12 months are not recorded in the consolidated balance sheets
|
|
Unoccupied lease charges |
$ 5,000
|
$ 257,000
|
$ 168,000
|
$ 786,000
|
Gain on lease termination |
|
|
|
105,000
|
Lease termination costs |
2,000
|
|
73,000
|
|
Lease impairment |
|
$ 51,000
|
|
$ 248,000
|
Additional costs of lease termination |
$ 1,000
|
|
162,000
|
|
Payment of settlement on lease termination |
|
|
$ 27,000
|
|
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v3.23.3
RELATED PARTIES (Details Narrative) - USD ($)
|
1 Months Ended |
3 Months Ended |
9 Months Ended |
|
|
Feb. 28, 2023 |
Jun. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Dec. 31, 2022 |
Dec. 31, 2021 |
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Net revenue |
|
|
$ 29,280,000
|
$ 33,723,000
|
$ 88,643,000
|
$ 106,292,000
|
|
|
Receivable balance due from customer |
|
|
12,310,000
|
16,281,000
|
12,310,000
|
16,281,000
|
$ 14,773,000
|
$ 17,006,000
|
Security deposits |
|
|
16,000
|
|
16,000
|
|
16,000
|
|
Lease expense per month for temporary housing |
|
|
|
|
6,200
|
|
|
|
Operating lease, right-of-use asset |
|
|
4,491,000
|
|
4,491,000
|
|
4,921,000
|
|
Operating lease liability (current portion) |
|
|
1,810,000
|
|
1,810,000
|
|
2,273,000
|
|
Operating lease liability |
|
|
2,789,000
|
|
2,789,000
|
|
3,207,000
|
|
Executive Chairman [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Payments to related party |
|
|
|
|
330,000
|
42,000
|
|
|
Advances, balance |
|
|
34,000
|
|
34,000
|
|
|
|
Related Party Lease [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Operating lease, right-of-use asset |
|
|
388,000
|
|
388,000
|
|
467,000
|
|
Operating lease liability (current portion) |
|
|
207,000
|
|
207,000
|
|
158,000
|
|
Operating lease liability |
|
|
172,000
|
|
172,000
|
|
301,000
|
|
Physician [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Net revenue |
|
|
36,000
|
5,000
|
86,000
|
16,000
|
|
|
Physician [Member] | Related Party [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Receivable balance due from customer |
|
|
13,000
|
|
13,000
|
|
$ 13,000
|
|
Executive Chairman [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Rent expense |
|
|
$ 69,000
|
$ 49,000
|
186,000
|
149,000
|
|
|
Operating lease upgradations |
|
|
|
|
$ 1,800,000
|
$ 633,000
|
|
|
Director [Member] | Series B Preferred Stock [Member] | Consulting Agreement [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Stock issued during period shares acquisitions |
|
10,000
|
|
|
|
|
|
|
Preferred stock dividend percentage per annum |
|
8.75%
|
|
|
|
|
|
|
Director [Member] | Series B Preferred Stock [Member] | Consulting Agreement [Member] | February 2023 [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Stock issued during period shares new issues |
14,000
|
|
|
|
|
|
|
|
Director [Member] | Series B Preferred Stock [Member] | Consulting Agreement [Member] | January 2024 [Member] |
|
|
|
|
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
|
|
|
|
Stock issued during period shares new issues |
|
|
|
|
14,000
|
|
|
|
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v3.23.3
SHAREHOLDERS’ EQUITY (Details Narrative) - USD ($)
|
|
3 Months Ended |
9 Months Ended |
Mar. 18, 2022 |
Mar. 31, 2023 |
Sep. 30, 2022 |
Jun. 30, 2022 |
Mar. 31, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Series B Preferred Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Proceeds from sale of stock |
|
|
|
|
|
$ 1,400,000
|
$ 30,300,000
|
Sale of preferred stock, shares |
|
|
|
|
|
|
1,299,216
|
Series B Preferred Stock [Member] | Preferred Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Sale of stock number of shares issued in transaction |
|
59,773
|
98,968
|
49,876
|
1,150,372
|
59,773
|
|
Series A Preferred Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Preferred stock dividend percentage per annum |
11.00%
|
|
|
|
|
|
|
Series A Preferred Stock [Member] | Preferred Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Redemption of Series A Preferred Stock, shares |
800,000
|
|
|
|
800,000
|
|
|
Preferred stock redemption price per share |
$ 25.00
|
|
|
|
|
|
|
ATM [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Authorized sale of stock, value |
|
|
|
|
|
|
$ 198,406
|
ATM [Member] | Common Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Authorized sale of stock, value |
|
|
|
|
|
$ 50,000,000
|
|
Under writer commission fees percentage |
|
|
|
|
|
3.00%
|
|
Common stock issued, shares |
|
|
|
|
|
0
|
|
ATM [Member] | Series B Preferred Stock [Member] |
|
|
|
|
|
|
|
Subsidiary, Sale of Stock [Line Items] |
|
|
|
|
|
|
|
Authorized sale of stock, value |
|
|
|
|
|
$ 35,000,000
|
|
Under writer commission fees percentage |
|
|
|
|
|
3.00%
|
|
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v3.23.3
SCHEDULE OF DISAGGREGATION OF REVENUE (Details) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Revenues |
$ 29,280
|
$ 33,723
|
$ 88,643
|
$ 106,292
|
Healthcare IT [Member] |
|
|
|
|
Revenues |
25,592
|
29,964
|
78,531
|
96,146
|
Healthcare IT [Member] | Technology-enabled Business Solutions [Member] |
|
|
|
|
Revenues |
18,763
|
21,626
|
57,878
|
68,457
|
Healthcare IT [Member] | Professional Services [Member] |
|
|
|
|
Revenues |
5,691
|
7,434
|
17,755
|
25,572
|
Healthcare IT [Member] | Printing and Mailing Services [Member] |
|
|
|
|
Revenues |
749
|
594
|
2,149
|
1,515
|
Healthcare IT [Member] | Group Purchasing Services [Member] |
|
|
|
|
Revenues |
389
|
310
|
749
|
602
|
Medical Practice Management [Member] |
|
|
|
|
Revenues |
$ 3,688
|
$ 3,759
|
$ 10,112
|
$ 10,146
|
X |
- DefinitionAmount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.
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v3.23.3
SCHEDULE OF ACCOUNTS RECEIVABLE, CONTRACT ASSET AND DEFERRED REVENUE (Details) - USD ($) $ in Thousands |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Revenue from Contract with Customer [Abstract] |
|
|
Accounts Receivable - Net, Opening |
$ 14,773
|
$ 17,006
|
Contract Assets, Opening |
4,399
|
4,725
|
Deferred Revenue (current), Opening |
1,386
|
1,085
|
Deferred Revenue (long term), Opening |
342
|
341
|
Accounts Receivable - Net, Increase (decrease), net |
(2,463)
|
(725)
|
Contract Assets, Increase (decrease), net |
549
|
(318)
|
Deferred Revenue (current), Increase (decrease), net |
141
|
332
|
Deferred Revenue (long term), Increase (decrease), net |
80
|
49
|
Accounts Receivable - Net, Closing |
12,310
|
16,281
|
Contract Assets, Closing |
4,948
|
4,407
|
Deferred Revenue (current), Closing |
1,527
|
1,417
|
Deferred Revenue (long term), Closing |
$ 422
|
$ 390
|
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v3.23.3
REVENUE (Details Narrative) - USD ($)
|
3 Months Ended |
9 Months Ended |
|
|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Jan. 01, 2023 |
Dec. 31, 2022 |
Disaggregation of Revenue [Line Items] |
|
|
|
|
|
|
Deferred commissions |
|
|
$ 543,000
|
$ 692,000
|
|
|
Accumulated deficit |
$ (30,789,000)
|
|
(30,789,000)
|
|
|
$ (25,621,000)
|
Trade Accounts Receivable [Member] | Accounting Standards Update 2016-13 [Member] |
|
|
|
|
|
|
Disaggregation of Revenue [Line Items] |
|
|
|
|
|
|
Accumulated deficit |
|
|
|
|
$ 186,000
|
|
Revenue Cycle Management and Orion Acquisition [Member] |
|
|
|
|
|
|
Disaggregation of Revenue [Line Items] |
|
|
|
|
|
|
Revenue, remaining performance obligation, amount |
4,600,000
|
|
$ 4,600,000
|
|
|
|
Orion Acquisition [Member] |
|
|
|
|
|
|
Disaggregation of Revenue [Line Items] |
|
|
|
|
|
|
Estimated recognition period for remaining performance obligations |
|
|
3 months
|
|
|
|
Contract asset - group purchasing services |
331,000
|
|
$ 331,000
|
|
|
|
Digital Health Services [Member] |
|
|
|
|
|
|
Disaggregation of Revenue [Line Items] |
|
|
|
|
|
|
Revenue |
$ 623,000
|
$ 24,000
|
$ 1,200,000
|
$ 30,000
|
|
|
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v3.23.3
DISCLOSURE OF SHARE-BASED COMPENSATION ARRANGEMENTS BY SHARE-BASED PAYMENT AWARD (Details) - Restricted Stock Units (RSUs) [Member] - shares
|
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Series A Preferred Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested shares, beginning |
|
34,000
|
Granted |
|
|
Vested |
|
(34,000)
|
Forfeited |
|
|
Outstanding and unvested shares, ending |
|
|
Series B Preferred Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested shares, beginning |
80,462
|
|
Granted |
62,000
|
80,000
|
Vested |
(75,263)
|
(10,000)
|
Forfeited |
|
|
Outstanding and unvested shares, ending |
67,199
|
70,000
|
Common Stock [Member] |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Outstanding and unvested shares, beginning |
645,475
|
418,039
|
Granted |
1,056,453
|
625,252
|
Vested |
(843,950)
|
(426,299)
|
Forfeited |
(58,388)
|
(55,616)
|
Outstanding and unvested shares, ending |
799,590
|
561,376
|
X |
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v3.23.3
SCHEDULE OF EMPLOYEE SERVICE SHARE-BASED COMPENSATION, ALLOCATION OF RECOGNIZED PERIOD COSTS (Details) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
|
|
Stock-based compensation |
$ 1,209
|
$ 1,328
|
$ 3,783
|
$ 3,399
|
Direct Operating Costs [Member] |
|
|
|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
|
|
Stock-based compensation |
271
|
247
|
659
|
665
|
General and Administrative Expense [Member] |
|
|
|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
|
|
Stock-based compensation |
771
|
703
|
2,225
|
1,848
|
Research and Development Expense [Member] |
|
|
|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
|
|
Stock-based compensation |
26
|
82
|
105
|
225
|
Selling and Marketing Expense [Member] |
|
|
|
|
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] |
|
|
|
|
Stock-based compensation |
$ 141
|
$ 296
|
$ 794
|
$ 661
|
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STOCK-BASED COMPENSATION (Details Narrative) - USD ($)
|
3 Months Ended |
9 Months Ended |
|
|
Sep. 30, 2023 |
Sep. 30, 2023 |
Dec. 31, 2022 |
Sep. 30, 2022 |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
|
Executives stock ownership plan compensation expense |
$ 254,000
|
$ 629,000
|
|
|
Number of cash-setttled awards |
|
41,430
|
|
|
Liability for cash settled amount |
577,000
|
$ 577,000
|
$ 1,000,000.0
|
|
Cash settlement |
$ 0
|
$ 0
|
|
$ 13,000
|
Common Stock [Member] | Restricted Stock Units (RSUs) [Member] |
|
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
|
Number of shares available for grant |
500,427
|
500,427
|
|
|
Preferred Stock [Member] | Series B Preferred Stock [Member] | Restricted Stock Units (RSUs) [Member] |
|
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
|
Number of shares available for grant |
38,000
|
38,000
|
|
|
Amended and Restated Equity Incentive Plan [Member] | Series B Preferred Stock [Member] |
|
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
|
Shares added to the A&R Plan for future issuance |
|
|
200,000
|
|
Amended and Restated Equity Incentive Plan [Member] | Common Stock [Member] |
|
|
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
|
|
Shares added to the A&R Plan for future issuance |
|
|
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|
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SCHEDULE OF FAIR VALUE, LIABILITIES MEASURED ON RECURRING BASIS, UNOBSERVABLE INPUT RECONCILIATION (Details) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
|
|
Change in fair value |
|
$ (1,660)
|
|
$ (2,890)
|
Fair Value, Inputs, Level 3 [Member] |
|
|
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
|
|
Beginning balance |
|
|
|
3,090
|
Acquisitions |
|
|
|
|
Change in fair value |
|
|
|
(2,890)
|
Payments |
|
|
|
|
Ending balance |
|
$ 200
|
|
$ 200
|
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SCHEDULE OF REVENUES, OPERATING EXPENSES AND OPERATING INCOME (LOSS) BY REPORTABLE SEGMENT (Details) - USD ($) $ in Thousands |
3 Months Ended |
9 Months Ended |
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Segment Reporting Information [Line Items] |
|
|
|
|
Net revenue |
$ 29,280
|
$ 33,723
|
$ 88,643
|
$ 106,292
|
Direct operating costs |
18,260
|
20,406
|
53,843
|
64,866
|
Selling and marketing |
2,337
|
2,504
|
7,529
|
7,314
|
General and administrative |
5,482
|
6,500
|
16,518
|
18,479
|
Research and development |
1,260
|
1,168
|
3,523
|
3,251
|
Change in contingent consideration |
|
(1,660)
|
|
(2,890)
|
Depreciation and amortization |
3,903
|
2,810
|
10,282
|
8,686
|
Net loss on lease terminations and unoccupied lease charges |
8
|
307
|
430
|
928
|
Total operating expenses |
31,250
|
32,035
|
92,125
|
100,634
|
OPERATING (LOSS) INCOME |
(1,970)
|
1,688
|
(3,482)
|
5,658
|
Healthcare IT [Member] |
|
|
|
|
Segment Reporting Information [Line Items] |
|
|
|
|
Net revenue |
25,592
|
29,964
|
78,531
|
96,146
|
Direct operating costs |
15,369
|
17,582
|
46,003
|
56,878
|
Selling and marketing |
2,329
|
2,496
|
7,503
|
7,293
|
General and administrative |
2,719
|
3,231
|
8,466
|
10,213
|
Research and development |
1,260
|
1,168
|
3,523
|
3,251
|
Change in contingent consideration |
|
(1,660)
|
|
(2,890)
|
Depreciation and amortization |
3,814
|
2,721
|
10,013
|
8,420
|
Net loss on lease terminations and unoccupied lease charges |
8
|
307
|
430
|
928
|
Total operating expenses |
25,499
|
25,845
|
75,938
|
84,093
|
OPERATING (LOSS) INCOME |
93
|
4,119
|
2,593
|
12,053
|
Medical Practice Management [Member] |
|
|
|
|
Segment Reporting Information [Line Items] |
|
|
|
|
Net revenue |
3,688
|
3,759
|
10,112
|
10,146
|
Direct operating costs |
2,891
|
2,824
|
7,840
|
7,988
|
Selling and marketing |
8
|
8
|
26
|
21
|
General and administrative |
466
|
455
|
1,362
|
1,312
|
Research and development |
|
|
|
|
Change in contingent consideration |
|
|
|
|
Depreciation and amortization |
89
|
89
|
269
|
266
|
Net loss on lease terminations and unoccupied lease charges |
|
|
|
|
Total operating expenses |
3,454
|
3,376
|
9,497
|
9,587
|
OPERATING (LOSS) INCOME |
234
|
383
|
615
|
559
|
Unallocated Corporate Expenses [Member] |
|
|
|
|
Segment Reporting Information [Line Items] |
|
|
|
|
Net revenue |
|
|
|
|
Direct operating costs |
|
|
|
|
Selling and marketing |
|
|
|
|
General and administrative |
2,297
|
2,814
|
6,690
|
6,954
|
Research and development |
|
|
|
|
Change in contingent consideration |
|
|
|
|
Depreciation and amortization |
|
|
|
|
Net loss on lease terminations and unoccupied lease charges |
|
|
|
|
Total operating expenses |
2,297
|
2,814
|
6,690
|
6,954
|
OPERATING (LOSS) INCOME |
$ (2,297)
|
$ (2,814)
|
$ (6,690)
|
$ (6,954)
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