| Dec 31, 2011 | Dec 31, 2012 | Dec 31, 2013 | Dec 31, 2014 | Dec 31, 2015 | Dec 31, 2016 | Dec 31, 2017 | Dec 31, 2018 | Dec 31, 2019 | Dec 31, 2020 | Dec 31, 2021 | Dec 31, 2022 |
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Net income (loss) | - | - | - | - | - | - | - | - | - | - | 26 | -18,873,758 |
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Depreciation and amortization | - | - | - | - | - | - | - | - | - | - | - | 2 |
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Gain on sale of property, plant and equipment | - | - | - | - | - | - | - | - | - | - | - | 212,831 |
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Stock based compensation | 839,232 | 521,427 | 705,612 | 834,593 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 1 |
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Provision for doubtful accounts receivable | - | - | - | - | - | - | - | - | - | - | 9,990 | -39,502 |
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Provision for doubtful lease receivable | - | - | - | - | - | - | - | - | - | - | - | 140,448 |
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Gain on the extinguishment of debt | 131,093 | - | - | - | - | - | -424,527 | - | - | 1 | 10,000 | - |
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Change in fair value of contingent consideration promissory notes and earn-out agreements | - | - | - | - | - | - | - | - | - | - | 4 | 516,970 |
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Change in fair value of warrant derivative liabilities | - | - | - | - | - | - | - | - | - | - | 37 | 7 |
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Gain of extinguishment of warrant derivative liabilities | - | - | - | - | - | - | - | - | - | - | - | 4 |
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Warrant modification expense | - | - | - | - | - | - | - | - | - | - | 295,780 | - |
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Provision for inventory obsolescence | -186,396 | -169,852 | -116,617 | 339,865 | 601,833 | 797,509 | 990,782 | 597,798 | 856,242 | 275,690 | 2 | 2 |
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Accounts receivable – trade | 2 | -48,798 | 1 | 1 | 334,030 | -854,722 | -540,248 | -131,050 | -716,868 | 634,443 | 29,838 | -722,498 |
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Accounts receivable – other (including related party) | - | - | - | - | - | 198,853 | -2,708 | 43,794 | 132,318 | 1 | 693,992 | 2 |
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Inventories | 3 | -441,580 | -635,133 | 2 | 2 | -277,946 | 155,184 | -1,153,855 | -862,406 | 3 | 1 | -1,245,677 |
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Prepaid expenses | 39,266 | 42,874 | -115,217 | 15,118 | 231,235 | -183,857 | -192,995 | 148,796 | -48,313 | 2 | 4 | -1,293,080 |
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Operating lease right of use assets | - | - | - | - | - | - | - | - | - | - | -180,497 | -328,772 |
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Other assets | -6,721 | -143,592 | -3,599 | -10,703 | 82,179 | -54,606 | -146,872 | 141,706 | 275,751 | -177,619 | 738,466 | 3 |
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Accounts payable | -2,309,997 | 673,171 | -79,056 | 969,725 | -1,036,716 | 1 | 737,690 | -2,345,555 | 2 | -1,195,310 | -1,907,608 | 5 |
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Accrued expenses | - | - | - | -325,522 | -173,626 | 606,402 | -302,300 | 862,126 | -1,234,786 | -41,274 | 166,874 | -112,896 |
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Income taxes payable | - | - | - | - | - | - | - | - | - | - | -5,331 | 6,270 |
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Operating lease obligations | - | - | - | - | - | - | - | - | - | - | -195,884 | -328,772 |
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Contract liabilities | - | - | - | - | - | - | - | - | - | - | 856,967 | 4 |
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Net cash used in operating activities | 945,519 | -440,972 | -564,660 | -3,172,812 | -7,686,769 | -5,902,901 | -6,354,853 | -9,011,857 | -1,124,373 | -13,284,715 | -17,825,108 | -18,580,385 |
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Purchases of property, plant and equipment | 120,978 | 389,037 | 275,468 | 433,932 | 423,063 | 340,674 | 322,714 | 42,526 | 204,013 | 621,860 | 6 | 2 |
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Proceeds from sale of property, plant and equipment | - | - | - | - | - | - | - | 76,268 | - | - | - | 609,559 |
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Purchases of intangible assets | 30,123 | 26,556 | 61,525 | 76,887 | 195,890 | 100,037 | 153,485 | 104,690 | 62,131 | 77,329 | 1 | 116,990 |
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Proceeds from sale of intangible assets | - | - | - | - | - | - | - | - | - | - | - | 18,975 |
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Cash paid for acquisition of Medical Billing Company | - | - | - | - | - | - | - | - | - | - | 1 | - |
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Cash paid for acquisition of Medical Billing Company | - | - | - | - | - | - | - | - | - | - | 2 | - |
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Cash paid for acquisition of Medical Billing Company | - | - | - | - | - | - | - | - | - | - | 9 | 1 |
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Cash paid for asset acquisition of Medical Billing Company | - | - | - | - | - | - | - | - | - | - | - | 230,000 |
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Collection of notes receivable | - | - | - | - | - | - | - | - | - | - | -405,000 | - |
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Net cash used in investing activities | -151,101 | -1,078,093 | -336,993 | -1,348,319 | 881,047 | -940,711 | -476,199 | -70,948 | -266,144 | -1,499,189 | -19,124,379 | -2,940,591 |
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Proceeds from issuance of common stock upon exercise of pre-funded warrants | - | - | - | - | - | - | - | - | - | - | 53 | - |
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Net proceeds from sale of common stock in registered direct offerings | - | - | - | - | - | - | - | 7 | - | - | 13 | - |
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Repurchase and cancellation of common stock | - | - | - | - | - | - | - | - | - | - | 2 | 4 |
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Distribution to noncontrolling interest in consolidated subsidiary | - | - | - | - | - | - | - | - | - | - | - | 15,692 |
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Principal payment on contingent consideration promissory notes | - | - | - | - | - | - | - | - | - | - | - | 527,402 |
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Proceeds from issuance of Series A & B convertible redeemable preferred shares, net of issuance costs | - | - | - | - | - | - | - | - | - | - | - | 13 |
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Redemption of Series A & B convertible redeemable preferred shares | - | - | - | - | - | - | - | - | - | - | - | 16 |
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Net cash provided by (used in) financing activities | 852,500 | -48,156 | 653,459 | 7 | 11 | 4 | 3 | 12 | -1,848,605 | 19 | 65 | -6,954,617 |
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Net increase (decrease) in cash and cash equivalents | - | - | - | - | - | - | - | 3 | -3,239,122 | 4 | 28 | -28,475,593 |
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Cash payments for interest | - | - | - | - | - | - | 238,259 | 1 | 30,937 | 128,911 | - | 49,070 |
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Cash payments for income taxes | - | - | - | - | 2,185 | 10,591 | 6,908 | 6,452 | 3,755 | 4,776 | 1,224 | 8,730 |
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Restricted common stock grant | - | - | - | - | - | - | - | - | - | - | 856 | 61 |
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Restricted common stock forfeitures | - | - | - | - | - | - | - | - | - | - | 8 | 3 |
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Issuance of contingent consideration earn-out agreement for business acquisitions | - | - | - | - | - | - | - | - | - | - | 4 | 750,000 |
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Issuance of contingent consideration promissory note for business acquisitions | - | - | - | - | - | - | - | - | - | - | 1,000,000 | - |
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Issuance of contingent consideration promissory note for asset acquisitions | - | - | - | - | - | - | - | - | - | - | - | 105,000 |
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Assets acquired in business acquisitions | - | - | - | - | - | - | - | - | - | - | 6 | 190,631 |
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Identifiable intangible assets acquired in business acquisitions | - | - | - | - | - | - | - | - | - | - | 7 | - |
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Goodwill acquired in business acquisitions | - | - | - | - | - | - | - | - | - | - | 10 | 2 |
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Liabilities assumed in business acquisitions | - | - | - | - | - | - | - | - | - | - | 5 | 387,005 |
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ROU and lease liability recorded on extension of lease | - | - | - | - | - | - | - | - | - | - | - | 42,403 |
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Common stock issued as consideration for business acquisitions | - | - | - | - | - | - | - | - | - | - | 990,360 | - |
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Amounts allocated to initial measurement of warrant derivative liabilities in connection to the warrants and pre-funded warrants | - | - | - | - | - | - | - | - | - | - | 51 | - |
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Issuance of common stock through warrant exchange agreement | - | - | - | - | - | - | - | - | - | - | - | 4 |
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Cancellation of treasury stock | - | - | - | - | - | - | - | - | - | - | 2 | - |
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