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Basis of Presentation and summary of significant accounting policies (Policies) | 12 Months Ended
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Sep. 30, 2025
Nature of operations |
Basis of accounting | Basis of accounting These consolidated financial statements as of and for the years ended September 30, 2025 and 2024 (the “consolidated financial statements”) of the Company were prepared in accordance with accounting principles generally accepted in the US (“GAAP”). The consolidated financial statements, which are presented in US dollars, have been prepared under the historical cost convention, as modified by the measurement at fair values of certain financial assets and financial liabilities. The consolidated financial statements of the Company are presented in US dollars, which is the Company’s functional currency, determined using management’s judgment that the primary economic environment in which it will derive its revenues and expenses incurred to generate those revenues is the US.
Basis of measurement | Basis of measurement These consolidated financial statements have been prepared on a going concern basis that assumes that the Company will continue its operations for the foreseeable future and be able to realize its assets and discharge its liabilities and commitments in the normal course of operation.
Principles of consolidation | Principles of consolidation These consolidated financial statements include the accounts of the Company and its subsidiaries. All intercompany transactions have been eliminated. The Company’s consolidated entities have a functional currency of US dollars, and are listed in the table below. They are wholly owned, except for IRB Medical Equipment, LLC, dba Hart Medical Equipment (“Hart”), which is 60%-owned. Prior to closing, 100% of the equity interests in Hart were contributed to the Hart HoldCo, LLC (“the Hart Seller”) by its previous owners. Pursuant to the purchase agreement, the Company acquired 60% of the membership interests of Hart directly from the Hart Seller, and the Hart Seller retained the remaining 40% membership interests. In connection with the transaction, the parties entered into an administrative support services agreement, and Hart’s operating agreement was amended and restated pursuant to the Sixth Amended and Restated Operating Agreement to provide for the operation of Hart as a joint venture between the Company and the Hart Seller. The Company has control of Hart and therefore its financial statements are included in the Company’s consolidated financial statements, with the noncontrolling 40% interest reflected as a line item on the consolidated statements of financial position, income (loss) and changes in shareholders’ equity. ​
​ | ​ | ​
100 W. Commercial Street, LLC | ​ ​ ​ | Med Supply Center, Inc.
Acadia Medical Supply, Inc. | ​ ​ ​ | Medical West Healthcare Center, LLC
Access Respiratory Home Care, L.L.C. | ​ | Mediserve Medical Equipment of Kingsport, Inc.
Alliance Home Care & Mobile Diagnostics, L.L.C. | ​ | Metro-Med, Inc.
At Home Health Equipment, LLC | ​ | Metro-Med, Inc. - Los Alamitos
Black Bear Medical, Inc. |  | Metro-Med, Inc. - Ventura
Black Bear Medical Group, Inc. | ​ | NorCal Respiratory, Inc.
Black Bear Medical NH, Inc. | ​ | Northwest Medical, LLC
Care Medical Atlanta, LLC | ​ | Oxygen Plus
Care Medical of Athens, Inc. | ​ | Patient-Aids, Inc.
Care Medical of Augusta, LLC | ​ | Patient Home Monitoring, Inc
Care Medical of Gainesville, LLC | ​ | QHM Holdings Inc.
Care Medical Partners, LLC | ​ | QHM Investments I, LLC
Care Medical Savannah, LLC | ​ | Quipt Home Medical Inc.
Central Oxygen, Inc. | ​ | Rejuvenight, LLC
Coastal Med-Tech Corp. | ​ | Resource Medical, Inc.
Cooley Medical Equipment, Incorporated | ​ | Resource Medical Group Charleston, LLC
Focus Respiratory, LLC | ​ | Resource Medical Group, LLC
Good Night Medical, LLC | ​ | Respicare, Inc.
Good Night Medical of Ohio, LLC | ​ | Riverside Medical, Inc.
Good Night Medical of Texas, Inc | ​ | RTA Homecare, LLC
Great Elm Healthcare, LLC | ​ | Semo Drugs - Care Plus of Mo, Inc.
Health Technology Resources, LLC | ​ | Sleep Health Diagnostics, LLC
Heartland Health Therapy, LLC | ​ | Sleepwell, LLC
Heckman Healthcare Service & Supplies Inc. | ​ | Southeastern Biomedical Services, LLC
Hometown Medical LLC | ​ | Southern Pharmaceutical Corporation
IRB Medical Equipment, LLC |  | Thrift Home Care, Inc.
Legacy Oxygen and Home Care Equipment, LLC | ​ | Tuscan, Inc.
Mayhugh Drugs, Inc. | ​ | United Respiratory Services, LLC
Use of estimates | Use of estimates Preparing financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount of assets and liabilities and 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. The Company’s management reviews these estimates, judgments, and assumptions on an ongoing basis, based on experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances. Revisions to estimates are adjusted prospectively in the period in which the estimates are revised. Actual results could differ from those estimates. Estimates where management has made subjective judgments and where there is significant risk of material adjustments to assets and liabilities in future accounting periods include fair value measurements for financial instruments and share-based transactions, useful lives and impairment of non-financial assets (property and equipment, goodwill, and intangible assets), provision for expected credit losses, fair value measurements for assets and liabilities acquired in business acquisitions, and calculation of deferred taxes.
Accounts receivable | Accounts receivable Due to the nature of our industry and the reimbursement environment in which the Company operates, certain estimates are required to record total net revenues and accounts receivable at their net realizable values, including estimating variable consideration. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third-party billing arrangements, contractual terms, and the uncertainty of reimbursement amounts for certain services may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application, claim denial, or account review. Net realizable values are estimated based on a number of factors, including age of the receivables, changes in customer payment patterns, historical experience, industry trends, and current economic conditions. The balance of Accounts receivable, net was $34,697,000, $29,116,000, and $25,978,000 as of September 30 2025, 2024, and 2023, respectively. As of September 30, 2025, the Company has 18% of its accounts receivable with Medicare. As this is a US government program, the Company believes there is very little credit risk associated with these balances. No customer represented more than 10% of outstanding accounts receivable.
Inventory | Inventory Inventory is stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. The Company’s inventory consists of finished goods purchased from vendors; therefore, no labor or overhead is included in the inventory cost. Inventory is subsequently recorded within cost of inventory sold on the consolidated statements of operations at the time the inventory is sold. Inventory is transferred to property and equipment as rental equipment at the time of rental revenue recognition. The Company reviews inventory for obsolete, redundant, and slow-moving goods, and any such inventories are written down to their estimated net realizable value.
Property, equipment, and right-of-use assets | Property, equipment, and right-of-use assets Property and equipment are stated at cost less accumulated depreciation. Major renewals and improvements are capitalized in the property accounts, while maintenance and repairs which do not extend the useful life of the respective assets, are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the respective assets. The estimated useful lives of the assets are as follows: ​
​ | ​ | ​ | ​ | ​
Description | ​ ​ ​ | Estimated Useful Life
Rental equipment |  | 1 | - | 5 years
Vehicles | ​ | 1 | - | 5 years
Leasehold improvements |  | Life of lease 1 | - | 11 years
Office and technology equipment |  | ​ | ​ | 5 years
Buildings | ​ | ​ | ​ | 25 years
Right-of-use real estate |  | Life of lease 2 | - | 11 years
Right-of-use vehicles |  | Life of lease 2 | - | 7 years
​ Depreciation of rental equipment commences once it has been delivered to a patient and put in use. Property and equipment and other non-current assets with definite useful lives are tested for impairment whenever events or changes in circumstances indicate that their carrying amount may not be recoverable.
Intangible assets | Intangible assets The Company has recorded various intangible assets consisting of customer relationships, customer contracts, trade names and non-compete agreements, in connection with various business acquisitions. Customer relationships are recognized based on the estimated fair value given to the long-term associations with referral sources such as doctors, hospitals, and sleep centers. Customer contracts are recognized at the estimated fair value of the present value of expected future customer billings based on the statistical life of a customer. Trade names are recognized at the estimated fair value associated with the trade name of the acquired company. Non-compete agreements are recognized at the estimated fair value associated with the non-compete agreements entered into by the sellers of acquired companies. Definite life intangible assets are amortized on a straight-line basis over the estimated useful lives of the related assets as follows: ​
​ | ​ | ​ | ​ | ​
Description | ​ ​ ​ | Estimated Useful Life
Customer relationships |  | 10 | - | 20 years
Customer contracts | ​ | ​ | ​ | 2 years
Trade names |  | ​ | ​ | 10 years
Non-compete agreements |  | ​ | ​ | 5 years
​ The Company reviews the estimates for useful lives on an annual basis, or more frequently if events during the year indicate that a change may be required, with consideration given to technological obsolescence and other relevant business factors. A change in management’s estimates could impact depreciation/amortization expense and the carrying value of property and equipment and intangible assets. The Company periodically evaluates the recoverability of long-lived assets whenever events and changes in circumstances indicate that the carrying amount of an asset may not be fully recoverable. When indicators of impairment are present, the carrying values of the assets are evaluated in relation to the operating performance and future undiscounted cash flows of the underlying business. The net book value of the underlying asset is adjusted to fair value if the sum of the expected discounted cash flows is less than book value. Fair values are based on estimates of market prices and assumptions concerning the amount and timing of estimated future cash flows and discount rates, reflecting varying degrees of perceived risk, which are Level 3 unobservable inputs. The Company did not have any long-lived asset impairments in the years ended September 30, 2025 or 2024.
Goodwill impairment | Goodwill impairment The Company tests goodwill for impairment on an annual basis on July 1, or more frequently if an event occurs or circumstances change that would indicate that impairment may exist. The Company determines the fair value of our reporting units using the income approach (a Level 3 fair value input) and market approach (a Level 2 fair value input) to valuation, as well as other generally accepted valuation methodologies. The income approach utilizes a discounted cash flow analysis using management’s assumptions. The market approach compares the reporting unit to similar companies with the assumption that companies operating in the same industry will share similar characteristics and that company values will correlate to those characteristics. If the carrying amount of the reporting unit exceeds the reporting unit’s fair value, an impairment loss is recognized equal to the difference between the carrying amount and the estimated fair value of the reporting unit. The Company concluded that there was no impairment of goodwill during the years ended September, 30, 2025 or 2024. The income approach uses cash flow projections based upon a financial forecast approved by management, covering a five-year period. Cash flows for the years thereafter are extrapolated using the estimated terminal growth rate. The risk premiums expected by market participants related to uncertainties about the industry and assumptions relating to future cash flows may differ or change quickly, depending on economic conditions and other events.
Equity method investee | Equity method investee The Company, through QHM Investments I, LLC, acquired an ownership interest in DMEScripts, LLC (“DMEScripts”). As of September 30, 2025, the Company has cumulatively invested $1,710,000 and has a 7.0% ownership interest in DMEScripts. DMEScripts is an independent e-prescribe company in the US that automates the medical equipment ordering process. This technology is dedicated to improving the patient, prescriber, and provider experience by eliminating inefficiencies and reducing paperwork. The investment in DMEScripts is accounted for using the equity method. The Company applies the equity method of accounting for investments when it determines it has a significant influence, but not a controlling interest in the investee. Significant influence is determined by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. The equity method investment is reported at cost and adjusted each period for the Company’s share of the investee's income (loss). The Company records “share of loss in equity method investment” on the consolidated statements of income (loss) for its pro rata share ownership percentage of the investee’s net loss.
Foreign currency transactions | Foreign currency transactions Transactions in foreign currencies are initially recorded at the foreign currency spot rate or the rate realized in the transaction. Monetary items are translated at the foreign currency spot rate as of the reporting date and exchange differences from monetary items are recognized in profit or loss. Non-monetary items that are not carried at fair value are translated using the exchange rates at the date of the initial transaction. Non-monetary items measured at fair value in a foreign currency are translated using the exchange rates at the date when the fair value is determined. The assets and liabilities of foreign operations are translated into US dollars at the rate of exchange prevailing at the reporting date and their statements of operations are translated at the average monthly rates of exchange.
Revenue recognition | Revenue recognition Revenues are billed to, and collections are received from customers. Because of continuing changes in the health care industry and third-party reimbursement, the consideration receivable from these insurance companies is variable as these billings can be challenged by the payor. Therefore, the amount billed by the Company is reduced to an estimate of the amount that the Company believes will be ultimately allowed by the insurance contract, including co-pays and deductibles. This estimate involves significant judgment including an analysis of past collections and historical modification rates. Management regularly reviews the actual claims approved by the insurance companies, adjusting estimated revenue as necessary. The Company does not offer warranties to customers in excess of the manufacturer’s warranty. Any taxes due upon sale of the products or services are not recognized as revenue. The Company records deferred revenue on the consolidated statement of financial position for the unelapsed portion of the rental month that exists as of the balance sheet date. All of the deferred revenue as of September 30, 2024 was recognized during the year ended September 30, 2025. Rental of medical equipment Revenue that is generated from equipment that the Company rents to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental revenue, less estimated adjustments, is recognized as earned on a straight-line basis over the noncancellable lease term. Sales of medical equipment and supplies The Company sells equipment, consumable supplies, and replacement parts to customers and recognizes revenue on delivery, as at that point all performance obligations have been met. Shipping and handling The Company provides shipping and handling at no charge in sending product to customers. The Company does not consider this a separate performance obligation since these shipping and handling activities occur before the customer obtains control of the goods. The shipping and handling are considered activities to fulfill the entity’s promise to transfer the goods and are expensed within operating expenses.
Stock-based compensation | Stock-based compensation The Company grants stock options and restricted stock units to employees, members of the Board of Directors, and consultants. The Company measures equity settled share-based payments based on their fair value at the grant date and recognizes compensation expense on a straight-line basis over the vesting period. Fair value is measured using the Black-Scholes Model. In estimating fair value, management is required to make certain assumptions and estimates, such as the expected life of units, volatility of the Company’s future share price, risk-free interest rates, and future dividend yields, at the initial grant date. Changes in assumptions used to estimate fair value could result in materially different results. The Company has elected to recognize the effect of forfeitures in compensation cost when they occur. Previously recognized compensation cost for an award is reversed in the period that the award is forfeited. Further, the Company has elected to use the contractual term as the expected term. Compensation expense is recognized on a straight-line basis, by amortizing the grant date fair value over the vesting period for each separately vesting portion of the award.
Fair value measurement | Fair value measurement Financial instruments carried at fair value on the consolidated statements of financial position are classified using a fair value hierarchy that reflects the significance of the inputs used in making the measurements. The fair value hierarchy has the following levels: Level 1 – Where financial instruments are traded in active financial markets, fair value is determined by reference to the appropriate quoted market price at the reporting date. Active markets are those in which transactions occur in significant frequency and volume to provide pricing information on an ongoing basis; Level 2 – If there is no active market, fair value is established using valuation techniques, including discounted cash flow models. The inputs to these models are taken from observable market data where possible, including recent arm’s length market transactions and comparisons to the current fair value of similar instruments, but where this is not feasible, inputs such as liquidity risk, credit risk, and volatility are used; and Level 3 – In this level, fair value determinations are made with inputs other than observable market data. There were no transfers between the levels of fair value hierarchy during the years ended September 30, 2025 or 2024. The carrying amounts that have been reported in the accompanying consolidated balance sheets for cash approximate its fair value due to its highly liquid nature.
Loss per share | Loss per share The Company presents basic and diluted loss per share data for its ordinary shares. Basic loss per share is calculated by dividing the net loss by the weighted average number of Common Shares outstanding during the period. Contingently issuable shares (including shares held in escrow) are not considered outstanding common shares and consequently are not included in the loss per share calculations. The Company’s potentially dilutive common share equivalents are stock options and restricted stock units. The years ended September 30, 2025 and 2024 were periods of net losses, therefore, the potentially dilutive common share equivalents are excluded in the determination of dilutive net loss per share because their effect is antidilutive. In order to determine diluted loss per share, it is assumed that any proceeds from the exercise of dilutive instruments would be used to repurchase common shares at the average market price during the period.
Leases | Leases Leases are classified as operating or finance leases based on the terms of the lease agreement and certain characteristics of the identified assets. The Company’s operating leases are for real estate and range from 2 to 11 years. The Company’s finance leases are for vehicles and range from 2 to 7 years. The Company’s leases include fixed payments, as well as in some cases, scheduled base rent increases over the term of the lease. Certain leases require variable payments of common area maintenance, operating expenses, and real estate taxes applicable to the property. Variable payments are excluded from the measurements of lease liabilities and are expensed as incurred. Any tenant improvement allowances received from the lessor are recorded as a reduction to rent expense over the term of the lease. Some of the Company’s vehicle lease agreements contain residual value guarantees. The Company determines if an arrangement is a lease at the inception of the contract. Lease liabilities are recognized at the commencement date based on the present value of lease payments over the lease term for those arrangements where there is an identified asset, and the contract conveys the right to control its use. The right-of-use asset is measured at the initial amount of the lease liability. Right-of-use assets are included in property and equipment in the Company's consolidated balance sheets. Operating lease expense is recognized on a straight-line basis over the term of the lease. Finance lease cost includes a.) depreciation, which is recognized on a straight-line basis over the expected life of the right-of-use asset and included in depreciation in the Company’s consolidated statements of income (loss), and b.) interest expense, which is recognized following an effective interest rate method and is included in interest expense in the Company’s consolidated statements of income (loss). The Company’s real estate operating leases do not provide an implicit rate that can be easily determined. Therefore, the Company applies its incremental borrowing rate to the lease based on the information available at the commencement date. This estimate impacts the carrying amount of the lease liabilities and the interest expense recorded on the consolidated statement of income (loss). Vehicle finance leases are recorded at the interest rate implicit in the lease based on the current value and the estimated residual value of the vehicle. Certain leases include one or more options to renew or terminate the lease at the Company’s discretion. When the Company recognizes a lease, it assesses the lease term based on the conditions of the lease and determines whether it is probable that it will choose to extend the lease at the end of the initial lease term. This estimate could affect future results if the Company extends the lease or exercises an early termination option. The Company accounts for non-lease and lease components to which they relate as a single lease component. Additionally, the Company recognized lease payments under short-term leases with an initial term of twelve months or less, as well as low value assets, as an expense on a straight-line basis over the lease term without recognizing the lease liability and ROU asset.
Income taxes | Income taxes Deferred taxes are determined based on the differences between the financial statement amounts and the tax bases using rates as enacted in the laws. A valuation allowance is established if it is “more likely than not” that all or a portion of the deferred tax assets will not be realized. Interest and penalties related to unrecognized tax benefits are recognized in the tax provision. Liabilities for uncertain tax positions are recognized when it is more likely than not that a tax position will not be sustained upon examination and settlement with various taxing authorities. Liabilities for uncertain tax positions are measured based upon the largest amount of benefit that is greater than 50% likely of being realized upon ultimate settlement. There are not any material interest or penalties during any of the years presented.
Business combinations | Business combinations The Company accounts for business combinations using the acquisition method when control is obtained by the Company. The Company measures the consideration transferred, the assets acquired, and the liabilities assumed in a business combination at their acquisition-date fair values. Acquisition-related costs are recognized as expenses in the periods in which the costs are incurred, and the services are received. The excess of the consideration transferred to obtain control, over the net of the acquisition-date amounts of the identifiable assets acquired and the liabilities assumed, is recognized as goodwill as of the acquisition date. Contingent consideration for a business combination is measured at its acquisition-date fair value and included as part of the consideration transferred in a business combination. Contingent consideration that is classified as a liability is measured at subsequent reporting dates at fair value with the corresponding gain or loss being recognized in profit or loss.
Noncontrolling interest | Noncontrolling interest The Company owns 60% of Hart and has determined that it has control of Hart. Therefore, its financial statements are included in the Company’s consolidated financial statements, with the noncontrolling 40% noncontrolling interest reflected as a line item on the consolidated statements of financial position, income (loss) and changes in shareholders’ equity.
Financial instruments concentration of credit risk | Financial instruments concentration of credit risk The Company maintains cash with various major financial institutions which generally exceeds federally insured limits. The Company performs periodic evaluations of the financial institutions in which its cash is invested.
Derivatives financial instruments | Derivatives financial instruments The Company is exposed to risks related to changes in interest rates. The financial risk management program is designed to manage the exposure arising from cash flow variability and uses derivative financial instruments to minimize this risk. The Company does not enter into derivative financial instruments for trading or speculative purposes. The Company’s derivative instruments consist of interest rate swap contracts. Derivative instruments are recorded in the consolidated balance sheets and the changes in the fair values of these interest rate swap contracts are recorded on the consolidated statements of income/(loss).
Recently adopted and issued accounting pronouncements | Recently adopted accounting pronouncements Effective October 1, 2024, the Company adopted Accounting Standards Update (“ASU”) 2023-07, Segment Reporting ("Topic 280"), which requires disclosure of incremental segment information, including significant segment expenses that are regularly provided to the chief operating decision maker and to disclose how reported measures of segment profit or loss are used in assessing segment performance and allocating resources. The new disclosures are included as Note 14. Recently issued accounting pronouncements The Company is an “emerging growth company” as defined by the Jumpstart Our Business Startups Act of 2012 (“JOBS Act”). The JOBS Act provides that an emerging growth company can take advantage of the extended transition period provided in Section 7(a)(2)(B) of the Securities Act of 1933, as amended, for complying with new or revised accounting standards. In other words, an emerging growth company can selectively delay the adoption of all accounting standards until those standards would otherwise apply to private companies. The Company has elected to utilize this exemption and, as a result, the consolidated financial statements may not be comparable to the financial statements of issuers that are required to comply with the effective dates for new or revised accounting standards that are applicable to public companies. To date, however, the Company has not delayed the adoption of any accounting standards except as noted below. Section 107 of the JOBS Act provides that the Company can elect to opt out of the extended transition period at any time, which election is irrevocable. In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (“Topic 740”): Improvements to Income Tax Disclosures, which is intended to improve the transparency of income tax disclosures by requiring consistent categories and greater disaggregation of information in the effective tax rate reconciliation and income taxes paid by jurisdiction. The ASU is effective for public business entities' annual periods beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the impact of adopting this guidance on its consolidated financial statements. In March 2024, the FASB issued ASU No. 2024-01, Compensation-Stock Compensation ("Topic 718"), which provides illustrative guidance to help entities determine whether profits interest and similar awards should be accounted for as share-based payment arrangements within the scope of ASC 718. ASU 2024-01 is effective for annual periods beginning after December 15, 2024, and interim periods within those annual periods. The Company is currently evaluating the impact that this standard will have on its consolidated financial statements and related disclosures.

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