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Bank Loan and Lines of Credit (Details) - USD ($)
6 Months Ended
Oct. 03, 2018
Sep. 05, 2018
Mar. 03, 2017
Jun. 30, 2019
May 31, 2019
Apr. 17, 2019
Apr. 16, 2019
Dec. 31, 2018
Sep. 01, 2018
Aug. 31, 2018
Jun. 14, 2018
Dec. 31, 2010
Debt Instrument [Line Items]                        
Restricted cash       $ 3,537,470       $ 0        
ICC | Bank Loan                        
Debt Instrument [Line Items]                        
Face amount of debt                       $ 4,600,000.0
Interest rate on debt               5.50%        
Standby Letters of Credit | APC                        
Debt Instrument [Line Items]                        
Maximum loan availability       $ 300,000                
Term of facility       1 year                
Preferred Bank | Line of Credit | NMM | NMM Business Loan Agreement                        
Debt Instrument [Line Items]                        
Maximum loan availability                 $ 27,000,000.0 $ 20,000,000.0 $ 20,000,000.0  
interest rate at end of period       5.625%       5.625%        
Amount outstanding       $ 5,000,000       $ 13,000,000        
Amount available       $ 15,400,000       $ 700,000        
Preferred Bank | Line of Credit | NMM | NMM Line of Credit Agreement                        
Debt Instrument [Line Items]                        
Maximum loan availability   $ 20,000,000.0       $ 16,000,000.0 $ 20,000,000.0          
interest rate at end of period       5.625%       5.625%        
Amount available       $ 16,000,000       $ 20,000,000        
Term of converted loan   5 years                    
Term of facility   5 years                    
Preferred Bank | Line of Credit | APC | APC Business Loan Agreement                        
Debt Instrument [Line Items]                        
Maximum loan availability           $ 40,000,000.0 $ 10,000,000.0       $ 10,000,000.0  
interest rate at end of period       5.625%       5.625%        
Amount outstanding       $ 39,600,000       $ 0        
Amount available       100,000       $ 9,700,000        
Amount drawn during period       $ 39,600,000                
Preferred Bank | Standby Letters of Credit | APAACO                        
Debt Instrument [Line Items]                        
Maximum loan availability $ 6,600,000.0   $ 6,700,000.0                  
Term of facility 1 year   1 year                  
Period of notification of termination 90 days   90 days                  
Prime Rate | Preferred Bank | Line of Credit | NMM | NMM Business Loan Agreement                        
Debt Instrument [Line Items]                        
Basis spread on variable rate       0.125%                
Prime Rate | Preferred Bank | Line of Credit | NMM | NMM Line of Credit Agreement                        
Debt Instrument [Line Items]                        
Basis spread on variable rate       0.125%                
Prime Rate | Preferred Bank | Line of Credit | APC | APC Business Loan Agreement                        
Debt Instrument [Line Items]                        
Basis spread on variable rate       0.125%                
Alpha Care Medical Group, Inc. | Standby Letters of Credit | APC and APC-LSMA                        
Debt Instrument [Line Items]                        
Term of facility 1 year                      
Standby letters of credit assumed         $ 3,500,000