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Summary of Significant Accounting Policies (Policies)
9 Months Ended
Mar. 31, 2022
Accounting Policies [Abstract]  
Basis of Presentation

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with the instructions for Form 10-Q and, therefore, do not include all information and footnotes which are normally included in the Company’s Form 10-K. These financial statements reflect all adjustments (consisting of normal recurring items or items discussed herein) that management believes are necessary to fairly state results for the interim periods presented. Results of operations for interim periods are not necessarily indicative of annual results of operations. The condensed consolidated balance sheet as of June 30, 2021, presented herein, has been derived from the Company’s audited consolidated financial statements as of and for the year-ended June 30, 2021.

All assets and liabilities related to discontinued operations are excluded from the notes unless otherwise noted. In addition, the historical results of the real estate business operating segment have been reflected in the accompanying consolidated statements of operations for the three and nine months ended March 31, 2021 as discontinued operations. See Note 4 – Discontinued Operations.

Use of Estimates

Use of Estimate

The preparation of these financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP) requires the Company to make estimates and assumptions that affect the reported amounts in the financial statements and disclosures of contingent assets and liabilities. On an on-going basis, the Company evaluates all of these estimates and assumptions. Included in these estimates and assumptions are items that relate to revenue recognition, recognition of rental income, the valuation of excess and obsolete inventories, depreciable lives of equipment, impairment of long lived tangible and intangible assets, valuation allowance for deferred tax assets, fair value measurements including stock-based compensation and contingent consideration, estimates associated with the application of acquisition accounting, and the value of lease liabilities and corresponding right to use assets. Although these and other estimates and assumptions are based on the best available information, actual results could be different from these estimates.

Principles of Consolidation

Principles of Consolidation

The Company consolidates the assets, liabilities, and operating results of its wholly-owned subsidiaries; majority-owned subsidiaries; and subsidiaries in which we hold a controlling financial interest as of the financial statement date. In most cases, a controlling financial interest reflects ownership of a majority of the voting interests. We consolidate a variable interest entity (VIE) when we possess both the power to direct the activities of the VIE that most significantly impact its economic performance and we are either obligated to absorb the losses that could potentially be significant to the VIE or we hold the right to receive benefits from the VIE that could potentially be significant to the VIE.

All intercompany accounts and transactions have been eliminated in consolidation.

Non-controlling interests in the Company’s subsidiaries are reported as a component of liabilities for mandatorily redeemable interests, temporary equity for contingently redeemable interests or permanent equity, separate from the Company’s equity. See Note 15 – Non-Controlling Interests and Preferred Stock of Subsidiaries. Results of

operations attributable to the non-controlling interests are included in the Company’s condensed consolidated statements of operations.

Segments

Segments

The Company has two business operating segments: durable medical equipment and investment management, with general corporate representing unallocated costs and activity to arrive at consolidated operations. The Company regularly reviews each segment for purposes of allocating resources and assessing performance.

Cash and Cash Equivalents

Cash and Cash Equivalents

Cash and cash equivalents are comprised of cash and highly liquid investments with original maturities of 90 days or less at the date of purchase. Cash equivalents consist primarily of exchange-traded money market funds. The Company is exposed to credit risk in the event of default by the financial institutions or the issuers of these investments to the extent the amounts on deposit or invested are in excess of amounts that are insured.

Accounts Receivable

Accounts Receivable

Substantially all of the accounts receivable balance relates to the durable medical equipment business. Accounts receivable are customer obligations due under normal sales and rental terms and represent the amount estimated to be collected from the customers and, if applicable, the third-party private insurance provider or government program (collectively, Payors), based on the contractual agreements. The Company does not require collateral in connection with its customer transactions and aside from verifying insurance coverage, does not perform credit checks on patient customers. Revenue and accounts receivable have been constrained to the extent that billed amounts exceed the amounts estimated to be collected. The constrained transaction price relates primarily to expected billing adjustments with the Payors and patient customers. Management’s evaluation of variable consideration takes into account such factors as past experience, information about specific receivables, Payors and patient customers. The revenue reserves related to constraints on variable consideration were $2.2 million and $2.5 million as of March 31, 2022 and June 30, 2021, respectively. During the three and nine months ended March 31, 2022 and 2021, the Company recognized reductions to revenue of $1.2 million and $3.0 million, and $2.2 million and $4.9 million, respectively, related to such constraints. See Note 3 – Revenue.

The assessment of variable consideration to be constrained is based on estimates, and ultimate losses may vary from current estimates. As adjustments to these estimates become necessary, they are reported in earnings in the periods in which they become known. There were no material adjustments to revenues made in the nine months ended March 31, 2022 relating to prior periods. Changes in constraints on variable consideration are recorded as a component of net revenues.

The Company generally does not allow returns from customers for reasons not covered under the manufacturer’s standard warranty. Therefore, there is no provision for sales return reserves. The Company does not have significant bad debt experience with Payors, and therefore the allowance for doubtful accounts is immaterial.

As of March 31, 2022 and June 30, 2021, the Company had unbilled receivables of approximately $0.1 million and $0.3 million, respectively, that relate to transactions where the Company has the ultimate right to invoice a Payor under the terms of the arrangement but are not currently billed. These unbilled amounts are included in accounts receivable in the condensed consolidated balance sheets.

Net Income (Loss) Per Share

Net Income (Loss) per Share

The following table presents the calculation of basic and diluted income (loss) per share:

 

 

For the three months ended March 31,

 

 

For the nine months ended March 31,

 

(in thousands except per share amounts)

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Loss from continuing operations

 

$

(6,135

)

 

$

(2,818

)

 

$

(10,188

)

 

$

(7,440

)

Income from discontinued operations, net of tax

 

 

-

 

 

 

73

 

 

$

-

 

 

$

211

 

Net loss

 

$

(6,135

)

 

$

(2,745

)

 

$

(10,188

)

 

$

(7,229

)

Less: net income (loss) attributable to non-controlling interest, continuing operations

 

 

(226

)

 

 

(173

)

 

 

159

 

 

 

(907

)

Less: net income attributable to non-controlling interest, discontinued operations

 

 

-

 

 

 

15

 

 

 

-

 

 

 

45

 

Net loss attributable to Great Elm Group, Inc.

 

$

(5,909

)

 

$

(2,587

)

 

$

(10,347

)

 

$

(6,367

)

Weighted average shares basic and diluted:

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average shares of common stock outstanding

 

 

26,842

 

 

 

25,757

 

 

 

26,963

 

 

 

25,669

 

Weighted average shares used in computing income (loss) per share

 

 

26,842

 

 

 

25,757

 

 

 

26,963

 

 

 

25,669

 

Basic and diluted income (loss) per share from:

 

 

 

 

 

 

 

 

 

 

 

 

Loss from continuing operations

 

$

(0.22

)

 

$

(0.10

)

 

$

(0.38

)

 

$

(0.25

)

Income from discontinued operations

 

 

-

 

 

 

0.00

 

 

 

-

 

 

 

0.00

 

Net loss

 

$

(0.22

)

 

$

(0.10

)

 

 

(0.38

)

 

 

(0.25

)

 

When calculating earnings per share, we are required to adjust for the dilutive effect of common stock equivalents. As of March 31, 2022, the Company had 13,298,887 potential shares of common stock, including 10,139,031 potential shares of Company common stock issuable upon conversion of Convertible Notes and 3,159,856 potential shares issuable upon the exercise of stock options and vesting of restricted stock units and restricted stock awards, that are not included in the diluted net income (loss) per share calculation because to do so would be anti-dilutive. As of March 31, 2021, the Company had 13,088,564 potential shares of common stock, including 9,656,616 shares of common stock issuable upon the conversion of the Company Convertible Notes and 3,431,948 potential shares issuable upon the exercise of stock options and vesting of restricted stock units and restricted stock awards, that are not included in the diluted net income (loss) per share calculation because to do so would be anti-dilutive.

As of March 31, 2022 and 2021, the Company had an aggregate of 579,423 and 732,909 issued shares, respectively, that are subject to forfeiture by the employee at a nominal price if service and/or performance milestones are not met. The Company does not account for such shares as being outstanding for accounting purposes since they are unvested and subject to forfeiture.

Restrictions on Subsidiary Dividends

Restrictions on Subsidiary Dividends

The ability of HC LLC to pay dividends is subject to compliance with the restricted payment covenants under the DME Revolver (as defined below).

Concentration of Risk

Concentration of Risk

The Company’s net investment revenue and receivables for the periods presented were primarily attributable to the management of one investment vehicle, GECC. See Note 6 – Related Party Transactions.

The Company’s durable medical equipment revenue and related accounts receivable are concentrated with third-party Payors. The following table summarizes customer concentrations as a percentage of revenues:

 

 

For the three months ended March 31,

 

For the nine months ended March 31,

 

 

2022

 

2021

 

2022

 

2021

Government Payor

 

33%

 

32%

 

35%

 

35%

Third-party Payor

 

10%

 

11%

 

13%

 

12%

(1)
Revenue concentration percentages have been recast from those previously reported to reflect the presentation of the real estate business within discontinued operations

The following table summarizes customer concentrations as a percentage of accounts receivable:

 

 

As of

 

 

March 31, 2022

 

June 30, 2021

Government Payor

 

28%

 

30%

Third-party Payor

 

19%

 

14%

Recently Adopted and Issued Accounting Standards

Recently Adopted Accounting Standards

Accounting for Convertible Instruments. In August 2020, the Financial Accounting Standards Board (FASB) issued Accounting Standard Update (ASU) 2020-06, Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which simplifies the accounting for convertible instruments by eliminating certain separation models. Under ASU 2020-06, a convertible debt instrument will generally be reported as a single liability at its amortized cost with no separate accounting for embedded conversion features. Consequently, the interest rate of convertible debt instruments will be closer to the coupon interest rate. In addition, ASU 2020-06 eliminates the treasury stock method to calculate diluted earnings per share for convertible instruments and requires the use of the if-converted method. The guidance in ASU 2020-06 is effective for fiscal years beginning after December 31, 2023, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. The Company adopted ASU 2020-06 on July 1, 2021 using the full retrospective method.

Prior to adoption, under Accounting Standards Codification 470-20, Debt with Conversion and Other Options ("ASC 470-20"), we had separately accounted for the liability and equity components upon the original issuance of our Convertible Notes in February 2020 due to the existence of a temporary cash conversion feature. Under ASC 470-20, the equity component of the Convertible Notes was recorded as additional paid-in capital within stockholders’ equity on our consolidated balance sheet and generated an original issue discount on the carrying value of the Convertible Notes. As a result, prior to the adoption of ASU 2020-06, we recorded a greater amount of non-cash interest expense as the discounted carrying value is accreted up to their face value over the Convertible Notes term. Under the full retrospective method, the prior period condensed consolidated financial statements have been retrospectively adjusted to reflect the adoption of the accounting standard in those periods. The following tables shows the impact of the adoption on our previously reported financial information:

Consolidated Balance Sheet Impact

 

As of June 30, 2021

 

 

 

As Reported(1)

 

 

ASU 2020-06 Adjustment

 

 

As Adjusted

 

Liabilities

 

 

 

 

 

 

 

 

 

Convertible notes

 

$

22,054

 

 

$

11,279

 

 

$

33,333

 

Other liabilities

 

 

1,070

 

 

 

(155

)

 

 

915

 

           Total Liabilities

 

 

95,321

 

 

 

11,124

 

 

 

106,445

 

Stockholders' equity

 

 

 

 

 

 

 

 

 

Additional paid-in-capital

 

 

3,319,767

 

 

 

(12,154

)

 

 

3,307,613

 

Accumulated deficit

 

 

(3,265,433

)

 

 

1,030

 

 

 

(3,264,403

)

Total Great Elm Group, Inc Stockholder's Equity

 

 

54,360

 

 

 

(11,124

)

 

 

43,236

 

Total Stockholder's Equity

 

 

63,909

 

 

 

(11,124

)

 

 

52,785

 

 

 

 

 

 

 

 

 

 

 

Consolidated Statement of

 

 

 

 

 

 

 

 

 

Operations Impact

 

For the three months ended March 31, 2021

 

 

 

As Reported(1)

 

 

ASU 2020-06 Adjustment

 

 

As Adjusted

 

Non-operating expenses

 

 

 

 

 

 

 

 

 

Interest expense

 

$

(1,534

)

 

$

173

 

 

$

(1,361

)

Net loss from continuing operations

 

 

 

 

 

 

 

 

 

Net loss from continuing operations

 

 

(2,991

)

 

 

173

 

 

 

(2,818

)

Net loss per share (basic and diluted)

 

 

(0.11

)

 

 

0.01

 

 

 

(0.10

)

 

 

 

 

 

 

 

 

 

 

 

 

For the nine months ended March 31, 2021

 

 

 

As Reported(1)

 

 

ASU 2020-06 Adjustment

 

 

As Adjusted

 

Non-operating expenses

 

 

 

 

 

 

 

 

 

Interest expense

 

$

(4,105

)

 

$

498

 

 

$

(3,607

)

Net loss from continuing operations

 

 

 

 

 

 

 

 

 

Net loss from continuing operations

 

 

(7,938

)

 

 

498

 

 

 

(7,440

)

Net loss per share (basic and diluted)

 

 

(0.27

)

 

 

0.02

 

 

 

(0.25

)

(1)
As re-casted to reflect the operations of our real estate business as discontinued operations and therefore excluded.

Recently Issued Accounting Standards

Current Expected Credit Losses. In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326), which changes the impairment model for financial instruments, including trade receivables from an incurred loss method to a new forward looking approach, based on expected losses. The estimate of expected credit losses will require entities to incorporate considerations of historical experience, current information and reasonable and supportable forecasts. The amendments in this ASU are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. The Company is evaluating the potential impact that the adoption of this ASU will have on its consolidated financial statements.

Reference Rate Reform. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): facilitation of the Effects of Reference Rate Reform on Financial Reporting, in response to the United Kingdom Financial Conduct Authority which announced the desire to phase out the use of the London Interbank Offered Rate (LIBOR) by the end of 2021. The provisions provide optional expedients and exceptions for applying GAAP to contracts, hedging relationships and other transactions affected by reference rate reform on financial reporting due to the cessation of LIBOR if certain criteria are met. If LIBOR ceases to exist, we may need to renegotiate outstanding notes payable outstanding which extend beyond 2021 with the respective counterparties. Adoption of the provisions in ASU 2020-04 are optional and effective from March 12, 2020 through December 31, 2022. We are currently evaluating the impact of this ASU on our financial statements.

Revenue Revenue

The revenues from each major source of revenue are summarized in the following table:

 

 

For the three months ended March 31,

 

 

For the nine months ended March 31,

 

(in thousands)

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Product and Services Revenue

 

 

 

 

 

 

 

 

 

 

 

 

Investment Management

 

 

 

 

 

 

 

 

 

 

 

 

Management Fees

 

$

779

 

 

$

613

 

 

$

2,550

 

 

$

1,823

 

Administration and Service Fees

 

 

209

 

 

 

115

 

 

 

442

 

 

 

438

 

 

 

 

988

 

 

 

728

 

 

 

2,992

 

 

 

2,261

 

Durable Medical Equipment

 

 

 

 

 

 

 

 

 

 

 

 

Equipment Sales

 

 

8,976

 

 

 

7,309

 

 

 

26,674

 

 

 

23,728

 

Service Revenues

 

 

1,383

 

 

 

1,297

 

 

 

4,038

 

 

 

3,635

 

 

 

 

10,359

 

 

 

8,606

 

 

 

30,712

 

 

 

27,363

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total product and services revenue

 

$

11,347

 

 

$

9,334

 

 

$

33,704

 

 

$

29,624

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rental Revenue

 

 

 

 

 

 

 

 

 

 

 

 

Durable Medical Equipment

 

 

 

 

 

 

 

 

 

 

 

 

Medical Equipment Rental Income

 

 

5,275

 

 

 

4,511

 

 

 

16,205

 

 

 

14,907

 

Total rental revenue

 

 

5,275

 

 

 

4,511

 

 

 

16,205

 

 

 

14,907

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

$

16,622

 

 

$

13,845

 

 

$

49,909

 

 

$

44,531

 

 

Revenue Accounting Under Topic 606

In determining the appropriate amount of revenue to be recognized under FASB Accounting Standards Codification Topic 606, Revenues (Topic 606) the Company performed the following steps: (i) identified the promised goods or services in the contract; (ii) determined whether the promised goods or services are performance obligations including whether they are distinct in the context of the contract; (iii) measured the transaction price, including the constraint on variable consideration; (iv) allocated the transaction price to the performance obligations; and (v) recognized revenue when (or as) the Company satisfies each performance obligation.

Durable Medical Equipment Revenue

Equipment Sales and Services Revenues

The Company sells durable medical equipment, replacement parts and supplies to customers and recognizes revenue at the point control is transferred through delivery to the customer. Each piece of equipment, part or supply is distinct and separately priced thus they each represent a single performance obligation. The revenue is allocated amongst the performance obligations based upon the relative standalone selling price method, however, items are typically all delivered or supplied together. The customer and, if applicable, the Payors are generally charged at the time that the product is sold, although separate layers of insurance coverage may need to be invoiced before final billings may occur.

The Company also provides sleep study services to customers and recognizes revenue when the results of the sleep study are complete as that is when the performance obligation is met.

The transaction price on both equipment sales and sleep studies is the amount that the Company expects to receive in exchange for the goods and services provided. Due to the nature of the durable medical equipment business, billing adjustments customarily occur during the collections process when explanations of benefits are received by Payors, and as amounts are deferred to secondary Payors or to patient responsibility. As such, we constrain the transaction price for the difference between the gross charge and what we believe we will collect from Payors and from patients. The transaction price therefore is predominantly based on contractual payment rates determined by the Payors. The Company does not generally contract with uninsured customers. We determine our estimates of billing adjustments based upon contractual agreements, our policies and historical experience. While the rates are fixed for the product or service with the customer and the Payors, such amounts typically include co-payments, co-insurance and deductibles, which vary in amounts, from the patient customer. The Company includes in the transaction price only the amount that the Company expects to be entitled, which is substantially all of the Payor billings at contractual rates. The transaction price is initially constrained by the amount of customer co-payments we estimate will not be collected.

Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenue and accounts receivable. 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 and the uncertainty of reimbursement amounts for certain services from certain Payors may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application or claim denial. The Company constrains revenue for these estimated adjustments. There were no material changes in estimates recorded in the three and nine months ended March 31, 2022, relating to prior periods.

The payment terms and conditions of customer contracts vary by customer type and the products and services offered.

The Company may provide shipping services prior to the point of delivery and has concluded that the services represent a fulfilment activity and not a performance obligation. Returns and refunds are not accepted on either equipment sales or sleep study services. 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 does not incur contract acquisition costs. The Company does not have any partially or unfilled performance obligations related to contracts with customers. However, during the quarter ended June 30, 2020, the Company applied for and received $4.4 million in advanced payments from the Centers for Medicare and Medicaid Services (CMS) under their Accelerated and Advance Payment Program, which was expanded to increase cash flow to providers of services and suppliers impacted by the COVID-19 pandemic. CMS began recoupments during fiscal 2021, leaving a remaining balance of $3.5 million as of June 30, 2021. During the three and nine months ended March 31, 2022, we issued recoupments of $0.7 million and $3.0 million, leaving a remaining balance of $0.5 million as of March 31, 2022. These amounts are included within deferred revenue on the condensed consolidated balance sheet. The Company has no other contract liabilities as of March 31, 2022 or June 30, 2021.

Included in sales and services revenue are unbilled amounts for which the revenue recognition criteria had been met as of period end but were not yet billed to the Payor. The estimate of net unbilled rental revenue recognized is based on historical trends and estimates of future collectability. As of March 31, 2022 and June 30, 2021, net unbilled sales and services revenue is approximately $0.1 million and $0.2 million, respectively, and is included in accounts receivable.

Investment Management Revenue

The Company recognizes revenue from its investment management business at amounts that reflect the consideration to which it expects to be entitled in exchange for providing services to its customer. Investment management revenue primarily consists of fees based on a percentage of assets under management; fees based on the performance of managed assets; and administrative fees. Fees are based on agreements with each investment product and may be terminated at any time by either party subject to the specific terms of each respective agreement.

Management Fees

The Company earns management fees based on the investment management agreements GECM has with GECC and other private funds managed by GECM (collectively, the Funds). The performance obligation is satisfied over time as the services are rendered, since the Funds simultaneously receive and consume the benefits provided as GECM performs services. Management fee rates range from 1% to 1.5% of the management fee assets specified with each agreement. Based on the terms of the specific agreement, management fees may be calculated and billed in advance or in arrears of the period, no less frequently than quarterly. Management fee revenue is recognized over time as the services are provided.

Incentive Fees

The Company earns incentive fees based on the investment management agreements GECM has with GECC and separately managed accounts. Where an investment management agreement includes both management fees and incentive fees, the performance obligation is considered to be a single obligation for both fees. Incentive fees are variable consideration associated with the GECC investment management agreement. Incentive fees are recognized based on investment performance during the period, subject to the achievement of minimum return levels or high-water marks, in accordance with the terms of the respective investment management agreements. Incentive fees range from 5.0% to 20.0% of the performance-based metric specified within each agreement. Effective March 31, 2022 the Company unconditionally waived all accrued incentive fees through March 31, 2022, therefore the accrued yet constrained incentive fees is $0.0 million.

Administration and Service Fees

The Company earns administration fees based on the administration agreement GECM has with GECC whereby GECC reimburses GECM for costs incurred in performing administrative functions for GECC. This revenue is recognized over time as the services are performed. Administrative fees are billed quarterly in arrears, which is consistent with the timing of the delivery of services and reflect agreed upon rates for the services provided. The services are accounted for as a single performance obligation that is a series of distinct services with substantially the same pattern of transfer as the services are provided on a daily basis.

The Company also earns service fees based on a shared services agreement with certain portfolio companies of GECC. This revenue is recognized over time as the services are performed. Service fees are billed quarterly in arrears, which is consistent with the timing of the delivery of services and reflect agreed upon rates for the services provided. The services are accounted for as a single performance obligation that is a series of distinct services with substantially the same pattern of transfer as the services are provided on a daily basis.

Revenue Accounting Under Topic 842

Durable Medical Equipment Revenue

Equipment Rental Revenue

Under FASB Accounting Standards Codification Topic 842, Leases (Topic 842) rental income from operating leases is recognized on a straight-line basis, based on contractual lease terms with fixed and determinable increases over the non-cancellable term of the related lease when collectability is reasonably assured. The Company leases durable medical equipment to customers for a fixed monthly amount on a month-to-month basis. The contractual length of the lease term varies based on the type of equipment that is rented to the customer, but generally is from 10 to 36 months. In the case of capped rental agreements, title to the equipment transfers to the customer at the end of the contractual rental period. The customer has the right to cancel the lease at any time during the rental period for a subsequent month’s rental and payments are generally billed in advance on a month-to-month basis. Under Topic 842, rental income from operating leases is recognized on a month-to-month basis, based on contractual lease terms when collectability is reasonably assured. Certain customer co-payments are included in revenue when considered probable of payment.

The lease term begins on the date products are delivered to patients and are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including Medicare, private payors, and Medicaid. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenue and accounts receivable at their net realizable values. 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 and the uncertainty of reimbursement amounts for certain services from certain Payors may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application or claim denial. There were no material changes in estimates recorded in the nine months ended March 31, 2022, relating to prior periods.

Although invoicing typically occurs at the beginning of the monthly rental period, we recognize revenue from rentals on a daily basis. Since rental agreements can commence at any time during a given month, we defer revenue related to the remaining monthly rental period as of period end. Deferred revenue related to rentals was $0.9 million and $1.0 million as of March 31, 2022 and June 30, 2021, respectively.

Included in rental revenue are unbilled amounts for which the revenue recognition criteria had been met as of period end but were not yet billed to the Payor. Net unbilled rental revenue is recognized to the extent payment is probable. As of March 31, 2022 and June 30, 2021, net unbilled rental revenue is approximately $0.04 million and $0.1 million, respectively, and is included in accounts receivable.