Note 14 – Income Taxes

 

The provision for income taxes for the Company consists of the following for the years ended December 31, 2025, 2024 and 2023:

 

  

Year ended

       
  

December 31,

  

December 31,

  

December 31,

 
  

2025

  

2024

  

2023

 

Current:

            

Federal

 $(16) $24  $61 

State

  59   (9)  186 

Total current expense

  43   15   247 
             

Deferred:

            

Federal

     (223)  (85)

State

     1,150   (31)

Change in valuation allowance

     (927)  116 

Total deferred expense

         

Total provision

 $43  $15  $247 

 

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes.

 

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income taxes. The significant components of the Company’s deferred tax assets as of December 31, 2025 and 2024 are as follows:

 

  

December 31,

  

December 31,

 
  

2025

  

2024

 

Deferred tax assets:

        

Net operating loss carryforwards

 $14,089  $14,145 

Stock-based compensation

  2,551   2,021 

Research & development capitalization

  1,286   2,007 

Research & development credits

  1,438   42 

Medicare reserves

  2,390   1,767 

Accruals and other

  2,829   1,011 

Total deferred tax assets

  24,583   20,993 

Valuation allowance

  (23,101)  (20,589)

Deferred tax assets

 $1,482  $404 
         

Deferred tax liabilities:

        

Prepaid expenses

 $(838) $(174)

IRC 481(a) adjustments

  (483)   

Deferred consideration discount

  (62)  (182)

Right-of-use assets

  (79)  (45)

Other deferred tax liabilities

  (20)  (3)

Deferred tax liabilities

 $(1,482) $(404)
         

Net deferred tax assets (liabilities)

 $  $ 

 

In assessing the realizability of deferred tax assets, the Company considers all available positive and negative evidence to evaluate whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. As of December 31, 2025, the Company believes it is more likely than not that the Company's net deferred tax assets would not be realized and continues to record a full valuation allowance on its net deferred tax assets. The Company's valuation allowance represents the amount of tax benefits that are likely to not be realized. 

 

The Company has gross federal net operating losses of $49,697, which can be carried forward indefinitely, and gross state net operating losses of $52,400, which begin to expire in 2035. The Company's federal net operating losses, and certain state net operating losses, are subject to an 80% annual utilization limitation. In addition, under Sections 382 and 383 of the Internal Revenue Code of 1986, as amended, and corresponding provisions of state law, if a corporation undergoes an “ownership change,” which is generally defined as a greater than 50% change (by value) in its equity ownership over a three-year period, the corporation’s ability to use its pre-change NOL carryforwards and other pre-change tax attributes (such as research tax credits) to offset its post-change income may be limited.

 

A reconciliation of the provision for income taxes to the amount computed by applying the statutory federal income tax rate to income taxes after the adoption of ASU 2023-09 is as follows:

 

  

Year ended December 31, 2025

 
  

Amount

  

%

 

U.S federal statutory tax rate

 $(957)  21.00%
         

State and local income taxes (1)

        

State income tax, net of federal tax benefit

  (170)  3.75%

Change in valuation allowance

  207   (4.54%)

Change in state tax rate

  21   (0.47%)

Change in uncertain tax position reserve

  (22)  0.48%

Return to provision related to tax credit study

  23   (0.51%)
         

Income tax credits

        

Research and development tax credits

  (63)  1.37%

Orphan drug tax credits

  (391)  8.58%

Return to provision related to tax credit study

  (741)  16.25%
         

Changes in valuation allowance

  2,305   (50.59%)
         

Nontaxable or nondeductible items

        

Section 162(m) limitation

  389   (8.53%)

Stock-based compensation

  (424)  9.30%

Return to provision adjustments

  64   (1.41%)

Other

  9   (0.15%)
         

Changes in unrecognized tax benefits

  (207)  4.53%
         

Effective tax rate

 $43   (0.94%)

 

(1) The state jurisdiction that contributes to the majority (greater than 50%) of the tax effect in this category is Tennessee.

 

A reconciliation of the provision for income taxes to the amount computed by applying the statutory federal income tax rate to income before income taxes after the adoption of ASU 2023-09 is as follows:

 

  

Year ended

 
  

December 31,

  

December 31,

 
  

2024

  

2023

 

Benefit based on federal statutory rate

 $(800) $(145)

Stock-based compensation

  880   254 

Change in state tax rate

  814   - 

State income tax, net of federal tax benefit

  (31)  (45)

Section 162(m) limitation

  169   - 

Other permanent differences

  18   299 

Research and development credits

  (277)  - 

Change in uncertain tax position reserve

  382   - 

Return to provision

  (213)  - 

Change in valuation allowance

  (927)  (116)

Income tax expense

 $15  $247 

 

The Company recognizes tax benefits from uncertain positions if it is more likely than not that the tax position will be sustained by the tax authority upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits of the position. If a tax position meets the more likely than not threshold, the Company measures the tax position as the largest amount of benefit that is greater than 50% likely to be realized upon ultimate settlement. A reconciliation of uncertain tax positions at the beginning and end of the years below is as follows:

 

  

Year ended

 
  

December 31,

  

December 31,

  

December 31,

 
  

2025

  

2024

  

2023

 

Beginning balance

 $382  $  $ 

Gross increases (decreases) related to prior year positions

  (61)  243   - 

Gross increases (decreases) related to current year positions

  113   139   - 

Ending balance

 $434  $382  $ 

 

 

As of December 31, 2025, approximately $434, would reduce the Company’s annual effective tax rate, if recognized. The Company recognizes interest and, if applicable, penalties for any uncertain tax positions. Interest and penalties related to uncertain tax positions are recorded as a component of income tax expense. The Company accrued for interest and penalties associated with unrecognized tax benefits for the years ended December 31, 2025 and 2024 in the amount of $3 and $6, respectively. No interest or penalties associated with unrecognized tax benefits were accrued for in the year ended December 31, 2023.

 

The Company files income tax returns in the U.S. federal jurisdiction and various state jurisdictions. With the exception of tax attributes created in prior years that may potentially be adjusted, the federal statute of limitations remains open for the 2022 tax year to present and the state statutes of limitations generally remain open for the 2021 tax year to present.

 

The amounts of cash income taxes, net of refunds, paid by the Company during the year ended December 31, 2025 was as follows:

 

Federal

 $ 

Tennessee

  75 

Other states

  43 

Total net payments (refunds)

 $118 

 

The amount of cash income taxes, net of refunds, paid by the Company during the years ended December 31, 2024 and 2023 was $82 and $247, respectively.

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Historical Timeline

Fiscal YearFiled
2025Mar 19, 2026Showing above
2024Mar 18, 2025
2023Mar 14, 2024
2022Mar 16, 2023
2021Mar 16, 2022
2020Mar 16, 2021
2019Mar 5, 2020
2018Mar 25, 2019

About Income Taxes Disclosures

The income tax disclosure reveals how much a company actually pays in taxes versus what the statutory rate would predict. Analysts focus on the effective tax rate (ETR) reconciliation, which breaks down every item driving the gap between the 21% federal rate and the company's reported ETR — including R&D credits, foreign rate differentials, and state taxes. Deferred tax assets (DTAs) and their valuation allowances signal management's confidence in future profitability: a rising allowance suggests the company doubts it can use accumulated tax benefits. Uncertain tax benefit (UTB) reserves quantify exposure to IRS challenges on aggressive positions.

Key signals to watch: sudden ETR drops without clear operational reasons, large increases in valuation allowances, growing UTB balances, and significant unremitted foreign earnings. Post-TCJA, pay attention to GILTI and BEAT provisions that affect multinational tax structures. Compare the cash taxes paid (from the cash flow statement) against the income tax provision to gauge earnings quality.