Orthofix Medical Inc. (OFIX) FY 2021 MD&A
This page reproduces the company's own Item 7 MD&A text from the linked SEC filing. It is filer text, not grepcent analysis, scoring, or investment advice.
Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following discussion and analysis of our financial condition and result of operations should be read in conjunction with “Forward-Looking Statements” and our consolidated financial statements and notes thereto appearing elsewhere in this Annual Report. The discussion and analysis below is focused on our 2021 and 2020 financial results, including comparisons of our year-over-year performance between these years. Discussion and analysis of our 2019 fiscal year specifically, as well as the year-over-year comparison of our 2020 financial performance to 2019, is located in Part II, Item 7 – Management’s Discussion and Analysis of Financial Condition and Results of Operations in our Annual Report on Form 10-K for the fiscal year ended December 31, 2020, filed with the SEC on February 26, 2021, which is available on our website at www.orthofix.com and the SEC’s website at www.sec.gov.
Executive Summary
We are a global medical device company with a spine and orthopedics focus. Our mission is to deliver innovative, quality-driven solutions as we partner with health care professionals to improve patient mobility. Headquartered in Lewisville, Texas, our spine and orthopedic products are distributed in over 60 countries via our sales representatives and distributors.
Notable financial results in 2021 include the following:
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Net sales were $464.5 million, an increase of 14.2% on a reported basis and 13.5% on a constant currency basis |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Double-digit net sales growth over the prior year for both Global Spine (11.6%) and Global Orthopedics (24.4%) |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Net sales growth in the U.S. and internationally for both the Global Spine and Global Orthopedics segments |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Generation of net cash flows from operations of $18.5 million |
COVID-19 Update and Outlook
The global COVID-19 pandemic has significantly affected our hospital and physician customers, patients, communities, employees, and business operations over the last two years. At various points in time, the pandemic has led to the cancellation or deferral of elective surgeries and procedures with certain hospitals, ambulatory surgery centers, and other medical facilities; restrictions on travel; the implementation of physical distancing measures; and the temporary or permanent closure of businesses. At this time, the future trajectory of the COVID-19 pandemic remains uncertain, both in the U.S. and in other markets, particularly due to the uncertainty as to the nature of future variants, and whether vaccines will protect against severe illness with respect to such future variants.
Given these various uncertainties, it is unclear the extent to which lingering slowdowns in elective procedures will affect our business during 2022 and beyond. We expect that the effects of COVID-19 on our business will depend on various factors including (i) the magnitude, length, and virulence of additional case waves and future variants, (ii) the continued distribution, efficacy, refinement, and public acceptance of COVID-19 vaccines, (iii) the comfort level of patients in visiting clinics and hospitals, and (iv) the extent to which further elective surgery slowdowns occur during periods when hospital capacity is stretched because of the need to treat COVID-19 patients.
Results of Operations
The following table presents certain items in our consolidated statements of operations as a percent of net sales:
| Year ended December 31, | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021 (%) | 2020 (%) | 2019 (%) | ||||||||||
| Net sales | 100.0 | 100.0 | 100.0 | |||||||||
| Cost of sales | 24.7 | 25.1 | 21.9 | |||||||||
| Gross profit | 75.3 | 74.9 | 78.1 | |||||||||
| Sales and marketing | 47.6 | 50.3 | 48.6 | |||||||||
| General and administrative | 14.9 | 16.7 | 18.6 | |||||||||
| Research and development | 10.7 | 9.6 | 7.5 | |||||||||
| Acquisition-related amortization and remeasurement | 3.9 | (0.2 | ) | 7.5 | ||||||||
| Operating income (loss) | (1.8 | ) | (1.5 | ) | (4.1 | ) | ||||||
| Net income (loss) | (8.3 | ) | 0.6 | (6.2 | ) |
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Net Sales by Reporting Segment
The following table provides net sales by major product category by reporting segment:
| Percentage Change | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021/2020 | 2021/2020 | 2020/2019 | 2020/2019 | |||||||||||||||||||||||||
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | Reported | Constant Currency | Reported | Constant Currency | |||||||||||||||||||||
| Bone Growth Therapies | $ | 187,448 | $ | 171,396 | $ | 197,181 | 9.4 | % | 9.4 | % | -13.1 | % | -13.1 | % | ||||||||||||||
| Spinal Implants | 115,094 | 94,857 | 94,544 | 21.3 | % | 20.8 | % | 0.3 | % | 0.2 | % | |||||||||||||||||
| Biologics | 56,421 | 55,482 | 65,496 | 1.7 | % | 1.7 | % | -15.3 | % | -15.3 | % | |||||||||||||||||
| Global Spine | 358,963 | 321,735 | 357,221 | 11.6 | % | 11.4 | % | -9.9 | % | -10.0 | % | |||||||||||||||||
| Global Orthopedics | 105,516 | 84,827 | 102,734 | 24.4 | % | 21.3 | % | -17.4 | % | -18.2 | % | |||||||||||||||||
| Net sales | $ | 464,479 | $ | 406,562 | $ | 459,955 | 14.2 | % | 13.5 | % | -11.6 | % | -11.8 | % |
Global Spine
Global Spine offers the following products categories:
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| - | Bone Growth Therapies, which manufactures, distributes, sells, and provides support services for market leading devices that enhance bone fusion. Bone Growth Therapies uses distributors and sales representatives to sell its devices and provide associated services to hospitals, healthcare providers, and patients. |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| - | Spinal Implants, which designs, develops and markets a broad portfolio of motion preservation and fixation implant products used in surgical procedures of the spine. Spinal Implants distributes its products globally through a network of distributors and sales representatives to sell spine products to hospitals and healthcare providers. |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| - | Biologics, which provides a portfolio of regenerative products and tissue forms that allow physicians to successfully treat a variety of spinal and orthopedic conditions. Biologics markets its tissues to hospitals and healthcare providers, primarily in the U.S., through a network of employed and independent sales representatives. |
2021 Compared to 2020
Net sales increased $37.2 million or 11.6%
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Bone Growth Therapies net sales increased $16.1 million or 9.4%, primarily driven by an increase in gross orders across all sales channels as restrictions associated with the COVID-19 pandemic have lessened, particularly when compared to the second quarter of 2020 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Spinal Implants net sales increased $20.2 million or 21.3%, primarily driven by the continued recovery from the effects of the COVID-19 pandemic within our Spine Fixation product line, both in the U.S. and internationally, and from the continued growth and adoption of our Motion Preservation product line in the U.S. |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Biologics net sales increased $0.9 million or 1.7%, primarily driven by the continued recovery from the effects of the COVID-19 pandemic and an increase in revenues from new distributors added over the last 12 months |
Global Orthopedics
Global Orthopedics offers products and solutions that allow physicians to successfully treat a variety of orthopedic conditions specifically related to limb reconstruction and deformity correction unrelated to the spine. Global Orthopedics distributes its products world-wide through a network of distributors and sales representatives to sell orthopedic products to hospitals and healthcare providers.
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2021 Compared to 2020
Net sales increased $20.7 million, or 24.4%
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $18.1 million, primarily driven by the continued recovery from the effects of the COVID-19 pandemic, coupled with the continued growth of our FITBONE product line, in both the U.S. and international markets |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $2.6 million due to changes in foreign currency exchange rates, which had a favorable impact on net sales |
Gross Profit
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Net sales | $ | 464,479 | $ | 406,562 | $ | 459,955 | 14.2 | % | -11.6 | % | ||||||||||
| Cost of sales | 114,914 | 101,889 | 100,607 | 12.8 | % | 1.3 | % | |||||||||||||
| Gross profit | $ | 349,565 | $ | 304,673 | $ | 359,348 | 14.7 | % | -15.2 | % | ||||||||||
| Gross margin | 75.3 | % | 74.9 | % | 78.1 | % | 0.4 | % | -3.2 | % |
2021 Compared to 2020
Gross profit increased $44.9 million, or 14.7%
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase in gross profit is primarily due to the continued recovery from the effects of the COVID-19 pandemic as net sales have recovered to levels consistent with periods prior to the COVID-19 pandemic and due to increased absorption of fixed costs when compared to the prior year period |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase in gross margin primarily as a result of significant non-cash inventory related charges recorded in the prior year due to lower procedure volumes, largely as a result of COVID-19, and partially offset by unfavorable shifts in product mix, and from a short-term increase in electronic procurement costs caused by a global shortage of semiconductor chips, which are used in certain of our products |
Sales and Marketing Expense
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Sales and marketing | $ | 221,318 | $ | 204,434 | $ | 223,676 | 8.3 | % | -8.6 | % | ||||||||||
| As a percentage of net sales | 47.6 | % | 50.3 | % | 48.6 | % | -2.7 | % | 1.7 | % |
2021 Compared to 2020
Sales and marketing expense increased $16.9 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $14.0 million in variable compensation expenses as a result of the recovery in net sales |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $4.6 million as a result of additional headcount, increased benefit costs, and increased travel and professional expenses, as the majority of marketing events and trade shows were virtual in 2020 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by a decrease in expense of $2.7 million related to the Italian Medical Device Payback liability, as a result of temporary relief provided by the Italian National Healthcare System in response to the COVID-19 pandemic through a law enacted in December 2021 |
General and Administrative Expense
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| General and administrative | $ | 69,353 | $ | 67,948 | $ | 85,607 | 2.1 | % | -20.6 | % | ||||||||||
| As a percentage of net sales | 14.9 | % | 16.7 | % | 18.6 | % | -1.8 | % | -1.9 | % |
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2021 Compared to 2020
General and administrative expense increased $1.4 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $2.9 million a result of savings initiatives executed in 2020 in response to the COVID-19 pandemic, including temporary salary reductions in the U.S., suspension of the 401(k) match, and restrictions on travel and related expenses, which are no longer in place for 2021 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Offset by a decrease of $1.6 million related to the 2019 CEO transition |
Research and Development Expense
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Research and development | $ | 49,621 | $ | 39,056 | $ | 34,637 | 27.1 | % | 12.8 | % | ||||||||||
| As a percentage of net sales | 10.7 | % | 9.6 | % | 7.5 | % | 1.1 | % | 2.1 | % |
2021 Compared to 2020
Research and development expense increased $10.6 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $4.2 million related directly to our European Union medical device regulation implementation efforts |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $3.3 million related to increased employee costs as a result of planned headcount increases in 2021 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $2.5 million to support our development of new, innovative, and differentiated products or indications and the integration of certain acquired products and assets into our business |
Acquisition-related Amortization and Remeasurement
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Acquisition-related amortization and remeasurement | $ | 17,588 | $ | (499 | ) | $ | 34,212 | -3624.6 | % | -101.5 | % | |||||||||
| As a percentage of net sales | 3.9 | % | -0.2 | % | 7.5 | % | 4.1 | % | -7.7 | % |
2021 Compared to 2020
Acquisition-related amortization and remeasurement increased $18.1 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $11.8 million attributable to the impairment of our Global Orthopedics goodwill in 2021 primarily due to current and planned investments in our growth |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $4.1 million primarily related to the remeasurement of potential future revenue-based milestone payments associated with the Spinal Kinetics acquisition that become due upon achievement of certain revenue targets |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $1.5 million associated with acquired in-process research and development assets in 2021, which were recognized immediately upon acquisition |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $1.1 million from amortization of intangible assets acquired through business combinations or asset acquisitions |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by a decrease of $0.4 million associated with the reassessment of contingent consideration associated with the acquisition of a former distributor |
Non-operating Expense
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Interest expense, net | $ | (1,837 | ) | $ | (2,483 | ) | $ | (122 | ) | -26.0 | % | 1935.2 | % | |||||||
| Other income (expense) | (3,343 | ) | 8,381 | (8,143 | ) | -139.9 | % | -202.9 | % |
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Non-operating income and expense largely consists of interest income and expense, transaction gains and losses from changes in foreign currency exchange rates, changes in fair value related to our equity holdings in certain privately-held companies, and credit losses recognized on certain convertible debt investments. Foreign exchange gains and losses are primarily a result of several of our foreign subsidiaries holding trade and intercompany payables or receivables in currencies (most notably the U.S. Dollar) other than their functional currency.
2021 Compared to 2020
Interest expense, net, decreased $0.6 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $0.8 million associated with interest expense incurred in the prior year on our outstanding indebtedness under the secured revolving credit facility |
Other income (expense), net, decreased $11.7 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $7.9 million associated with changes in foreign currency exchange rates, as we recorded a non-cash remeasurement loss of $4.0 million in 2021 compared to a gain of $3.9 million in 2020 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $4.7 million attributable to funds received in the prior year from the U.S. Department of Health and Human Services as part of the Provider Relief Fund included within the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act” |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by gains recognized in total of $0.6 million associated with our equity investments in Neo Medical and Bone Biologics |
Income Tax Expense
| Percentage Change | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | 2021/2020 | 2020/2019 | |||||||||||||||
| Income tax expense (benefit) | $ | 24,884 | $ | (2,885 | ) | $ | 1,413 | -962.5 | % | -304.2 | % | |||||||||
| Effective tax rate | -184.4 | % | 784.0 | % | -5.2 | % | -968.4 | % | 789.2 | % |
2021 Compared to 2020
Net income tax expense increased $27.7 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $16.0 million primarily due to statute expirations on uncertain tax positions that did not recur in 2021 |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $13.3 million for net increase in valuation allowances recognized on domestic and foreign deferred tax assets primarily due to cumulative losses |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $0.8 million for lower tax benefit on the change in fair value of contingent consideration |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by tax benefit driven by lower earnings |
2020 Compared to 2019
Net income tax expense decreased by $4.3 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $14.6 million primarily due to statute expirations on uncertain tax positions |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $7.1 million due to the net decrease in the fair value of contingent consideration |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $14.7 million due to net increase in valuation allowance recognized on foreign deferred tax assets primarily due to cumulative losses |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Further offset by tax expense driven by higher earnings |
A reconciliation of the effective tax rate for each year is reported in Note 20 to the Notes to the Consolidated Financial Statements contained in Item 8 of this Annual Report.
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Segment Review
Our business is managed through two reporting segments: Global Spine and Global Orthopedics. The primary metric used in managing the business by segment is EBITDA (which is described further in Note 16 to the Notes to the Consolidated Financial Statements contained in Item 8 of this Annual Report).
The following table reconciles EBITDA to loss before income taxes:
| Year Ended December 31, | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | 2019 | |||||||||
| Global Spine | $ | 58,014 | $ | 63,036 | $ | 39,528 | ||||||
| Global Orthopedics | 3,374 | (4,993 | ) | 7,496 | ||||||||
| Corporate | (31,691 | ) | (25,382 | ) | (49,252 | ) | ||||||
| Total EBITDA | 29,697 | 32,661 | (2,228 | ) | ||||||||
| Depreciation and amortization | (29,599 | ) | (30,546 | ) | (24,699 | ) | ||||||
| Goodwill impairment | (11,756 | ) | — | — | ||||||||
| Interest expense, net | (1,837 | ) | (2,483 | ) | (122 | ) | ||||||
| Loss before income taxes | $ | (13,495 | ) | $ | (368 | ) | $ | (27,049 | ) |
Liquidity and Capital Resources
Cash, cash equivalents, and restricted cash at December 31, 2021, was $87.8 million compared to $96.8 million at December 31, 2020.
| Year Ended December, 31, | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | Change | |||||||||
| Net cash from operating activities | $ | 18,475 | $ | 74,272 | $ | (55,797 | ) | |||||
| Net cash from investing activities | (23,013 | ) | (52,334 | ) | 29,321 | |||||||
| Net cash from financing activities | (3,621 | ) | 3,245 | (6,866 | ) | |||||||
| Effect of exchange rate changes on cash and restricted cash | (815 | ) | 1,235 | (2,050 | ) | |||||||
| Net change in cash, cash equivalents, and restricted cash | $ | (8,974 | ) | $ | 26,418 | $ | (35,392 | ) |
The following table presents free cash flow, a non-GAAP financial measure, which is calculated by subtracting capital expenditures from net cash from operating activities.
| Year Ended December, 31, | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (U.S. Dollars, in thousands) | 2021 | 2020 | Change | |||||||||
| Net cash from operating activities | $ | 18,475 | $ | 74,272 | $ | (55,797 | ) | |||||
| Capital expenditures | (19,592 | ) | (17,094 | ) | (2,498 | ) | ||||||
| Free cash flow | $ | (1,117 | ) | $ | 57,178 | $ | (58,295 | ) |
Operating Activities
Cash flows from operating activities decreased $55.8 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease in net income (loss) of $40.9 million |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Net increase of $29.5 million in non-cash gains and losses, largely related to our impairment of Global Orthopedics goodwill, deferred income taxes, and changes in fair value of contingent consideration |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Net decrease of $44.4 million relating to changes in working capital accounts, primarily attributable to changes in our contract liability associated with the CMS Accelerated and Advance Payment Program and from changes in accounts receivable |
Two of our primary working capital accounts are accounts receivable and inventory. Day’s sales in receivables remained consistent and was 58 days at December 31, 2021, compared to 57 days at December 31, 2020 (calculated using fourth quarter net sales and ending accounts receivable). Inventory turns were 1.4 times as of December 31, 2021, compared to 1.2 times at December 31, 2020,
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primarily resulting from an increase in sales volumes, and thus an increase in cost of sales, as 2020 results were heavily impacted by the COVID-19 pandemic.
Investing Activities
Cash flows from investing activities increased $29.3 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $18.0 million associated with cash paid in March 2020 to acquire assets associated with the FITBONE intramedullary lengthening system for limb lengthening of the femur and tibia bones |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $7.8 million associated with cash paid for purchases of investment securities, primarily attributable to our investments in Neo Medical SA in the form of preferred stock and convertible loans |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Increase of $6.0 million associated with cash paid for asset acquisitions and other investments |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by a decrease in capital expenditures of $2.5 million |
Financing Activities
Cash flows from financing activities decreased $6.9 million
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Decrease of $8.4 million associated with cash paid for the achievement of a revenue-based milestone associated with the Spinal Kinetics acquisition; the milestone payment totaled $15.0 million with a portion of the payment reflected in both operating and financing activities |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | Partially offset by an increase in net proceeds of $1.2 million from the issuance of common shares |
Credit Facilities
On October 25, 2019, we entered into a Second Amended and Restated Credit Agreement (the “Amended Credit Agreement”), which provides for a five year $300 million secured revolving credit facility. The Amended Credit Agreement has a maturity date of October 25, 2024, and amends and restates the previous $125 million secured revolving credit facility.
Borrowings under the Amended Credit Agreement may be used for, among other things, working capital and other general corporate purposes (including share repurchases, permitted acquisitions and permitted payments of dividends and other distributions). Borrowings under the Amended Credit Agreement may be limited based upon EBITDA levels recognized over the preceding 12 months.
As of December 31, 2021, we have no outstanding borrowings under the Amended Credit Agreement. For additional information regarding the credit facility, see Note 11 of the Notes to the Consolidated Financial Statements in Item 8 of this Annual Report.
In addition, we have no borrowings outstanding on our Italian line of credit of €5.5 million ($6.3 million) as of December 31, 2021. This unsecured line of credit provides us the option to borrow amounts in Italy at rates which are determined at the time of borrowing.
Other
For information regarding Contingencies, see Note 13 of the Notes to the Consolidated Financial Statements in Item 8 of this Annual Report.
Impact of COVID-19 and the CARES Act on Liquidity and Capital Resources
In March 2020, the CARES Act entered into U.S. federal law, which provided emergency assistance and health care for individuals, families, and businesses affected by the COVID-19 pandemic.
In April 2020, we received $13.9 million in funds from the CMS Accelerated and Advance Payment Program to increase cash flow to providers of services and suppliers impacted by the COVID-19 pandemic. Starting in April 2021, Medicare began to recoup 25% of Medicare payments otherwise owed to the provider or supplier for submitted claims. Beginning March 2022, recoupment increases to 50% for another six months. Thus, during these time periods, rather than receiving the full amount of payment for newly submitted claims, our outstanding accelerated / advance payment balance will be reduced by the recoupment amount until the full balance has been repaid. As of December 31, 2021, the balance of the liability associated with the Accelerated and Advance Payment Program of the CARES Act totaled $4.8 million, which is classified within other current liabilities based upon our estimates of when such funds will be recouped.
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Given the various uncertainties attributable to the COVID-19 pandemic that remain, both in the U.S. and in other markets, our liquidity may be impacted in the future by the potential of decreases or delays of elective surgical procedures, delays in payments from customers, facility closures, or other reasons related to the COVID-19 pandemic. As of the date of issuance of these consolidated financial statements, the extent to which COVID-19 is likely to materially impact our liquidity in the future remains uncertain.
Spinal Kinetics Acquisition and Contingent Consideration
As part of the consideration for the Spinal Kinetics acquisition, we agreed to make contingent milestone payments of up to $60.0 million. One milestone payment, which was for $15.0 million, became due upon FDA approval of Spinal Kinetics’ M6-C artificial cervical disc (the “FDA Milestone”). The FDA Milestone was achieved and paid in 2019. A second milestone payment, totaling $15.0 million, was achieved and paid in 2021 upon meeting certain net sales targets.
The remaining milestone payment is a revenue-based milestone payment of $30.0 million in connection with future sales of the acquired artificial discs. The fair value of the contingent consideration arrangement as of December 31, 2021, was $17.2 million; however, the actual amount ultimately paid could be higher or lower than the fair value of the contingent consideration (ultimate payment will either be $30.0 million or the liability will be reversed if the milestone is not met within the required timeline). As of December 31, 2021, we classified the remaining contingent consideration liability within other current liabilities, as we expect to pay the revenue-based milestone in the next twelve months. For additional discussion of this matter, see Note 12 of the Notes to the Consolidated Financial Statements in Item 8 of this Annual Report.
Related Party Transaction
On February 2, 2021, we entered into a technology assignment and royalty agreement with a medical device technology company partially owned and controlled by the wife of President and Chief Executive Officer, Jon Serbousek, whereby we acquired the intellectual property rights to certain assets for consideration of up to $10.0 million. Consideration is comprised of $1.0 million, which was paid at signing, and $9.0 million in contingent consideration, dependent upon multiple milestones, such as receipt of 510(k) clearance or the attainment of certain net sales targets. For additional discussion of this transaction, see Note 4 of the Notes to the Consolidated Financial Statements in Item 8 of this Annual Report.
IGEA S.p.A Exclusive License and Distribution Agreement
On April 7, 2021, we entered into an Exclusive License and Distribution Agreement (the “License Agreement”) with IGEA S.p.A (“IGEA”), an Italian manufacturer and distributor of bone and cartilage stimulation systems. Per the terms of the License Agreement, we will have the exclusive right to sell IGEA products in the U.S. and Canada. As consideration for the License Agreement, we agreed to pay up to $4.0 million, of which $0.5 million was paid in 2021, with certain payments contingent upon achieving an FDA milestone. The License Agreement also includes certain minimum purchase requirements.
Neo Medical Investment and Convertible Loan
In October 2020, we entered into a Convertible Loan Agreement (the “Convertible Loan”) with Neo Medical SA, a privately held Swiss-based Medtech company (“Neo Medical”), whereby we loaned CHF 4.6 million to Neo Medical ($5.0 million as of the issuance date). The loan bears interest at 8.0%, with interest due semi-annually. The Convertible Loan matures in October 2024; however, if a change in control of Neo Medical occurs prior to maturity, the Convertible Loan shall become immediately due upon such event.
FITBONE Asset Acquisition and Contract Manufacturing and Supply Agreement (“CMSA”)
In February 2020, we entered into an agreement with Wittenstein SE (“Wittenstein”), a privately-held German-based company, to acquire assets associated with the FITBONE intramedullary lengthening system for limb lengthening of the femur and tibia bones. At the time of the acquisition, we also entered into a CMSA with Wittenstein to manufacture the FITBONE product line. The CMSA has an initial term of up to two years. As consideration for the CMSA, we will pay $2.0 million to Wittenstein at the conclusion of the agreement if certain conditions are met. This payment is expected to be made in the first half of 2022.
Unremitted Foreign Earnings
Unremitted foreign earnings decreased from $53.7 million at December 31, 2020, to $50.0 million at December 31, 2021, due to currency translation. As a result of the 2017 Tax Act, current year earnings have been deemed to be repatriated. Our investment in foreign subsidiaries continues to be indefinite in nature, however, we may periodically repatriate a portion of these earnings to the extent that we do not incur significant additional tax liability.
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Contractual Obligations
As a result of our operations, we are subject to certain contractual obligations with material cash requirements. Our material contractual obligations include, but are not limited to i) our contingent consideration arrangement associated with the Spinal Kinetics acquisition, ii) contingent consideration arrangements associated with certain asset acquisitions, iii) operating lease and finance lease obligations, and iv) uncertain tax positions.
Refer to the Notes to the Consolidated Financial Statements in Item 8 of this Annual Report for a further description of our contingent consideration arrangements (Notes 4, 12, and 17), lease obligations (Note 9), and uncertain tax positions (Note 20).
Off-balance Sheet Arrangements
As of December 31, 2021, we did not have any off-balance sheet arrangements that have or are reasonably likely to have a current or future effect on our financial condition, changes in financial condition, revenues or expenses, results of operations, cash flows, liquidity, capital expenditures, or capital resources that are material to investors. In addition, we do not consider the backlog of firm orders to be material.
Critical Accounting Estimates
Our discussion of operating results is based upon the consolidated financial statements and accompanying notes. The preparation of these statements requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the financial statements and the reported amount of revenues and expenses during the reporting period. On an ongoing basis, we evaluate these estimates, which are based on historical experience and various other assumptions that management believe to be reasonable under the circumstances at that point in time. Actual results may differ, significantly at times, from these estimates.
We believe the estimates described below are the most critical in preparing our consolidated financial statements. We have reviewed these critical accounting estimates with the Audit Committee of the Board of Directors.
Revenue Recognition
The process for recognizing revenue involves significant assumptions and judgments for certain of our revenue streams. Revenue recognition policies are “critical accounting estimates” because changes in the assumptions used to develop the estimates could materially affect key financial measures, including net sales, gross margin, operating income, EBITDA, and net income.
Bone Growth Therapies revenue is largely attributable to the U.S. and is comprised of third-party payor transactions and wholesale revenue.
For revenue derived from third-party payors, including commercial insurance carriers, health maintenance organizations, preferred provider organizations, and governmental payors, such as Medicare, in connection with the sale of our stimulation products, we recognize revenue when the stimulation product is fitted to and accepted by the patient and all applicable documents that are required by the third-party payor have been obtained. Amounts paid by these third-party payors are generally based on fixed or allowable reimbursement rates. These revenues are recorded at the expected or preauthorized reimbursement rates, net of any contractual allowances or adjustments. Certain billings are subject to review by the third-party payors and may be subject to adjustment.
Wholesale revenue is related to the sale of our bone growth stimulators directly to physicians and other healthcare providers. Wholesale revenues are recognized upon shipment and receipt of a confirming purchase order, which is when the customer obtains control of the promised goods.
Biologics revenue is largely attributable to the U.S. and is primarily related to a collaborative arrangement with MTF. We have exclusive global marketing rights and receive marketing fees from MTF based on products distributed by MTF. MTF is considered the principal in these arrangements; therefore, we recognize these marketing service fees on a net basis upon shipment of the product to the customer and receipt of a confirming purchase order.
Spinal Implants and Global Orthopedics products are distributed world-wide, with U.S. sales largely comprised of commercial revenue and international sales derived from commercial sales and through stocking distributor arrangements.
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Commercial revenue is largely related to the sale of our Spinal Implants and Global Orthopedics products to hospital customers. Commercial revenues are recognized when these products have been utilized and a confirming purchase order has been received from the hospital.
Stocking distributors purchase our products and then re-sell them directly to customers, such as hospitals. Revenue derived from stocking distributor arrangements is recognized upon shipment and receipt of a confirming purchase order, which is when the distributor obtains control of the promised goods. The transaction price is estimated based upon our historical collection experience with the stocking distributor. To derive this estimate, we analyze twelve months of historical invoices by stocking distributor and the subsequent collections on those invoices, for a period of up to 24 months subsequent to the invoice date. This percentage, which is specific to each stocking distributor, is then used to calculate the transaction price. Cost of sales is also recorded upon transfer of control of the product to the customer, which is when our performance obligation has been satisfied.
Allowance for Expected Credit Losses and Contractual Allowances
The process for estimating the ultimate collection of accounts receivable involves significant assumptions and judgments. The determination of the contractual life of accounts receivable, the aging of outstanding receivables, as well as the historical collections, write-offs, and payor reimbursement experience over the estimated contractual lives of such receivables, are integral parts of the estimation process related to reserves for expected credit losses and the establishment of contractual allowances. Accounts receivable are analyzed on a quarterly basis to assess the adequacy of both reserves for expected credit losses and contractual allowances. Revisions in allowances for expected credit loss estimates are recorded as an adjustment to bad debt expense within sales and marketing expenses. Revisions to contractual allowances are recorded as an adjustment to net sales. These estimates are periodically tested against actual collection experience. In addition, we analyze our receivables by geography and by customer type, where appropriate, in developing estimates for expected credit losses.
We believe our allowance for credit losses is sufficient to cover customer credit risks; however, a 10% change in our allowance for credit losses as of December 31, 2021, would result in an increase or decrease to sales and marketing expense of $0.5 million. Additionally, we believe our estimate to establish contractual allowances is sufficient to cover customer credit risks; however, a 10% change in our reserve for contractual allowances as of December 31, 2021, would result in an increase or decrease to net sales of $0.4 million. Our allowance for credit losses and estimation of contractual allowances are “critical accounting estimates” because changes in the assumptions used to develop the estimates could materially affect key financial measures, including net sales, gross margin, operating income, EBITDA, net income, and accounts receivable.
Inventory Allowances
Reserves for excess, slow moving, and obsolete inventory are calculated as the difference between the cost of inventory and market value, and are based on assumptions and judgments about new product launch periods, overall product life cycles, forecasted demand, and market conditions. In the event of a decrease in demand for our products, excess product production, or a higher incidence of inventory obsolescence, we could be required to increase our inventory reserves, which would increase cost of sales and decrease gross profit. We regularly evaluate our exposure for inventory write-downs. If conditions or assumptions used in determining the market value or forecasted demand change, additional inventory adjustments in the future may be necessary. Our inventory allowance is a “critical accounting estimate” because changes in the assumptions used to develop the estimate could materially affect key financial measures, including gross profit, operating income, EBITDA, net income, and inventory.
Valuation of Intangible Assets
Our intangible assets are comprised primarily of patents, acquired or developed technology, in-process research and development (“IPR&D”), customer relationships, trade names, trademarks, and licensing arrangements. We make significant judgments in relation to the valuation of intangible assets resulting from business combinations or asset acquisitions. Intangible assets acquired in a business combination that are used for IPR&D activities are considered to have indefinite lives until the completion or abandonment of the associated project. Upon reaching the end of the relevant project, we will either amortize the acquired IPR&D over its estimated useful life or expense the acquired IPR&D should the project be unsuccessful with no future alternative use.
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Significant judgment is required related to the forecasting of future operating results within our discounted cash flow valuation models to determine the valuation of intangible assets. Key assumptions include the anticipated useful lives of acquired intangibles, the projected cash flows associated with each intangible asset, the estimated probability of success for acquired IPR&D projects, and projected growth rates and discount rates. It is possible that significant changes in plans or assumptions may affect the recoverability of these assets and could potentially result in impairment. Our valuation of intangible assets is a “critical accounting estimate” because changes in the assumptions used to develop these estimates could materially affect key financial measures, including operating income, EBITDA, and net income.
Goodwill
Our goodwill represents the excess of cost over fair value of net assets acquired from business combinations. The determination of the value of goodwill and intangible assets arising from business combinations requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of the net tangible and intangible assets acquired.
We test goodwill at least annually for impairment, and between annual tests if indicators of potential impairment exist. These indicators include, among others, significant declines in sales, earnings, or cash flows, or the development of a material adverse change in the business climate. Assessing goodwill impairment involves a high degree of judgment due to the estimates and assumptions used. We believe the estimates and assumptions involved in the impairment assessment to be critical because significant changes in such estimates and assumptions could materially affect key financial measures, including operating income, EBITDA, and net income.
In connection with our change in reporting segments, which occurred during the first quarter of 2019, we performed a quantitative assessment of goodwill immediately prior to and subsequently following the change in reporting segments. The analysis did not result in an impairment. In addition, the net carrying value of goodwill that was previously reported under the prior reporting segments of (i) Bone Growth Therapies, (ii) Spinal Implants, and (iii) Biologics was consolidated and is now included within the Global Spine reporting segment.
In the fourth quarters of 2020 and 2019, we performed qualitative assessments for our annual goodwill impairment analysis, which did not result in any impairment charge. This qualitative analysis considered all relevant factors specific to the reporting units, including macroeconomic conditions, industry and market considerations, overall financial performance, and relevant entity-specific events. As part of our qualitative assessment, we included quantitative factors to assess the likelihood of an impairment and concluded it more likely that not that an impairment has not occurred.
In the fourth quarter of 2021, we performed a quantitative assessment of goodwill as part of our annual goodwill impairment analysis. Upon estimating the fair value of each of its reporting units, we determined the Global Orthopedics reporting unit’s fair value was less than its carrying value of net assets. This resulted in recording a full impairment of the Global Orthopedics goodwill of $11.8 million, which is reflected within Acquisition-related amortization and remeasurement. The assessment concluded there were no indicators of impairment for the Global Spine goodwill.
We estimate the fair value of each reporting unit using a weighted average of fair value derived from both an income approach and a market approach. The fair value measurements are based on significant inputs that are unobservable in the market, with key assumptions including, but not limited to, our forecasted future net sales and expenses, terminal growth rates, discount rates applied, and allocation of corporate-level expenses to each reporting unit. Significant changes in these assumptions could result in a significantly higher or lower fair value, which in turn can affect the ultimate conclusion regarding if goodwill is impared.
Fair Value Measurements
Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The two most significant items that are or were recorded at fair value as of December 31, 2021, include (i) contingent consideration attributable to the Spinal Kinetics acquisition and (ii) our convertible loan agreements with Neo Medical.
The contingent consideration consists of potential future milestone payments of up to $60.0 million in cash associated with the Spinal Kinetics acquisition, which must be achieved within five years of the acquisition date to be paid. The milestone payments include (i) up to $15.0 million for meeting the FDA Milestone and (ii) revenue-based milestone payments of up to $45.0 million in connection with future sales of the M6-C artificial cervical disc and the M6-L artificial lumbar disc. The FDA milestone was achieved and paid in 2019 and one of the revenue-based milestones, resulting in a payment of $15.0 million, was achieved and paid in 2021.
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Prior to its attainment in 2019, we estimated the fair value of the FDA Milestone using a probability-weighted discounted cash flow model. This fair value was based on significant inputs not observable in the market, with key assumptions including our estimation of the probability of FDA approval for the M6-C artificial cervical disc, the timing of approval, and the discount rate applied. Significant changes in these assumptions could have resulted in a significantly higher or lower fair value prior to obtaining FDA approval.
We estimate the fair value of the remaining revenue-based milestone payment using a Monte Carlo simulation. This fair value measurement is based on significant inputs that are unobservable in the market, with key assumptions including the our forecasted future net sales of Motion Preservation products, discount rates applied, and assumptions for potential volatility of the forecasted revenue. Significant changes in these assumptions could result in a significantly higher or lower fair value. Holding other inputs constant, an increase in our forecasted future revenues by 5% would have resulted in an increase in the fair value of the contingent consideration of $4.8 million, whereas a decrease in our forecasted future revenues by 5% would have resulted in a decrease in the fair value of the contingent consideration by $5.2 million.
We estimate the fair value of our convertible loan agreements with Neo Medical using option-pricing models and a probability-weighted discounted cash flow model. The fair value measurement is based on significant inputs that are unobservable in the market, with significant unobservable inputs including applicable discount rates, implied volatility, the likelihood and projected timing of repayment or conversion, and projected cash flows in support of the estimated enterprise value of Neo Medical. Significant changes in these assumptions could result in a significantly higher or lower fair value. Holding other inputs constant, an increase in the assumed cost of equity discount rate by 2% would have resulted in a decrease in the fair value of the convertible loan of $1.2 million, whereas a decrease the cost of equity discount rate by 2% would have resulted in an increase in the fair value of the convertible loan by $1.7 million.
Our fair value measurements are a “critical accounting estimate” because changes in the assumptions used to develop the estimate could materially affect key financial measures, including operating income, EBITDA, and net income.
Litigation and Contingent Liabilities
From time to time, we are parties to or targets of lawsuits, investigations and proceedings, including product liability, personal injury, patent and intellectual property, health and safety, and employment and healthcare regulatory matters, which are handled and defended in the ordinary course of business. These lawsuits, investigations, or proceedings could involve a substantial number of claims and could also have an adverse impact on our reputation and customer base. Although we maintain various liability insurance programs for liabilities that could result from such lawsuits, investigations, or proceedings, we are self-insured for a significant portion of such liabilities.
We accrue for such claims when it is probable that a liability has been incurred and the amount can be reasonably estimated. The assessments of whether a loss is probable or a reasonable possibility, and whether the loss or range of loss is reasonably estimable, often involve a series of complex judgments about future events. Among the factors that we consider in this assessment are the nature of existing legal proceedings, investigations, and claims, the asserted or possible damages or loss contingency (if reasonably estimable), the progress of the matter, existing law and precedent, the opinions or views of legal counsel and other advisers, the involvement of the U.S. Government and its agencies in such proceedings, our experience in similar matters and the experience of other companies, the facts available to us at the time of assessment, and how we intend to respond, or have responded, to the proceeding, investigation or claim. Our assessment of these factors may change over time as individual proceedings, investigations or claims progress. For matters where we are not currently able to reasonably estimate the range of reasonably possible loss, the factors that have contributed to this determination include the following: (i) the damages sought are indeterminate, or an investigation has not manifested itself in a filed civil or criminal complaint, (ii) the matters are in the early stages, (iii) the matters involve novel or unsettled legal theories or a large or uncertain number of actual or potential cases or parties, and/or (iv) discussions with the government or other parties in matters that may be expected ultimately to be resolved through negotiation and settlement have not reached the point where we believe a reasonable estimate of loss, or range of loss, can be made. In such instances, we believe that there is considerable uncertainty regarding the timing or ultimate resolution of such matters, including a possible eventual loss, fine, penalty or business impact, if any.
Changes in the facts and circumstances associated with a claim could have a material impact on our results of operations and cash flows in the period that reserve estimates are recorded or revised. We believe our insurance coverage and reserves are sufficient to cover currently estimated exposures, but we cannot give any assurance that we will not incur liabilities in excess of recorded reserves or our present insurance coverage. Litigation and contingent liabilities are “critical accounting estimates” because changes
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in the assumptions used to develop the estimates could materially affect key financial measures, including operating income, EBITDA, and net income.
Tax Matters
We and each of our subsidiaries are taxed at the rates applicable within each of their respective jurisdictions. Our income tax expense, effective tax rate, deferred tax assets, and deferred tax liabilities will vary according to the jurisdiction in which profits arise. Further, certain of our subsidiaries sell products directly to our other subsidiaries or provide administrative, marketing and support services to our other subsidiaries. These intercompany sales and support services involve subsidiaries operating in jurisdictions with differing tax rates. The tax authorities in such jurisdictions may challenge our treatment under residency criteria, transfer pricing provisions, or other aspects of their respective tax laws, which could affect our composite tax rate and provisions.
We sometimes engage in transactions in which tax consequences may be subject to uncertainty. We account for these uncertain tax positions in accordance with applicable accounting guidance, which requires significant judgment in assessing the estimated tax consequences of a transaction. We evaluate the tax position taken or expected to be taken in a tax return by determining if the weight of available evidence indicates that it is more likely than not that, on an evaluation of the technical merits, the tax position will be sustained on audit, including resolution of any related appeals or litigation processes. We measure the tax benefit as the largest amount that is more than 50% likely to be realized upon ultimate settlement. We re-evaluate our income tax positions periodically to consider factors such as changes in facts or circumstances, changes in or interpretations of tax law, effectively settled issues under audit, and new audit activity. Such a change in recognition or measurement would result in recognition of a tax benefit or an additional charge to the tax provision, which could have a material impact to the financial statements.
We establish a valuation allowance when measuring deferred tax assets if it is more likely than not that certain deferred tax assets will not be realized in the foreseeable future. This process requires significant judgment as we must project the current tax liability and estimate the deferred tax assets and liabilities into future periods, including net operating loss and tax credit carry forwards. In assessing the need for a valuation allowance, we consider recent operating results, availability of taxable income in carryback years, future reversals of taxable temporary differences, future taxable income projections (exclusive of reversing temporary differences), and all prudent and feasible tax planning strategies.
Tax matters are “critical accounting estimates” because changes in the assumptions used to develop the estimates could materially affect key financial measures, including net income.
Share-based compensation
We use the Black-Scholes valuation model to calculate the fair value of service-based stock options. The value is recognized as expense over the service period net of actual forfeitures. The expected term of options granted is estimated based on a number of factors, including the vesting and expiration terms of the award, historical employee exercise behavior for both options that are currently outstanding and options that have been exercised or are expired, the historical volatility of our common stock, and an employee’s average length of service. The risk-free interest rate is determined based upon a constant U.S. Treasury security rate with a contractual life that approximates the expected term of the option award. We estimate expected volatility based on the historical volatility of our stock.
We use the Monte Carlo valuation methodology to calculate the fair value of market-based restricted stock units. The value is recognized as expense over the requisite service period and adjusted for forfeitures as they occur. The Monte Carlo methodology that we use to estimate the fair value of the awards incorporates the possibility that the market condition may not be satisfied.
The fair value of performance-based restricted stock awards and stock units is calculated based upon the closing stock price at the date of grant. The value is recognized as expense over the derived requisite service period beginning in the period in which the grants are deemed probable to vest. Vesting probability is assessed based upon forecasted earnings and financial results and requires significant judgment.
Determining the appropriate fair value model and calculating the fair value of employee stock awards requires estimates and judgments. Our share-based compensation is a “critical accounting estimate” because changes in the assumptions used to develop estimates of fair value or the requisite service period could materially affect key financial measures, including gross profit, operating income, EBITDA, and net income.
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Non-GAAP Financial Measures
We believe that providing non-GAAP financial measures that exclude certain items provides investors with greater transparency to the information used by senior management in its financial and operational decision-making. We believe it is important to provide investors with the same non-GAAP metrics that senior management uses to supplement information regarding the performance and underlying trends of our business operations in order to facilitate comparisons to historical operating results and internally evaluate the effectiveness of our operating strategies. Disclosure of these non-GAAP financial measures also facilitates comparisons of our underlying operating performance with other companies in the industry that also supplement their GAAP results with non-GAAP financial measures.
The non-GAAP financial measures used in this Annual Report may have limitations as analytical tools and should not be considered in isolation or as a replacement for GAAP financial measures. Some of the limitations associated with the use of these non-GAAP financial measures are that they exclude items that reflect an economic cost that can have a material effect on cash flows. Similarly, certain non-cash expenses, such as equity compensation expense, do not directly impact cash flows, but are part of total compensation costs accounted for under GAAP.
Constant Currency
Constant currency is a non-GAAP measure, which is calculated by using foreign currency rates from the comparable, prior-year period, to present net sales at comparable rates. Constant currency can be presented for numerous GAAP measures, but is most commonly used by management to analyze net sales without the impact of changes in foreign currency rates.
EBITDA
EBITDA is defined as earnings before interest income (expense), net, income taxes, depreciation, and amortization (including the impacts of any goodwill impairment). EBITDA is the primary metric used by our Chief Operating Decision Maker in managing the business.
Free Cash Flow
Free cash flow is a non-GAAP financial measure, which is calculated by subtracting capital expenditures from net cash from operating activities. Free cash flow is an important indicator of how much cash is generated or used by our normal business operations, including capital expenditures. Management uses free cash flow as a measure of progress on its capital efficiency and cash flow initiatives.