Notes to Consolidated Financial Statements
(unaudited)
(in thousands, except per share data, unless otherwise indicated)
Note 1—Summary of Significant Accounting Policies
Basis of Presentation
The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, our or the Company) and contain all adjustments (which are comprised only of normal recurring accruals and use of estimates) necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year.
Our business has two distinct segments: Products & Healthcare Services and Patient Direct. Products & Healthcare Services provides distribution, outsourced logistics and value-added services, and manufactures and sources medical surgical products through our production and kitting operations. Patient Direct expands our business along the continuum of care through delivery of disposable medical supplies sold directly to patients and home health agencies and is a leading provider of integrated home healthcare equipment and related services in the United States.
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation.
Use of Estimates
The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates.
Cash, Cash Equivalents and Restricted Cash
Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash as of March 31, 2023 and December 31, 2022 primarily represents cash held in an escrow account as required by the Centers for Medicare & Medicaid Services (CMS) in conjunction with the Bundled Payments for Care Improvement (BPCI) initiatives related to wind-down costs of Fusion5.
The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows.
| | | | | | | | | | | |
| March 31, 2023 | | December 31, 2022 |
Cash and cash equivalents | $ | 66,840 | | | $ | 69,467 | |
Restricted cash included in Other current assets | 16,354 | | | — | |
Restricted cash included in Other assets, net | — | | | 16,718 | |
Total cash, cash equivalents, and restricted cash | $ | 83,194 | | | $ | 86,185 | |
Rental Revenue
Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is generated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental revenue, less estimated adjustments, is recognized as earned on a straight-line basis over the noncancellable lease term. We recorded $172 million in revenue related to equipment we rent to patients for the three months ended March 31, 2023. Equipment rental revenue was not material for the three months ended March 31, 2022.
Note 2—Fair Value
Fair value is determined based on assumptions that a market participant would use in pricing an asset or liability. The assumptions used are in accordance with a three-tier hierarchy, defined by GAAP, that draws a distinction between market participant assumptions based on (i) observable inputs such as quoted prices in active markets (Level 1), (ii) inputs other than quoted prices in active markets that are observable either directly or indirectly (Level 2) and (iii) unobservable inputs that require the use of present value and other valuation techniques in the determination of fair value (Level 3).
The carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, and accrued payroll and related liabilities reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The carrying amount of restricted cash also approximates fair value due to its nature. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 6 for the fair value of debt. The fair value of our derivative contracts is determined based on the present value of expected future cash flows considering the risks involved, including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 8 for the fair value of derivatives.
Our acquisitions may include contingent consideration as part of the purchase price. The fair value of contingent consideration is estimated as of the acquisition date and at the end of each subsequent reporting period based on the present value of the contingent payments to be made using a weighted probability of possible payments (Level 3). Subsequent changes in fair value are recorded as adjustments to acquisition-related charges and intangible amortization within the consolidated statements of operations.
Note 3—Acquisition
On March 29, 2022 (the Acquisition Date), we completed the acquisition (the Apria Acquisition) of 100% of Apria Inc. (Apria) pursuant to the Agreement and Plan of Merger dated January 7, 2022, in exchange for approximately $1.7 billion, net of $144 million of cash acquired. The purchase was funded with a combination of debt and cash on hand. Apria is a leading provider of integrated home healthcare equipment and related services in the United States. This business is reported as part of the Patient Direct segment.
The following table presents the fair value of the assets acquired and liabilities assumed recognized as of the Acquisition Date. The fair value and useful lives of tangible and intangible assets acquired were determined based on various valuation methods, including the income and cost approach, using several significant unobservable inputs including, but not limited to projected cash flows and a discount rate. These inputs are considered Level 3 inputs. As of March 31, 2023, the allocation of purchase price to assets and liabilities acquired is finalized.
| | | | | | | | |
| | Fair Value as of Acquisition Date |
Assets acquired: | | |
Current assets | | $ | 139,560 | |
Goodwill | | 1,251,347 | |
Intangible assets | | 315,300 | |
Other non-current assets | | 354,237 | |
Total assets | | $ | 2,060,444 | |
Liabilities assumed: | | |
Current liabilities | | $ | 247,276 | |
Noncurrent liabilities | | 128,561 | |
Total liabilities | | 375,837 | |
Fair value of net assets acquired, net of cash | | $ | 1,684,607 | |
Current assets acquired includes $88.7 million in fair value of receivables, which reflects the approximate amount contractually owed. We are amortizing the fair value of acquired intangible assets, primarily customer relationships, including payor and capitated relationships, and trade names over their estimated weighted average useful lives of one to 15 years.
Goodwill of $1.3 billion, which we assigned to our Patient Direct segment, consists largely of expected opportunities to expand into new markets and further develop a presence in the home healthcare business. Approximately $33 million of the goodwill is deductible for income tax purposes.
The following table provides pro forma results of net revenue and net loss for the three months ended March 31, 2022 as if Apria was acquired on January 1, 2022. The pro forma results below are not necessarily indicative of the results that would have been if the acquisition had occurred on the dates indicated, nor are the pro forma results indicative of results which may occur in the future.
| | | | | |
| Three Months Ended March 31, 2022 |
|
Net revenue | $ | 2,684,065 | |
Net loss | $ | (78,861) | |
Pro forma net loss of $78.9 million for the three months ended March 31, 2022 includes pro forma adjustments for interest expense of $15.4 million, net of tax, and amortization of intangible assets of $8.9 million, net of tax. The pro forma net loss also includes $39.4 million in seller transaction expenses and stock compensation expense associated with $108 million owed to the holders of Apria stock awards in connection with the Apria Acquisition.
Acquisition-related charges within acquisition-related charges and intangible amortization presented in our consolidated statements of operations were $1.3 million and $31.9 million for the three months ended March 31, 2023 and 2022, which consisted primarily of costs related to the Apria Acquisition.
Note 4—Goodwill and Intangible Assets
The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill through March 31, 2023:
| | | | | | | | | | | | | | | | | |
| Patient Direct | | Products & Healthcare Services | | Consolidated |
Carrying amount of goodwill, December 31, 2022 | $ | 1,533,670 | | | $ | 103,035 | | | $ | 1,636,705 | |
Acquisition adjustment | 1,582 | | | — | | | 1,582 | |
Currency translation adjustments | — | | | 846 | | | 846 | |
Carrying amount of goodwill, March 31, 2023 | $ | 1,535,252 | | | $ | 103,881 | | | $ | 1,639,133 | |
Intangible assets subject to amortization at March 31, 2023 and December 31, 2022 were as follows:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| March 31, 2023 | | December 31, 2022 |
| | Customer Relationships | | Tradenames | | Other Intangibles | | | Customer Relationships | | Tradenames | | Other Intangibles |
Gross intangible assets | | $ | 447,661 | | | $ | 202,000 | | | $ | 73,183 | | | | $ | 447,107 | | | $ | 202,000 | | | $ | 73,181 | |
Accumulated amortization | | (210,575) | | | (54,984) | | | (32,755) | | | | (197,540) | | | (50,094) | | | (29,612) | |
Net intangible assets | | $ | 237,086 | | | $ | 147,016 | | | $ | 40,428 | | | | $ | 249,567 | | | $ | 151,906 | | | $ | 43,569 | |
Weighted average useful life | | 13 years | | 10 years | | 6 years | | | 13 years | | 10 years | | 6 years |
At March 31, 2023 and December 31, 2022, $294 million and $308 million in net intangible assets were held in the Patient Direct segment and $131 million and $137 million were held in the Products & Healthcare Services segment. Amortization expense for intangible assets was $20.9 million and $10.3 million for the three months ended March 31, 2023 and 2022.
As of March 31, 2023, based on the current carrying value of intangible assets subject to amortization, estimated amortization expense, were as follows:
| | | | | |
Year | |
2023 (remainder) | $ | 62,336 | |
2024 | 65,285 | |
2025 | 55,157 | |
2026 | 53,721 | |
2027 | 46,878 | |
2028 | 29,524 | |
Note 5—Exit and Realignment Costs
We periodically incur exit and realignment and other charges associated with optimizing our operations which includes the consolidation of certain distribution and outsourced logistics centers, administrative offices and warehouses, and information technology strategic initiatives. These charges also include costs associated with our operating model realignment program, which include professional fees, severance and costs to streamline functions and processes.
Exit and realignment charges for the three months ended March 31, 2023 and 2022 were $15.7 million and $1.7 million. These amounts are excluded from our segments operating income. We expect material additional costs in 2023 associated with the operating model realignment program and information technology strategic initiatives.
The following table summarizes the activity related to exit and realignment cost accruals through March 31, 2023 and 2022:
| | | | | |
| Total |
Accrued exit and realignment costs, December 31, 2022 | $ | 969 | |
Provision for exit and realignment activities: | |
Severance | 4,127 | |
Professional fees | 9,012 | |
Other | 2,535 | |
Cash payments | (5,546) | |
Accrued exit and realignment costs, March 31, 2023 | $ | 11,097 | |
| |
Accrued exit and realignment costs, December 31, 2021 | $ | 8,306 | |
Provision for exit and realignment activities: | |
Severance | 811 | |
Other | 871 | |
Cash payments | (6,903) | |
Accrued exit and realignment costs, March 31, 2022 | $ | 3,085 | |
Note 6—Debt
Debt, net of unamortized deferred financing costs, consists of the following:
| | | | | | | | | | | | | | | | | | | | | | | |
| March 31, 2023 | | December 31, 2022 |
| Carrying Amount | | Estimated Fair Value | | Carrying Amount | | Estimated Fair Value |
4.375% Senior Notes, due December 2024 | $ | 245,585 | | | $ | 237,466 | | | $ | 245,510 | | | $ | 237,772 | |
Receivables Securitization Program | — | | | — | | | 93,142 | | | 96,000 | |
Term Loan A | 476,612 | | | 474,694 | | | 490,816 | | | 485,000 | |
4.500% Senior Notes, due March 2029 | 493,056 | | | 396,655 | | | 492,762 | | | 396,625 | |
Term Loan B | 566,160 | | | 582,178 | | | 576,587 | | | 597,733 | |
6.625% Senior Notes, due April 2030 | 585,682 | | | 515,340 | | | 585,180 | | | 516,060 | |
Finance leases and other | 16,420 | | | 16,420 | | | 16,877 | | | 16,877 | |
Total debt | 2,383,515 | | | 2,222,753 | | | 2,500,874 | | | 2,346,067 | |
Less current maturities | (21,062) | | | (21,062) | | | (17,906) | | | (17,906) | |
Long-term debt | $ | 2,362,453 | | | $ | 2,201,691 | | | $ | 2,482,968 | | | $ | 2,328,161 | |
On March 29, 2022, we entered into an amendment to our accounts receivable securitization program (the Receivables Financing Agreement). The amended Receivables Financing Agreement has a maximum borrowing capacity of $450 million. The interest rate under the Receivables Financing Agreement is based on a spread over a benchmark SOFR rate (as described in the Fourth Amendment to the Receivables Financing Agreement, as further amended by the Fifth Amendment to the Receivables Financing Agreement). Under the Receivables Financing Agreement, certain of our accounts receivable balances are sold to our wholly owned special purpose entity, O&M Funding LLC. The Receivables Financing Agreement matures in March 2025.
We had no borrowings at March 31, 2023 and $96.0 million outstanding at December 31, 2022 under our Receivables Financing Agreement. At March 31, 2023 and December 31, 2022, we had maximum revolving borrowing capacity of $450 million and $354 million under our Receivables Financing Agreement.
On March 29, 2022, we entered into an amendment to our revolving credit agreement, dated as of March 10, 2021 with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (Revolving Credit Agreement). The amendment (i) increased the aggregate revolving credit commitments under the Revolving Credit Agreement by $150 million, to an aggregate amount of $450 million and (ii) replaced the Eurocurrency Rate with the Adjusted Term SOFR Rate (each as defined in the Revolving Credit Agreement). The Revolving Credit Agreement matures in March 2027.
At March 31, 2023 and December 31, 2022, our Revolving Credit Agreement was undrawn and we had letters of credit, which reduce Revolver availability, totaling $27.9 million leaving $422 million available for borrowing. We also had letters of credit and bank guarantees, which supports certain leased facilities as well as other normal business activities in the United States and Europe that were issued outside of the Revolving Credit Agreement for $2.0 million and $2.3 million as of March 31, 2023 and December 31, 2022.
On March 29, 2022, we entered into a term loan credit agreement with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (the Credit Agreement) that provides for two new credit facilities (i) a $500 million Term Loan A facility (the Term Loan A), and (ii) a $600 million Term Loan B facility (the Term Loan B). The interest rate on the Term Loan A is based on the sum of either Term SOFR or the Base Rate and an Applicable Rate which varies depending on the current Debt Ratings or Total Leverage Ratio, determined as to whichever shall result in more favorable pricing to the Borrowers (each as defined in the Credit Agreement). The interest rate on the Term Loan B is based on either the Term SOFR or the Base Rate plus an Applicable Rate. The Term Loan A will mature in March 2027 and the Term Loan B will mature in March 2029. In addition to our scheduled principal payment of $1.5 million on the Term Loan B, we made unscheduled principal payments of $10 million on Term Loan B and $15 million on Term Loan A during the three months ended March 31, 2023.
We have $246 million of 4.375% senior notes due in December 2024 (the 2024 Notes), with interest payable semi-annually. The 2024 Notes were sold at 99.6% of the principal amount with an effective yield of 4.422%. We have the option to redeem the 2024 Notes in part or in whole prior to maturity at a redemption price equal to the greater of 100% of the principal amount or the present value of the remaining scheduled payments discounted at the applicable Benchmark Treasury Rate (as defined) plus 30 basis points.
On March 29, 2022, we entered into a Security Agreement Supplement pursuant to which the Security and Pledge Agreement (the Security Agreement), dated March 10, 2021 was supplemented to grant collateral on behalf of the holders of the 2024 Notes, and the parties secured under the credit agreements (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Grantors (as defined in the Security Agreement) in the Grantors’ present and future subsidiaries, subject to certain customary exceptions, and (b) all present and future personal property and assets of the Grantors, subject to certain exceptions.
In March 2021, we issued $500 million of 4.500% senior unsecured notes due in March 2029 (the 2029 Unsecured Notes), with interest payable semi-annually (the Notes Offering). The 2029 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 4.500%. We may redeem all or part of the 2029 Unsecured Notes prior to March 31, 2024, at a price equal to 100% of the principal amount of the 2029 Unsecured Notes redeemed, plus accrued and unpaid interest, if any, to, but not including, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 10, 2021 (the Indenture). On or after March 31, 2024, we may redeem all or part of the 2029 Unsecured Notes at the applicable redemption prices described in the Indenture, plus accrued and unpaid interest, if any, to, but not including, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2029 Unsecured Notes at any time prior to March 31, 2024, at a redemption price equal to 104.5% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date.
On March 29, 2022, we completed the sale of $600 million in aggregate principal amount of our 6.625% senior notes due in April 2030 (the 2030 Unsecured Notes), with interest payable semi-annually. The 2030 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 6.625%. We may redeem all or part of the 2030 Unsecured Notes, prior to April 1, 2025, at a price equal to 100% of the principal amount of the 2030 Unsecured Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 29, 2022 (the New Indenture). From and after April 1, 2025, we may redeem all or part of the 2030 Unsecured Notes at the applicable redemption prices described in the New Indenture, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2030 Unsecured Notes at any time prior to April 1, 2025, at a redemption price equal to 106.625% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date.
The 2029 Unsecured Notes and the 2030 Unsecured Notes are subordinated to any of our secured indebtedness, including indebtedness under our credit agreements.
The Revolving Credit Agreement, the Credit Agreement, the Receivables Financing Agreement, the 2024 Notes, the 2029 Unsecured Notes, and the 2030 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of any of the related agreements. The terms of the applicable credit agreements also require us to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at March 31, 2023.
As of March 31, 2023, scheduled future principal payments of debt, excluding finance leases and other, were as follows:
| | | | | |
Year | |
2023 (remainder) | $ | 13,875 | |
2024 | 273,855 | |
2025 | 40,375 | |
2026 | 43,500 | |
2027 | 387,875 | |
2028 | 6,000 | |
2029 | 1,049,500 | |
2030 | 600,000 | |
Of the $274 million due in 2024, $254 million is due in December 2024. Current maturities at March 31, 2023 include $12.5 million in principal payments on our Term Loan A, $6.0 million in principal payments on our Term Loan B, and $2.6 million in current portion of finance leases.
Note 7—Retirement Plans
We have a frozen noncontributory, unfunded retirement plan for certain retirees in the United States (U.S. Retirement Plan). As of March 31, 2023 and December 31, 2022, the accumulated benefit obligation of the U.S. Retirement Plan was $38.9 million and $39.3 million. Certain of our foreign subsidiaries also have defined benefit pension plans covering substantially all of their respective teammates.
The components of net periodic benefit cost for the three months ended March 31, 2023 and 2022 were as follows: | | | | | | | | | | | |
| Three Months Ended March 31, |
| 2023 | | 2022 |
Service cost | $ | 441 | | | $ | 633 | |
Interest cost | 710 | | | 523 | |
Recognized net actuarial loss | 123 | | | 267 | |
Net periodic benefit cost | $ | 1,274 | | | $ | 1,423 | |
Note 8—Derivatives
We are directly and indirectly affected by changes in foreign currency, which may adversely impact our financial performance and are referred to as “market risks.” When deemed appropriate, we use derivatives as a risk management tool to mitigate the potential impact of certain market risks. We do not enter into derivative financial instruments for trading purposes.
We enter into foreign currency contracts to manage our foreign exchange exposure related to certain balance sheet items that do not meet the requirements for hedge accounting. These derivative instruments are adjusted to fair value at the end of each period through earnings. The gain or loss recorded on these instruments is substantially offset by the remeasurement adjustment on the foreign currency denominated asset or liability.
We pay interest on our Credit Agreement which fluctuates based on changes in our benchmark interest rates. In order to mitigate the risk of increases in benchmark rates, we entered into an interest rate swap agreement whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount. The interest rate swaps were designated as cash flow hedges. Cash flows related to the interest rate swap agreement are included in interest expense.
We determine the fair value of our foreign currency derivatives and interest rate swaps based on observable market-based inputs or unobservable inputs that are corroborated by market data. We do not view the fair value of our derivatives in isolation, but rather in relation to the fair values or cash flows of the underlying exposure. All derivatives are carried at fair value in our consolidated balance sheets. We consider the risk of counterparty default to be minimal. We report cash flows from our hedging instruments in the same cash flow statement category as the hedged items.
The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of March 31, 2023:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Derivative Assets | | Derivative Liabilities |
| Notional Amount | | Maturity Date | | Classification | | Fair Value | | Classification | | Fair Value |
Cash flow hedges | | | | | | | | | | | |
Interest rate swaps | $ | 350,000 | | | March 2027 | | Other assets, net | | $ | 10,898 | | | Other liabilities | | $ | — | |
| | | | | | | | | | | |
Economic (non-designated) hedges | | | | | | | | | | | |
Foreign currency contracts | $ | 70,473 | | | April 2023 | | Other current assets | | $ | 5 | | | Other current liabilities | | $ | 66 | |
The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2022:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | Derivative Assets | | Derivative Liabilities |
| Notional Amount | | Maturity Date | | Classification | | Fair Value | | Classification | | Fair Value |
Cash flow hedges | | | | | | | | | | | |
Interest rate swaps | $ | 400,000 | | | March 2027 | | Other assets, net | | $ | 15,461 | | | Other liabilities | | $ | — | |
| | | | | | | | | | | |
Economic (non-designated) hedges | | | | | | | | | | | |
Foreign currency contracts | $ | 58,321 | | | January 2023 | | Other current assets | | $ | 440 | | | Other current liabilities | | $ | 42 | |
The notional amount of the interest rate swaps represents the amount in effect at the end of the period. Based on contractual terms, the notional amount will decrease in increments of $50 million in March of each year until the maturity date.
The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three months ended March 31, 2023:
| | | | | | | | | | | | | | | | | | | | | | | |
| Amount of (Loss) Recognized in Other Comprehensive Income (Loss) | | Location of Gain Reclassified from Accumulated Other Comprehensive Loss into Income | | Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded | | Amount of Gain Reclassified from Accumulated Other Comprehensive Loss into Income (Loss) |
Interest rate swaps | $ | (2,387) | | | Interest expense, net | | $ | (42,198) | | | $ | 2,176 | |
The amount of ineffectiveness associated with these contracts was immaterial for the periods presented.
For the three months ended March 31, 2023 and 2022, we recognized no gain (loss) and a loss of $0.1 million associated with our economic (non-designated) foreign currency contracts.
We recorded the change in fair value of derivative instruments and the remeasurement adjustment of the foreign currency denominated asset or liability in other operating expense (income), net for our foreign exchange contracts.
Note 9—Income Taxes
The effective tax rate was 27.7% for the three months ended March 31, 2023, compared to 18.6% in the same quarter of 2022. The change in these rates resulted primarily from changes in income and losses and the incremental income tax benefit associated with the vesting of restricted stock recorded in the first quarter of 2022. The liability for unrecognized tax benefits was $22.6 million at March 31, 2023 and $22.5 million at December 31, 2022. Included in the liability at March 31, 2023 and December 31, 2022 were $2.7 million of tax positions for which ultimate deductibility is highly certain but for which there is uncertainty about the timing of such deductibility.
On August 26, 2020, we received a Notice of Proposed Adjustment (NOPA) from the Internal Revenue Service (IRS) regarding our 2015 and 2016 consolidated income tax returns. On June 30, 2021, we received a NOPA from the IRS regarding our 2017 and 2018 consolidated income tax returns. Within the NOPAs, the IRS has asserted that our taxable income for the aforementioned years should be higher based on their assessment of the appropriate amount of taxable income that we should report in the United States in connection with our sourcing of products by our foreign subsidiaries for sale in the United States by our domestic subsidiaries. Our amount of taxable income in the United States is based on our transfer pricing methodology, which has been consistently applied through the current date. We strongly disagree with the IRS position and will pursue all available administrative and judicial remedies, including those available under the U.S. - Ireland Income Tax Treaty to alleviate double taxation. We regularly assess the likelihood of adverse outcomes resulting from examinations such as this to determine the adequacy of our tax reserves. We believe that we have adequately reserved for this matter and that the final adjudication of this matter will not have a material impact on our consolidated financial position, results of operations or cash flows. However, the ultimate outcome of disputes of this nature is uncertain, and if the IRS were to prevail on its assertions, the additional tax, interest, and any potential penalties could have a material adverse impact on our financial position, results of operations or cash flows.
Note 10—Net (Loss) Income per Common Share
The following summarizes the calculation of net (loss) income per common share attributable to common shareholders for the three months ended March 31, 2023 and 2022:
| | | | | | | | | | | |
| Three Months Ended March 31, |
(in thousands, except per share data) | 2023 | | 2022 |
Net (loss) income | $ | (24,418) | | | $ | 39,279 | |
| | | |
Weighted average shares outstanding - basic | 75,177 | | | 73,643 |
Dilutive shares | — | | | 2,376 | |
Weighted average shares outstanding - diluted | 75,177 | | | 76,019 | |
| | | |
Net (loss) income per common share: | | | |
Basic | $ | (0.32) | | | $ | 0.53 | |
Diluted | $ | (0.32) | | | $ | 0.52 | |
Share-based awards for the three months ended March 31, 2023 of approximately 1.7 million shares were excluded from the calculation of net loss per diluted common share as the effect would be anti-dilutive.
Note 11—Shareholders' Equity
In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of March 31, 2023, no shares were issued and $50.0 million of common stock remained available under the at-the-market equity financing program.
Note 12—Accumulated Other Comprehensive (Loss) Income
The following table shows the changes in accumulated other comprehensive (loss) income by component for the three months ended March 31, 2023 and 2022:
| | | | | | | | | | | | | | | | | | | | | | | |
| Retirement Plans | | Currency Translation Adjustments | | Derivatives | | Total |
Accumulated other comprehensive (loss) income, December 31, 2022 | $ | (7,201) | | | $ | (40,095) | | | $ | 11,441 | | | $ | (35,855) | |
Other comprehensive income (loss) before reclassifications | — | | | 5,118 | | | (2,387) | | | 2,731 | |
Income tax | — | | | — | | | 621 | | | 621 | |
Other comprehensive income (loss) before reclassifications, net of tax | — | | | 5,118 | | | (1,766) | | | 3,352 | |
Amounts reclassified from accumulated other comprehensive income (loss) | 123 | | | — | | | (2,176) | | | (2,053) | |
Income tax | (270) | | | — | | | 565 | | | 295 | |
Amounts reclassified from accumulated other comprehensive income (loss), net of tax | (147) | | | — | | | (1,611) | | | (1,758) | |
Other comprehensive (loss) income | (147) | | | 5,118 | | | (3,377) | | | 1,594 | |
Accumulated other comprehensive (loss) income, March 31, 2023 | $ | (7,348) | | | $ | (34,977) | | | $ | 8,064 | | | $ | (34,261) | |
| | | | | | | | | | | | | | | | | | | | | | | |
| Retirement Plans | | Currency Translation Adjustments | | Derivatives | | Total |
Accumulated other comprehensive loss, December 31, 2021 | $ | (14,597) | | | $ | (25,994) | | | $ | — | | | $ | (40,591) | |
Other comprehensive loss before reclassifications | — | | | (787) | | | — | | | (787) | |
Income tax | — | | | — | | | — | | | — | |
Other comprehensive loss before reclassifications, net of tax | — | | | (787) | | | — | | | (787) | |
Amounts reclassified from accumulated other comprehensive loss | 249 | | | — | | | — | | | 249 | |
Income tax | (60) | | | — | | | — | | | (60) | |
Amounts reclassified from accumulated other comprehensive loss, net of tax | 189 | | | — | | | — | | | 189 | |
Other comprehensive income (loss) | 189 | | | (787) | | | — | | | (598) | |
Accumulated other comprehensive loss, March 31, 2022 | $ | (14,408) | | | $ | (26,781) | | | $ | — | | | $ | (41,189) | |
We include amounts reclassified out of accumulated other comprehensive (loss) income related to defined benefit pension plans as a component of net periodic pension cost recorded in Other expense, net.
Note 13—Segment Information
We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our United States distribution business (Medical Distribution), outsourced logistics and value-added services business, and Global Products which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare businesses (Byram and Apria).
We evaluate the performance of our segments based on their operating income excluding acquisition-related charges and intangible amortization and exit and realignment charges, along with other adjustments, that, either as a result of their nature or size, would not be expected to occur as part of our normal business operations on a regular basis. Segment assets exclude inter-segment account balances as we believe their inclusion would be misleading and not meaningful.
The following tables present financial information by segment:
| | | | | | | | | | | |
| Three Months Ended March 31, |
| 2023 | | 2022 |
Net revenue: | | | |
Products & Healthcare Services | $ | 1,915,489 | | | $ | 2,134,041 | |
Patient Direct | 607,360 | | | 272,911 | |
Consolidated net revenue | $ | 2,522,849 | | | $ | 2,406,952 | |
| | | |
Operating income: | | | |
Products & Healthcare Services | $ | 1,820 | | | $ | 89,083 | |
Patient Direct | 45,849 | | | 15,793 | |
Acquisition-related charges and intangible amortization | (22,188) | | | (42,135) | |
Exit and realignment charges | (15,674) | | | (1,682) | |
Consolidated operating income | $ | 9,807 | | | $ | 61,059 | |
| | | |
Depreciation and amortization: | | | |
Products & Healthcare Services | $ | 18,566 | | | $ | 18,994 | |
Patient Direct | 52,360 | | | 5,131 | |
Consolidated depreciation and amortization | $ | 70,926 | | | $ | 24,125 | |
| | | |
Capital expenditures: | | | |
Products & Healthcare Services | $ | 6,332 | | | $ | 10,643 | |
Patient Direct | 45,158 | | | 318 | |
Consolidated capital expenditures | $ | 51,490 | | | $ | 10,961 | |
| | | | | | | | | | | |
| March 31, 2023 | | December 31, 2022 |
Total assets: | | | |
Products & Healthcare Services | $ | 2,739,136 | | | $ | 2,809,600 | |
Patient Direct | 2,504,227 | | | 2,507,216 | |
Segment assets | 5,243,363 | | | 5,316,816 | |
Cash and cash equivalents | 66,840 | | | 69,467 | |
Consolidated total assets | $ | 5,310,203 | | | $ | 5,386,283 | |
The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services:
| | | | | | | | | | | |
| Three Months Ended March 31, |
| 2023 | | 2022 |
Net revenue: | | | |
United States | $ | 2,452,936 | | | $ | 2,262,019 | |
International | 69,913 | | | 144,933 | |
Consolidated net revenue | $ | 2,522,849 | | | $ | 2,406,952 | |
Note 14—Recent Accounting Pronouncements
In June 2016, the FASB issued Accounting Standards Update (ASU) No. 2016-13 Financial Instruments - Credit Losses, Measurement of Credit Losses on Financial Instruments, which changes the way entities measure credit losses for most financial assets and certain other instruments that are not measured at fair value through net earnings. Subsequent to the issuance of ASU No. 2016-13, the FASB issued various ASUs related to Credit Losses, Measurement of Credit Losses on Financial Instruments. These ASUs do not change the core principle of the guidance in ASU No. 2016-13. Instead these amendments are intended to clarify and improve operability of certain topics included within the credit losses standard. We adopted ASU No. 2016-13 and subsequent amendments beginning January 1, 2023. The adoption did not have a material impact on our consolidated financial statements and related disclosures.
Note 15—Legal Proceedings
O&M Halyard N95 Mask FDA Release
On April 5, 2023 we received a communication from the National Institute for Occupational Safety & Health (NIOSH) that products from one lot of a model (No. 46827) of surgical N95 respirator manufactured by O&M Halyard did not pass laboratory tests for fluid resistance and for filtration efficiency, and that products from one lot of another model (No. 46727) did not pass fluid resistance testing, but did pass filtration efficiency testing. At present, our investigation has determined that there are a limited number of lots potentially implicated by the results of the NIOSH particulate filtration testing on model 46827. The vast majority of the products in those lots remain in our possession and under our control, and those lots that had products that did reach the market have passed internal follow-up testing.
On April 12, 2023, the FDA recommended that consumers, health care providers, and facilities not use the two models (model numbers 46827 and 46727) of O&M Halyard surgical N95 respirators due to fluid resistance. In addition, the FDA also recommended against using certain of our surgical, procedure and pediatric face masks when fluid resistance is required. On or about that date, we voluntarily stopped the sale in the U.S. of the above-referenced surgical N95 respirators and similar models pending our investigation of the performance issues identified by the FDA and NIOSH. Regulatory bodies in other non-U.S. markets where we sell our facial protection products have inquired about the relevance of the FDA notification to products sold in their countries. The FDA updated its recommendation on April 21, 2023, to permit use of the model 46727 of Halyard N95 respirators when fluid resistance is not required. These items are included in our Products & Healthcare Services segment.
We are thoroughly investigating the matters identified by the FDA and NIOSH, and we are performing product retesting as we work closely with government agencies to resolve these matters. We are unable to reasonably estimate the amount of any possible loss or range of possible losses or predict the ultimate outcome of these matters. However, there is a risk that these matters and any other safety concerns could have a material adverse effect on our results of operations, financial condition, or cash flows, including as a result of a significant volume of customer product returns and/or recall of products, implementation of corrective action plans, and/or other costly remedial actions in the US and elsewhere. In addition, these matters could potentially have other negative impacts including: government investigations and enforcement actions by the FDA or other US or international regulators or governmental entities; the suspension or revocation of the authority to produce, distribute or sell products, and other sanctions; losses due to patient claims, including product liability claims and lawsuits; and customer claims related to their direct costs arising from supply disruption.
Other Litigation
We are party to various legal claims that are ordinary and incidental to our business, including ones related to commercial disputes, employment, workers’ compensation, product liability, regulatory and other matters. We maintain insurance coverage for employment, product liability, workers’ compensation and other personal injury litigation matters, subject to policy limits, applicable deductibles and insurer solvency. We establish reserves from time to time based upon periodic assessment of the potential outcomes of pending matters.
Based on current knowledge and the advice of counsel, we believe that the accrual as of March 31, 2023 for currently pending matters considered probable of loss, which is not material, is sufficient. In addition, we believe that other currently pending matters are not reasonably possible to result in a material loss, as payment of the amounts claimed is remote, the claims are immaterial, individually and in the aggregate, or the claims are expected to be adequately covered by insurance, subject to policy limits, applicable deductibles, exclusions, and insurer solvency.