UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
   
FORM 10-K/A
Amendment No. 3

FORM 10-K

ýAnnual report pursuant to SectionANNUAL REPORT PURSUANT TO SECTION 13 or 15(d) of the Securities Exchange Act ofOF THE SECURITIES EXCHANGE ACT OF 1934 for the fiscal year ended December 31, 2017
OR
¨
Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the transition period from  to .
For the fiscal year ended December 31, 2019
or
Commission file number: 000–33001
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from to
Commission file number: 000-33001
NATUS MEDICAL INCORPORATEDINCORPORATED
(Exact name of Registrantregistrant as specified in its charter)
Delaware 77–015483377-0154833
(State or other jurisdiction of
incorporation or organization)
 
(I.R.S. Employer
Identification Number)
6701 Koll Center Parkway, Suite 120, Pleasanton, CA94566
(Address of principal executive offices) (Zip Code)
(925) (925) 223-6700
(Registrant’s telephone number, including area code)
Securities Registered Pursuantregistered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $0.001 par value per shareNTUS
The NASDAQNasdaq Stock Market LLC
(The Nasdaq Global Select Market)
Securities Registered Pursuantregistered pursuant to Section 12(g) of the Act: None
Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act.    Yes  ý    No  ¨
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act.    Yes  ¨    No  ý
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports) and (2) has been subject to such requirements for the past 90 days.    Yes  ý    No  ¨
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  ý  No  ¨
Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K (§229.405 of this chapter) is not contained herein, and will not be contained, to the best of registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of the Form 10-K or any amendment to this Form 10-K.  ý
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” and “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act:
 
Large accelerated filer ý
Accelerated Filer
 
Accelerated filer¨
    
 
Non-accelerated filer¨

 
Smaller reporting company¨
 (Do not check if a smaller reporting company) 
Emerging growth company
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).    Yes  ¨    No  ý
As of June 30, 2017,2019, the last business day of Registrant’s most recently completed second fiscal quarter, there were 33,149,43934,040,230 shares of Registrant’s common stock outstanding, and the aggregate market value of such shares held by non-affiliates of Registrant (based upon the closing sale price of such shares on the Nasdaq Global Select Market on June 30, 2017)28, 2019) was $1,236,474,075.$874,493,509. Shares of Registrant’s common stock held by each executive officer and director and by each entity that owns 5% or more of Registrant’s outstanding common stock have been excluded in that such persons may be deemed to be affiliates. This determination of affiliate status is not necessarily a conclusive determination for other purposes.
On July 16, 2018,February 24, 2020, the registrant had 33,590,35134,105,116 shares of its common stock outstanding.
DOCUMENTS INCORPORATED BY REFERENCE
None.

EXPLANATORY NOTE
This Amendment No. 3 on Form 10-K/A amends ourCertain portions of the Registrant's Definitive Proxy Statement for the 2020 Annual Meeting of Stockholders or an amendment to this Annual Report on Form 10-K, for the fiscal year ended December 31, 2017, which weto be filed with the Securities and Exchange Commission, ("SEC") on March 1, 2018 (the "Original Filing") and which was amended on March 12, 2018 to update the list of exhibits included therein ("Amendment No. 1") and on April 30, 2018 to include certain information requiredare incorporated by reference into Part III of Form 10-K ("Amendment No. 2"). We are filing this amendment to include certification required by Exhibits 31 and 32 that refer to our entire Annual Report on Form 10-K for fiscal year ended December 31, 2017.
This Amendment No. 3 does not amend the information in the Original Filing, Amendment No. 1 or Amendment No. 2 other than to provide the certifications referred to above, and we have not updated disclosures to reflect events that occurred subsequent to the March 2, 2018 with respect to information included in the Original Filing, March 1, 2018 with respect to the information included in Amendment No. 1, or April 30, 2018 with respect to the information provided in Amendment No. 2.10-K.

NATUS MEDICAL INCORPORATED
ANNUAL REPORT ON FORM 10-K
TABLE OF CONTENTS
   
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PART I
ITEM 1.    Business
This Annual Report on Form 10-K (this “Annual Report”) contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934 about Natus Medical Incorporated (“Natus,” “we,” “us,” or “our Company”“our”). These statements include, among other things, statements concerning our expectations, beliefs, plans, intentions, future operations, financial condition and prospects, and business strategies. The words “may,” “will,” “continue,” “estimate,” “project,” “intend,” “believe,” “expect,” “anticipate,” and other similar expressions generally identify forward-looking statements. Forward-looking statements in this Item 1 include, but are not limited to, statements regarding the effectiveness and advantages of our products, factors relating to demand for and economic advantages of our products, our plan to develop and acquire additional technologies, products or businesses, our marketing, technology enhancement, and product development strategies, and our ability to complete all of our backlog orders.orders, and the anticipated timing and effect of the implementation of our new organizational structure.
Forward-looking statements are not guarantees of future performance and are subject to substantial risks and uncertainties that could cause our actual results to differ materially from those that we predicted in the forward-looking statements. Investors should carefully review the information contained under the caption “Risk Factors” contained in Item 1A for a description of risks and uncertainties that could cause actual results to differ from those that we predicted. All forward-looking statements are based on information available to us on the date hereof, and we assume no obligation to update forward-looking statements, except as required by Federal Securities laws.
“Natus” and other trademarks of ours appearing in this report are our property.
Overview
Natus isprovides innovative healthcare solutions focused on the diagnosis and treatment of central nervous and sensory system disorders for patients of all ages.
Our broad product portfolio represents a leading providerheritage of newborninnovation and leadership. Natus brands have been setting the standard for patient care neurology,for over eighty (80) years. Our products are trusted by medical professionals in university medical centers, public and hearingprivate hospitals, physician offices, clinics, research laboratories, and balance assessment healthcare products and services used forother sites around the screening, diagnosis, detection, treatment, monitoring and tracking of common medical ailments in newborn care, hearing impairment, neurological dysfunction, epilepsy, sleep disorders, neuromuscular diseases and balance and mobility disorders.
Product Familiesworld.
We are organized intouse our clinical expertise to support our customers' evolving needs with advanced products, continuing education and outstanding technical service. 
Natus provides product solutions for three end markets: Neuro, Newborn Care and Hearing & Balance.
On January 15, 2019, Natus announced the implementation of a new organizational structure designed to improve operational performance and make it a stronger, more profitable company. We consolidated our three strategic business units, eachNeuro, Newborn Care, and Hearing & Balance into "One Natus". The initiative is designed to create a single, unified company with multipleglobally led operational teams in Sales & Marketing, Manufacturing, Research & Development, Quality, and General and Administrative functions. As part of our refocus on more profitable core medical device businesses, we also exited non-core businesses which included Global Neuro-Diagnostic Services, the NeuroCom balance product families:line, and Medix. In January 2020 we also announced we completed the transition of the Peloton hearing screening services business to an external provider, Pediatrix Medical Group, as part of the implementation of the new organizational structure.
Markets
NeuroIncludes products and services that provide diagnostic, therapeutic and surgical solutions in neurodiagnostics, neurocritical care and neurosurgery. Neurology'sNeuro's comprehensive neurodiagnostic solutions include electroencephalography (“EEG”) and long termlong-term monitoring (“LTM”), Intensive Care Unit (“ICU”) monitoring, electromyography (“EMG”), sleep analysis or polysomnography (“PSG”), intra-operativeand intraoperative monitoring (“IOM”), and diagnostic and monitoring transcranial doppler (“TCD”) ultrasound technology. Additionally, Global Neuro-Diagnostic Services provides ambulatory EEG services with and without video in the patient's home.. These solutions enhance the diagnosis of neurological conditions such as epilepsy, sleep disorders and neuromuscular diseases.
Our neurocritical care solutions include management of traumatic brain injury by continuous monitoring of intracranial pressure (“ICP”) and cerebrospinal fluid (“CSF”) drainage.drainage, as well as cranial access kits for entry into the cranium. Our neurosurgical solutions provide options that promotesuch as dural healinggrafts facilitate dural repair in the cranium as well as valves, shunts and related treatment solutions for procedures involving hydrocephalus. We acquired our neurocritical care and neurosurgical product lines from Integra LifeSciences in October 2017 (“Integra Asset Acquisition”).
Newborn CareIncludes products and services for newborn care including hearing screening, brain injury, ROP vision screening, thermoregulation,monitoring, eye imaging, jaundice management, and various disposable newborn care supplies, as well assupplies.
Hearing & Balance — The Hearing portfolio includes products for diagnostic hearing assessment for children through adult populations, and products to diagnose and assist in treating balance and mobility disorders.
Otometrics—Includes products for hearing and diagnostics, and hearing aid fitting, including computer-based audiological, otoneurologic and vestibular instrumentation and sound rooms for hearing care professionals. Our Balance portfolio provides diagnosis and assessment of vestibular and balance care professionals. Otometrics has disorders. These solutions have

a complete product and brand portfolio known for its sophisticated design technology in the hearing and balance assessment markets. Global brands include Aurical®, ICS® and Madsen®. We acquired the Otometrics business in January 2017.
Neuro
Our neurology business unit representsNeuro portfolio is comprised of a comprehensive line of neurodiagnostic, neurocritical care, and neurosurgical products that are used by healthcare practitioners in the diagnosis and monitoring of neurological disorders of the central and peripheral nervous system.disorders. The environments in which these products are used include outpatient private practice facilities and inpatient hospital environments includingenvironments. Our products can be used throughout the continuum of care through diagnostic procedures and monitoring of patients during admissions, surgery, while under sedation, in post-operative care, and in intensive care units. Our neurologyNeuro products and services include:
Neurodiagnostic


Electroencephalography—Equipment, supplies and services used to monitor and visually display the electrical activity generated by the brain and other key physiological signals for both diagnosis and monitoring of neurological disorders in the hospital, research laboratory, clinician office and patient’s home.
Electromyography—Equipment and supplies used to measure electrical activity in nerves, muscles, and critical pathways includes EMG, nerve conduction and evoked potential functionality.
Polysomnography—Equipment and supplies used to measure a variety of respiratory and physiologic functions to assist in the diagnosis and monitoring of sleep disorders, such as insomnia and obstructive sleep apnea, a condition that causes a person to stop breathing intermittently during sleep.
Intraoperative monitoring—Equipment and supplies used to monitor the functional integrity of certain neural structures (i.e. nerves, spinal cord and parts of the brain) during surgery. The goal of IOM is to provide real time guidance to the surgeon and anesthesiologist which will reduce the risk to the patient during surgery.
Transcranial Doppler—Equipment and supplies used to measure blood flow parameters such as velocity in key vascular structures in the brain. This vascular information is helpful in identifying strokes, infarcts and vasospasms.
Electroencephalography — Equipment, supplies and services used to monitor and visually display the electrical activity generated by the brain and other key physiological signals for both diagnosis and monitoring of neurological disorders in the hospital, research laboratory, clinician office and patient’s home.
Electromyography — Equipment and supplies used to measure electrical activity in nerves, muscles, and critical pathways includes EMG, nerve conduction and evoked potential functionality.
Polysomnography — Equipment and supplies used to measure a variety of respiratory and physiologic functions to assist in the diagnosis and monitoring of sleep disorders, such as insomnia and obstructive sleep apnea.
Intraoperative monitoring — Equipment and supplies used to monitor the functional integrity of certain neural structures (i.e. nerves, spinal cord and parts of the brain) during surgery. The goal of IOM is to provide real time guidance to the surgeon and anesthesiologist, which will reduce the risk to the patient during surgery.
Neurocritical Care
Intracranial pressure monitoring—Equipment and catheters used to monitor pressure in the cranium/brain and catheters to drain cerebrospinal fluid from the brain to aid in hydrocephalus and traumatic brain injury cases.
Intracranial pressure monitoring — Equipment and catheters used to monitor pressure in the cranium/brain and catheters to drain cerebrospinal fluid from the brain to aid in hydrocephalus and traumatic brain injury cases.
Cranial access kits — Convenient, pre-packaged sterile sets containing all necessary components for entry into the cranium, to monitor intracranial pressure and provide temporary drainage of CSF.
Neurosurgery
Shunts and Dural grafts—Shunts are used to manage the drainage of cerebrospinal fluid from the brain to maintain appropriate levels of CSF when treating hydrocephalus. Dural grafts are used in procedures to repair or substitute a patient's dura mater in the brain.
Shunts and Dural grafts — Shunts are used to manage the drainage of cerebrospinal fluid from the brain to maintain appropriate levels of CSF when treating hydrocephalus. Dural grafts are used in procedures to repair or substitute a patient's dura mater which surrounds the brain.
Diagnostic EEG and Long-term Monitoring
We design, manufacture, and market a full line of instruments and supplies used to help diagnose the presence of seizure disorders and epilepsy, look for causes of confusion, evaluate head injuries, tumors, infections, degenerative diseases, and metabolic disturbances that affect the brain,brain; and assist in surgical planning. This type of testing is also done to diagnose brain death in comatose patients. These systems and instruments work by detecting, amplifying, and recording the brain’s electrical impulses, as well as other physiological signals needed to support clinical findings. Routine clinical EEG recording is done by placing electrodes on a patient’s scalp over various areas of the brain to record and detect patterns of activity and specific types of electrical events. EEG technologists perform the tests, and neurologists, neurophysiologists and epileptologists review and interpret the results.
Routine outpatient clinical EEG testing is performed in hospital neurology laboratories, private physician offices, and in ambulatory settings such as the patient’s home, providing physicians with a clinical assessment of a patient’s condition. Long-term inpatient monitoring of EEG and video to monitor behavior (LTM) is used to determine complex treatment plans, and for patients with seizures that do not respond to conventional therapeutic approaches, surgical solutions may be appropriate. Patients suffering from severe head trauma and other acute conditions that may affect the brain are monitored in ICUs. In addition, research facilities use EEG equipment to conduct research on humans and laboratory animals.
Global Neuro-Diagnostic Services (“GND”) which we acquired in early 2015, provides in-home ambulatory EEG monitoring. GND works with physicians and hospitals to provide superior care and testing services to its patients. Upon receiving a physician referral, GND provides program services in the patient's home, professional oversight throughout the study and preliminary report generation for physician review. GND has received accreditation by The Joint Commission as a home EEG testing services company and also has achieved the American Board of Registered Electroencephalographic and Evoked Potential Technologists (ABRET) Laboratory Accreditation in routine EEG services. GND is a leader in EEG testing services because of our focus on meeting the most stringent quality standards and providing the highest quality patient care.
Diagnostic Electroencephalograph Monitoring Product Lines
Our EEG diagnostic monitoring product lines for neurology consist of signal amplifiers, workstations to capture and store synchronizesynchronized video and EEG data, and proprietary software. These products are typically used in concert, as part of an EEG “system” by the neurology/neurophysiology department of a hospital or clinic to assist in the diagnosis and monitoring of neurological conditions.
NeuroWorks; Coherence; NicoletOne; Twin.
NeuroWorks; NicoletOne.    Our EEG Systems include a broad range of products, from software licenses and ambulatory monitoring systems to advanced laboratory systems with multiple capabilities for EEG, ICU monitoring systems to advanced laboratory systems with multiple capabilities for EEG, ICU monitoring,

long-term monitoring of up to 256 channels, as well as nursing stations to monitor patients and physician review stations with quantitative EEG analysis capabilities.

Stellate/Gotman Spike and Seizure; GridView; NicoletOne Trends.    Our proprietary spike and seizure detection algorithm detects, summarizes, and reports EEG events that save health care professionals time by increasing the speed and accuracy of interpretation. GridView is a tool that allows the clinician to correlate EEG patterns with electrode contacts on a 3D view of the patient brain using magnetic resonance (“MR”) or computed tomography (“CT”) images, thus enabling the visualization and annotation of the brain surface and internal structures involved in the diagnosis of epilepsy. NicoletOne Trends provides a comprehensive set of EEG analysis algorithms that are used to generate compressed trends of large amounts of data to assist in the clinical evaluation and data review process.
Proprietary Signal Amplifiers.    Our proprietary signal amplifiers function as the interface between the patient and the computer. The headbox connects electrodes attached to the patient’s head to our EEG monitoring systems. Our proprietary amplifier products are sold for a wide variety of applications under the following brand names: Xltek, Trex, EEG32U, EMU40EX, Brain Monitor, Quantum, Schwarzer EEG, Nicolet v32 and v44 models, C series and Nicolet Wireless 32- and 64- channel amplifiers.
Nicolet Cortical Stimulator.    This product is our proprietary device that provides cortical stimulation to the brain during functional brain mapping either before or during surgery to help the surgeon protect the eloquent parts of the brain. The device can be used as a standalone unit or with the fully integrated NicoletOne software that supports control of the device from the software, automated mapping and comprehensive report generation.
Supplies.    We also manufacture and market a full line of proprietary EEG needles and other supplies used in the electroencephalography field.
Global Neuro-Diagnostic Services.GND provides ambulatory EEG services with and without video in the patient’s home. Other services such as Remote Monitoring, ICU monitoring, Virtual EMU monitoring and Detailed Video EEG Technical Descriptions with cloud-based test results are also provided. Our services are specifically designed to partner with hospitals and physicians to improve efficiency, results, and turn-around time, and to reduce costs.
Stellate/Gotman Spike and Seizure; GridView; NicoletOne Trends.    Our proprietary spike and seizure detection algorithm detects, summarizes, and reports EEG events that save health-care professionals time by increasing the speed and accuracy of interpretation. GridView is a tool that allows the clinician to correlate EEG patterns with electrode contacts on a 3D view of the patient brain using magnetic resonance (“MR”) or computed tomography (“CT”) images, thus enabling the visualization and annotation of the brain surface and internal structures involved in the diagnosis of epilepsy. NicoletOne Trends provides a comprehensive set of EEG analysis algorithms that are used to generate compressed trends of large amounts of data to assist in the clinical evaluation and data review process.
Proprietary Signal Amplifiers.    Our proprietary signal amplifiers function as the interface between the patient and the computer. The headbox connects electrodes attached to the patient’s head to our EEG monitoring systems.
Nicolet Cortical Stimulator.    This product is our proprietary device that provides cortical stimulation to the brain during functional brain mapping either before or during surgery to help the surgeon protect the eloquent parts of the brain (parts of the brain that control speech, motor and sensory functionality). The device can be used as a standalone unit or with the fully integrated NicoletOne or NeuroWorks software that supports control of the device from the software, automated mapping and comprehensive report generation.
Supplies.    We also manufacture and market a full line of proprietary EEG electrodes and other supplies used in the electroencephalography field.
Electrodiagnostic Monitoring
Our electrodiagnostic systems include EMG,electromyography (EMG), nerve conduction (“NCS”), and often evoked potential (“EP”) functionality. EMG and NCS involve the measurement of electrical activity of muscles and nerves both at rest and during contraction. Measuring the electrical activity in muscles and nerves can help diagnose diseases of the peripheral, central nervous system or musculature system. An electromyogram is doneperformed to determine if there is any disease present that effects muscle tissue, nerves, or the junctions between nerve and muscle (neuromuscular junctions). An electromyogram can also be used to diagnose the cause of weakness, paralysis, and muscle twitching, and is also used as a primary diagnosis for carpal tunnel syndrome, which is the most frequently encountered peripheral compressive neuropathy. EMG is also used for clinical applications of botox to relieve muscle spasm and pain. We market both the clinical system and the needles used for these procedures.
In addition to EMG and NCS functionality, many of our Electrodiagnostic systems also include EP. Evoked brain potentials are elicited in response to a stimulus. These evoked potentials can come from the sensory pathways (such as hearing and visual) or from the motor pathways. An examination tests the integrity of these pathways including the associated area of the brain. Sophisticated amplifiers are required to recognize and average evoked potential EMG and NCS signals.
Electrodiagnostic Product Lines
Dantec Keypoint.    The Dantec Keypoint EMG and EP family of products features amplifiers, stimulators, and strong signal quality. The Keypoint is used for advanced neurodiagnostic applications such as single fiber EMG, visual and auditory evoked potentials, and in routine nerve conduction studies. The Keypoint system is also available in a portable laptop configuration.
Dantec Clavis.    The Dantec Clavis device is a hand-held EMG and current stimulation device that provides muscle and nerve localization information to assist with medication and botox injections. In conjunction with the Bo-ject hypodermic needle and electrodes, physicians can better localize the site of the injection.
Nicolet EDX family.    A hardware platform of amplifiers, base control units, stimulators and hand-held probes that are sold with Nicolet brand proprietary software. These mid to high end systems have full functionality, strong signal quality, and flexibility. They include EMG, NCS, EP’s, IOM and advanced data analysis features.
Nicolet VikingQuest.    An EMG system for the mid-range market. The device runs on our proprietary software.
Natus Neurology UltraPro.    This is a low to mid-level product that offers high quality data collection using the Dantec Keypoint amplifiers and the proprietary Natus EMG software.

Supplies.    We also manufacture and market a full line of proprietary EMG needles and other supplies used in the electrodiagnostic field.
Dantec Keypoint.    The Dantec Keypoint G-4 and Focus EMG and EP family of products features amplifiers, stimulators, and strong signal quality. The Keypoint G4 is used for advanced neurodiagnostic applications such as single fiber EMG, visual and auditory evoked potentials, and in routine nerve conduction studies. The Keypoint Focus system is also available in a portable laptop configuration.
Dantec Clavis.    The Dantec Clavis device is a hand-held EMG stimulation device that provides muscle and nerve localization information to assist with medication and botox injections. In conjunction with the Bo-ject or Myoject hypodermic needle and electrodes, physicians can better localize the site of the injection.
Nicolet EDX family.    A hardware platform of amplifiers, base control units, stimulators and hand-held probes that are sold with Nicolet brand proprietary software. These mid- to high-end systems have full functionality, strong signal quality, and flexibility. They include EMG, NCS, EP’s, IOM and advanced data analysis features.
Nicolet VikingQuest.    An EMG system for the mid-range market. The device runs on our proprietary software.
Natus UltraPro.    This is an entry level product with add on capabilities that offers high quality data collection using the Dantec Keypoint amplifiers and the proprietary Natus EMG/EP software.
Supplies.    We also manufacture and market a full line of proprietary EMG needles and other supplies used in the electrodiagnostic field.
Diagnostic Polysomnography Monitoring
PSG,Polysomnography (“PSG”), which involves the analysis of respiratory patterns, brain electrical activity and other physiological data, has proven critical for the diagnosis and treatment of sleep-related diseases such as apnea, insomnia, and narcolepsy. A full polysomnographic sleep study entails a whole-night recording of brain electrical activity, muscle movement, airflow, respiratory effort, oxygen levels, electrical activity of the heart, and other parameters. In some studies, patients are fitted

with treatment devices using Positive Airway Pressure technology (“PAP”) during the sleep study and the proper settings for the treatment devices are determined. In many cases, the sleep study is performed in the patient’s home.
Diagnostic PSG Monitoring Product Lines
We market dedicated diagnostic PSG monitoring products that can be used individually or as part of a networked system for overnight sleep studies to assist in the diagnosis of sleep disorders. Additionally, we offer products that are specifically designed to be used in the patient’s home. Some of our EEG systems described above can also be configured to perform diagnostic PSG monitoring. These products include software licenses, ambulatory monitoring systems, and laboratory systems that combine multiple capabilities, including EEG monitoring, physician review stations, and quantitative PSG analysis capabilities.
Embla REMlogic, and Sandman; Xltek SleepWorks; Schwartzer Coherence; and Grass Twin.    Our diagnostic PSG systems capture and store all data digitally. The systems enable users to specify rules and personal preferences to be used during analysis, summarizing the results graphically and incorporating them in detailed reports.
Proprietary Amplifiers.    Our data acquisition systems incorporate recent developments in superior amplifiers for sleep analysis and are sold under brand names such as Embla and MPR, Xltek Trex and SleepWorks, and Schwarzer. Our amplifiers are used in both hospitals and stand-alone clinics. In addition to exceptional signal quality, headboxes include various tools such as built-in oximeters and controls to allow the user to start and stop a study or perform electrode impedance testing either at the patient’s bedside or from the monitoring room.
Practice Management Software.    Our Embla Enterprise Practice Management Software provides a solution for institutions as well as private labs and physicians for patient scheduling, inventory control, staff scheduling, data management, business reports and billing interfaces. Enterprise may be used in conjunction with many Natus PSG products.
PMSD.    PastuerMatic Sterile Dryers are used in hospital and clinic sleep laboratories to provide non-chemical sterilization of products used in sleep therapy. An environmentally friendly approach to disinfection, the PMSD products offer cost effective sterilization for sleep labs of all sizes.
Supplies.    We also market a broad line of supplies, disposable products and accessories for the PSG laboratory.
Embla REMlogic, Sandman; and Xltek SleepWorks.    Our diagnostic PSG systems capture and store all data digitally. The systems enable users to specify rules and personal preferences to be used during analysis, summarizing the results graphically and incorporating them in detailed reports.
Proprietary Amplifiers.    Our data acquisition systems incorporate recent developments in superior amplifiers for sleep analysis. Our amplifiers are used in both hospitals and stand-alone clinics. In addition to exceptional signal quality, headboxes include various tools such as built-in oximeters and controls to allow the user to start and stop a study or perform electrode impedance testing either at the patient’s bedside or from the monitoring room.
Supplies.    We also market a broad line of supplies, disposable products and accessories for the PSG laboratory including the XactTrace respiratory monitoring belts.
Intraoperative Monitoring
Intraoperative monitoring (“IOM”) is the use of electrophysiological methods such as EEG, EMG, and evoked potentials to monitor the functional integrity of certain neural structures (i.e. nerves, spinal cord and parts of the brain) during surgery. The purpose of IOM is to reduce the risk to the patient’s nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist during surgery.
Diagnostic IOM Product Lines
Xltek Protektor.    The Protektor system is an IOM system that provides medical professionals with all information necessary to make immediate and critical surgical decisions. The system combines flexibility with multi-modality allowing full coverage of IOM techniques. The Protektor comes in 16 or 32 channel options.
Nicolet Endeavor.    A dedicated multi-modality IOM system that offers complete flexibility in work flow and test protocols.
Nicolet EDX.    These combo systems are used in IOM applications where a smaller number of channels is sufficient. This approach is primarily followed in international markets that utilize the integrated system approach that allows for the use of the system in EMG clinical applications as well as in IOM applications.
Transcranial Doppler
Transcranial Doppler is the use of Doppler ultrasound technology to measure blood flow parameters such as velocity in key vascular structures in the brain. A Doppler probe is held against a specific location on the head and the device displays the information in both visual and auditory formats. This technology is used as preventative screening, diagnosis, and monitoring of various diseases and brain injuries such as stroke, embolism, reduced blood flow during surgery, and vasospasm.

Transcranial Doppler Products
Sonara and Sonara Tek.    The Sonara is an embedded system that is a self-contained unit that includes a CPU, data display screen and speakers. It uses proprietary software with a touch screen menu. Sonara Tek is a small portable device used with a laptop. Both models enable the uploading of images to the hospital information system.
Xltek Protektor.    The Protektor system is an IOM system that provides medical professionals with all information necessary to make immediate and critical surgical decisions. The system combines flexibility with multi-modality allowing full coverage of IOM techniques. The Protektor comes in 16 or 32 channel options.
Nicolet EDX.    These combo systems are used in IOM applications where a smaller number of channels is sufficient. This approach is primarily followed in international markets that utilize the integrated system approach that allows for the use of the system in EMG clinical applications as well as in IOM applications.
Neurocritical Care Products
Intracranial pressure and temperature provide insight into the health of the brain, especially in patients experiencing a traumatic brain injury, other traumatic, ischemic or hemorrhagic incidents, or a major neurosurgical procedure. A small hole is drilled into the braincranium to allow insertion of a catheter that contains a pressure/temperature or pressure only transducer that allows continuous monitoring of brain temperature and/or pressure.
Camino ICP Monitor. The Camino ICP Monitor is a compact, portable device that provides tools for continuously determining and monitoring intracranial pressure and intracranial temperature. It has a touch screen interface, physiological alarms, and can output data to either a patient bedside monitor or to remote media types via a USB drive. These systems are used in the intensive care unit (ICU) environment.
Camino Catheters. Camino catheters use either fiber optic or strain gauge technology to measure either pressure and temperature or just pressure. Camino catheters measure their respective values at the tip of the catheter which eliminates the need for a fluid-filled system that uses an external transducer to measure pressure. The Camino Flex Ventricular Intracranial Pressure Monitoring Kit has a catheter that allows both the measurement of ICP and CSF drainage.
Camino ICP Monitor. The Camino ICP Monitor is a compact, portable device that provides tools for continuously determining and monitoring intracranial pressure and intracranial temperature. It has a touch screen interface, physiological alarms, and can output data to either a patient bedside monitor or to remote media types via a USB drive. These systems are used in the intensive care unit (ICU) environment.
Camino Catheters. Camino catheters use either fiber optic or strain gauge technology to measure either pressure and temperature or just pressure. Camino catheters measure their respective values at the tip of the catheter, which eliminates the need for a fluid-filled system that uses an external transducer to measure pressure. The Camino Flex Ventricular Intracranial Pressure Monitoring Kit has a catheter that allows both the measurement of ICP and CSF drainage.
Cranial Access Kits. Cranial Access Kits are convenient procedural kits that include all the instrumentation and items needed to access the subarachnoid space or the lateral ventricles of the brain. The kit is intended to be used with an external drainage and monitoring system in selected patients to reduce intracranial pressure, to provide temporary drainage of CSF, and to monitor ICP. The kit is a convenient, pre-packaged sterile set containing all necessary components for entry into the cranium and is available with or without drugs and with a variety of drill bits and instrumentation.
Neurosurgical Products

During brain surgery, the dura of the brain may need to be repaired or replaced. A dural graft is used to serve as a dural substitute for the surgical repair of dural defects. Moreover, brain surgery is performed to place shunts in the brain to help drain excess CSF either externally or into the body for reabsorption to help treat hydrocephalus.
DURAFORM. DURAFORM Dural Graft Implant is an absorbable collagen matrix to provide a soft, conforming, and easy to use dural substitute. This product is used in the operating room to provide repair of the dura mater and promote dural healing.
Shunts. Shunts are used in the operating room to provide solutions for hydrocephalus.
DURAFORM. DURAFORM Dural Graft Implant is an absorbable collagen matrix to provide a soft, conforming, and easy to use dural substitute. This product is used in the operating room to provide repair of the dura mater and promote dural healing.
Shunts. Shunts are used in the operating room to provide solutions for hydrocephalus or brain trauma. Shunts are used to manage the drainage of cerebrospinal fluid from the brain to maintain appropriate levels of CSF when treating hydrocephalus.
Newborn Care
Our newborn care business unit represents a line of products and services that are used by healthcare practitioners in the diagnosis and treatment of common medical ailments in newborn care, as well as other products used in newborn through adult populations, including hearing diagnostics and balance & mobility systems.care. Our products are organized in nineeight modalities and include:
Newborn Hearing Screening—Products used to screen hearing in newborns.
Diagnostic Hearing Assessment—Products used to screen for or diagnose hearing loss, or to identify abnormalities affecting the peripheral and central auditory nervous systems in patients of all ages.
Balance and Mobility—Systems to diagnose and assist in treating balance disorders in an evidence-based, multidisciplinary approach.
Thermoregulation—Products used to control the newborn environment including incubators and warmers.
Jaundice Management—Products used to treat jaundice, the single largest cause for hospital readmission of newborns in the U.S.
Newborn Brain Injury—Products used to diagnose the severity of brain injury, monitor the effectiveness of drug therapies, detect seizure activity and monitor general neurological status.
Vision—Imaging systems and products used in the advanced science and practice of neonatal and pediatric retinal imaging.
Essentials—Products used in the everyday operation of neonatal intensive care unit (“NICU”) and well-baby nursery department within the hospital environment.
NICVIEW—Live streaming video for families with babies in the NICU that enables family members and approved friends to see the new baby, 24/7, from anywhere in the world - from any device, within a secured environment.
Newborn Hearing Screening — Products used to screen hearing in newborns.
Diagnostic Hearing Assessment — Products used to screen for or diagnose hearing loss, or to identify abnormalities affecting the peripheral and central auditory nervous systems in patients of all ages.
Jaundice Management — Products used to treat jaundice, the single largest cause for hospital readmission of newborns in the U.S.
Newborn Brain Injury — Products used to diagnose the severity of brain injury, monitor the effectiveness of drug therapies, detect seizure activity and monitor general neurological status.
Eye Imaging — Systems and products used in the advanced science and practice of neonatal and pediatric retinal imaging.
Essentials — Products used in the everyday operation of neonatal intensive care unit (“NICU”) and well-baby nursery department within the hospital environment.
NICVIEW — Live streaming video for families with babies in the NICU that enables family members and approved friends to see the new baby, 24/7, from anywhere in the world - from any Internet connected device, within a secured environment.
Newborn Hearing Screening

Hearing impairment is the most common treatable chronic disorder in newborns, affecting as many as five babies out of every 1,000 newborns. It is estimated that 20,000 hearing-impaired babies are born in the United States (“U.S.”) every year, and as many as 60,000 more in the rest of the developed world. Until the introduction of universal newborn hearing screening programs, screening was generally performed only on those newborns that had identifiable risk factors for hearing impairment. However, screening only those newborns with risk factors for hearing impairment overlooks approximately half of newborns with some level of hearing impairment.
Early identification of hearing impairment and early intervention has been shown to improve language development significantly. Undetected hearing impairment often results in the failure to learn, process spoken language, and speak.
Newborn Hearing Screening Techniques
The two traditional technologies used to screen newborns and infants for hearing impairment are auditory brainstem response and otoacoustic emissions.
Auditory brainstem response (“ABR”).   ABR technology is the most accurate and comprehensive method for screening and diagnosing hearing impairment. ABR technology is based on detecting the brain’s electricelectrical impulses resulting from a specific auditory stimulus.
Otoacoustic emission (“OAE”). OAEs are sounds created by the active biomechanical processes within the sensory cells of the cochlea. They occur both spontaneously and in response to acoustic stimuli. OAE screening uses a probe placed in the ear canal to deliver auditory stimuli and to measure the response of the sensory cells with a sensitive microphone.
Newborn Hearing Screening Product Lines
Our newborn hearing screening product lines consist of the ALGO, ABaer, AuDX, and Echo-Screen newborn hearing screeners. These hearing screening products utilize proprietary signal detection technologies to provide accurate and non-invasive hearing screening for newborns and are designed to detect hearing loss at 30 or 35 dB nHL or higher. Each of these devices is designed to generate a PASS or REFER result.
ALGO 5 and 3i Newborn Hearing Screeners.    These AABR devices deliver thousands of soft audible clicks to the newborn’s ears through sound cables and disposable earphones connected to the instrument. Each click elicits an identifiable brain wave, which is detected by disposable electrodes placed on the head of the child and analyzed by the screening device. These devices use our proprietary AABR signal detection algorithm.
ABaer Newborn Hearing Screener.    The ABaer, which is a PC-based newborn hearing screening device, offers a combination of AABR, OAE, and diagnostic ABR technologies in one system.
Echo-Screen.    Our hand-held Echo-Screen products provide a choice or combination of proprietary ABR and OAE technologies that can also be used for children through adults. The Echo-Screen III device is a compact, multi-modality handheld hearing screener that is tightly integrated with audible Lite Hearing Screening Data Management.
ALGO 5 and 3i Newborn Hearing Screeners.    These Automated Auditory Brainstem Responses (“AABR”) devices deliver thousands of soft audible clicks to the newborn’s ears through sound cables and disposable earphones connected to the instrument. Each click elicits an identifiable brain wave, which is detected by disposable electrodes placed on the head of the child and analyzed by the screening device. These devices use our proprietary AABR signal detection algorithm.
ABaer Newborn Hearing Screener.    The ABaer, which is a PC-based newborn hearing screening device, offers a combination of AABR, OAE, and diagnostic ABR technologies in one system.
Echo-Screen.    Our hand-held Echo-Screen products provide a choice or combination of proprietary ABR and OAE technologies that can also be used for children through adults. The Echo-Screen III device is a compact, multi-modality handheld hearing screener that is tightly integrated with audible Lite Hearing Screening Data Management.
Hearing Screening Supply Products
For infection control, accuracy, and ease of use, the supply products used with our newborn hearing screening devices are designed as single-use, disposable products. Each screening supply product is designed for a specific hearing screening technology.
ABR Screening Supply Kits.    Each ABR screen is carried out with single-use earphones and electrodes, which are alcohol and latex-free. The adhesives used in these supply products are specially formulated for use on the sensitive skin of newborns. To meet the needs of our customers we offer a variety of packaging options. Echo-Screen and ABaer offer the choice of either an earphone or use of ear tips for perform ABR screening.
OAE Supply Products.    Each OAE screen is carried out with single-use ear tips that are supplied in a variety of sizes and packaging options.
ABR Screening Supply Kits.    Each ABR screen is carried out with single-use earphones and electrodes, which are alcohol and latex-free. The adhesives used in these supply products are specially formulated for use on the sensitive skin of newborns. To meet the needs of our customers we offer a variety of packaging options. Echo-Screen and ABaer offer the choice of either an earphone or use of ear tips for perform ABR screening.
OAE Supply Products.    Each OAE screen is carried out with single-use ear tips that are supplied in a variety of sizes and packaging options.
Peloton Screening Services
Peloton Screening Services is a nationwide service offering that provides hearing screening services to hospital-based customers. The platform of the program meets the objectives of today’s healthcare environment by aligning with family centered care principals and Joint Committee on Infant Hearing (JCIH) recommendations. Peloton provides all aspects of the program: equipment, supplies, professional oversight by nurses or audiologists, screening personnel, case management, quality review & oversight, and state data management reporting.
Balance and Mobility
Balance is an ability to maintain the line of gravity of the body within the base of support with minimal postural sway. Maintaining balance requires coordination of input from multiple sensory systems including the vestibular (i.e. inner ear), somatosensory (i.e. touch, temperature, body position), and visual systems. Balance disorders impact a large percentage of the

population in all age ranges from children to adults. Common complaints include dizziness, vertigo, or an inability to walk or drive a vehicle, which can all lead to the curtailment of daily life activities. These symptoms are exacerbated in elderly patients and can result in falls, orthopedic injuries, and sometimes death.
Balance and Mobility Products
Our principal balance and mobility products are sold under the Neurocom brand:
EquiTest.    Proprietary protocols in the EquiTest family of devices objectively quantify and differentiate among sensory, motor, and central adaptive impairments to balance control. This approach is commonly referred to as computerized dynamic posturography (“CDP”). CDP is complementary to clinical tests designed to localize and categorize pathological mechanisms of balance disorders in that it can identify and differentiate the functional impairments associated with the identified disorders.
Balance Master.    A family of devices providing objective assessment and retraining of the sensory and voluntary motor control of balance.
VSR and VSR Sport.    The VSR provides objective assessment of sensory and voluntary motor control of balance with visual biofeedback. The VSR Sport is designed specifically for the athletic market as part of a concussion management program. It is portable, easy-to use and offers athletic trainers, sports medicine practitioners, and other sport professionals the data needed to make objective return-to-play decisions without relying on subjective evaluation.
inVision.    Our inVision device incorporates a set of proprietary diagnostic tests that quantify a patient’s ability to maintain visual acuity and stable gaze while actively moving the head. The objective information enables the clinician to assess the patient’s ability to live and move safely in a dynamic world and to participate in daily-life functions such as driving, walking through a grocery store, or actively engaging in family activities.
Thermoregulation
Incubators offer a controlled, consistent microenvironment for thermoregulation and humidification within a closed system to maintain skin integrity and body temperature.
Thermoregulation products
Incubators.    Our NatalCare incubators, including those used for transporting infants, provide high thermal performance with a double wall design, easy to use control panels and features such as improved weighing functionality with automatic centering and an electronic tilting mechanism. The easy to clean, smooth design, and choice of options make these customizable incubators appropriate for different use environments.
Jaundice Management
The American Academy of Pediatrics estimates that each year 60% of the approximately four million newborns in the U.S. become jaundiced. According to the Journal of the American Medical Association, neonatal jaundice is the single largest cause for hospital readmission of newborns in the U.S., and accounts for approximately 50% of readmissions. Because of the serious consequences of hyperbilirubinemia, the American Academy of Pediatrics recommends that all newborns be closely monitored for jaundice and that phototherapy is the standard of care for the treatment of hyperbilirubinemia. The guidelines further recommend that all nurseries have the necessary equipment to provide intensive phototherapy, and specifically recommend the use of the “blue” light as incorporated into our neoBLUE products.
Jaundice Management Products
neoBLUE Product Family.    This product line consists of our neoBLUE, neoBLUE Mini, neoBLUE Cozy, neoBLUE Compact and neoBLUE blanket devices, which utilize light emitting diodes (“LEDs”) to generate a high-intensity, narrow spectrum of blue light that is clinically proven to be most effective in the treatment of newborn jaundice. Our neoBLUE phototherapy devices emit significantly less ultraviolet light and heat than conventional phototherapy devices, reducing the risk of skin damage and dehydration for infants undergoing treatment. Because of the high intensity of these lights, the treatment time associated with phototherapy is reduced.
Medix MediLED Product Family.    A full-size, free-standing LED phototherapy system and a MediLED mini light to be used on top of an incubator or attached to the Medix radiant warmer. The MediLED incorporates an array of blue and white LEDs, while the mini system utilizes blue “super LEDs” that provide high intensity phototherapy.
neoBLUE Product Family.    This product line consists of our neoBLUE Overhead, neoBLUE Mini, neoBLUE Cozy, neoBLUE Compact and neoBLUE blanket devices, which utilize light emitting diodes (“LEDs”) to generate a high-intensity, narrow spectrum of blue light that is clinically proven to be most effective in the treatment of newborn jaundice. Our neoBLUE phototherapy devices emit significantly less ultraviolet light and heat than conventional phototherapy devices, reducing the risk of skin damage and dehydration for infants undergoing treatment. Because of the high intensity of these lights, the treatment time associated with phototherapy is reduced.
Newborn Brain Injury
For many years, newborn infants admitted to the NICU of a hospital have been routinely monitored for heart activity, temperature, respiration, oxygen saturation, and blood pressure. Recently it has also been considered important to monitor brain activity. A

cerebral function monitor, utilizing amplitude-integrated EEGs (“aEEGs”), is a device for monitoring background neurological activity. Our simplified aEEG devices, introduced over ten years ago, allow neonatologistsare designed to be simple for use by nurses and nurses to set-up and interpret basic neurological traces without neurology oversight.neonatologists.
Newborn Brain Injury Products
Our newborn brain injury products record and display parameters that the neonatologist uses to assess and monitor neurological status in the newborn. These devices continuously monitor and record brain activity, aiding in the detection and treatment of HIEhypoxic-ischemic encephalopathy ("HIE"), and seizures. The devices also monitor the effects of drugs and other therapies on brain activity and improve the accuracy of newborn neurological assessments. They are used with electrodes attached to the head of the newborn to acquire an EEG signal that is then filtered, compressed, and displayed graphically on the device or as a hardcopy printout. The monitors have touch screens for easy navigation and onscreen keyboards for data entry at the bedside.

Olympic Brainz Monitor.    The Olympic Brainz Monitor is our latest generation Cerebral Function Monitor. The device can be used in single-channel, two-channel or three-channel modes to continuously monitor and record brain activity.
Olympic Brainz Monitor.    The Olympic Brainz Monitor is our latest generation Cerebral Function Monitor. The device can be used in single-channel, two-channel or three-channel modes to continuously monitor and record brain activity.
VisionEye Imaging
Our RetCam devices incorporate a camera combined with proprietary imaging software that are used to diagnose and monitor a range of ophthalmic maladies in premature infants. RetCam is the market leaderspecializes in NICU ophthalmic imaging used in the detection of retinopathy of prematurity (ROP) and Retinoblastoma (RB) in newborns. ROP and RB are diseases of the retina that must be detected very early after birth and treated immediately, so the RetCam diagnostic camera is a fundamental tool in preventing vision loss and total blindness in infants.

Eye Imaging Products
RetCam images assist physicians in the evaluation of pediatric ocular disease, which have preserved the vision in thousands of infants. Each of the RetCam systems deliver objective and interpretable detail, allow image comparison over time, enable remote consultations, and provide reliable and defensible medico-legal documentation.
RetCam 3. Full-featured imaging system with a range of interchangeable lenses, Fluorescein Angiography module option.
RetCam Shuttle. Laptop-based system with a smaller cart and dual wheel casters for improved transportability.
RetCam Portable. Laptop-based version in a case for maximum portability.
Essentials
The Newborn Care Essentials products include such items as: Biliband®Biliband eye protectors, GumDrop® pacifiers, MiniMuffs®MiniMuffs noise attenuators, NeatNick®NeatNick heal lancets, Olympic®Olympic Circumstraint, Olympic®Olympic Papoose Boards, Olympic®Olympic Smart Scales, OraSwab, Save the Gonads®Gonads x-ray protection devices and SugarPlum®SugarPlum glucose lancets.

Live Video Streaming
NICVIEW
TheLive video streaming solution NICVIEW offers parents and families secured access to a live video stream of their baby. For hospitals, the system offers a step into family centered care.

Live Video Steaming Products
OtometricsNICVIEW and NICVIEW 2 are user-friendly, web-based video systems for real-time streaming on any online device via a standard downloadable app. Password-protected access ensures parents can view only their own child, with end-to-end encryption and SSL authentication. The video stream can be turned on/off and repositioned at will, so that NICU staff remain in control of the care process at all times.
OtometricsHearing & Balance
Our Hearing & Balance product portfolio provides hearing diagnostic, hearing aid fitting and balance instrumentation and software solutions to hearing and balance care professionals worldwide. For more than 50 years, Otometrics has been helpingwe have helped hearing and balance care professionals succeed in improving the quality of life for their clients and patients by delivering expert knowledge, reliable solutions and services and trusted partnerships.
Otometrics develops, manufactures We will continue this tradition and marketslegacy as we develop, manufacture and market computer-based audiological, otoneurologic and vestibular instrumentation in more than 80 countries. The Otometricsthe future.
Our solutions portfolio covers key application areas within hearing assessment, hearing screening, hearing instrument fitting and balance assessment. Many of the Otometricsour hearing and balance care solutions are industry-firsts and de-facto standardshave set precedent within the hearing care industry and are used by thousands of clinicians around the world.

As an independent provider of hearing care diagnostic solutions, Otometrics workswe work closely with leading hearing aid manufacturers to develop new solutions within hearing assessment and hearing aid fitting.

Hearing Assessment
From otoacoustic emissions (OAE) and immittance screening to advanced audiological testing Otometrics offersand 3D digital ear scanning, we offer a wide range of flexible devices and PC-based solutions that are designed to screen, test and assess patients of all ages. OtometricsOur hearing assessment solutions offer a range of functionality to support basic audiometric testing to advanced tinnitus and pediatric hearing assessment. HearingOur hearing care solutions by Otometrics help streamline the hearing screening and assessment process making it easier and convenient for the professional and the patient. OtometricsWe also manufacturersmanufacturer and marketsmarket a broad line of supplies and disposable products and accessories for hearing assessment.

Hearing Instrument Fitting and Verification
Otometrics'
Hearing fitting solutions help professionals manage the entire hearing aid fitting process - from fitting and verifying the hearing aid to patient counseling and follow up. Used by thousands of hearing aid dispensers, audiologists and

clinicians around the world, Otometricsour fitting solutions support otoscopy, audiometry, hearing aid testing and programming, fitting and verification with wireless design and binaural fitting capability. OtometricsOur fitting solutions are PC-based Noah-compatible and supported by integrated audiometric software that helps to streamline the fitting process for greater efficiency and patient satisfaction. OtometricsWe also manufacturers and marketsmarket a broad line of supplies and disposable products and accessories for hearing instrument fitting and verification.
3D Digital Ear Scanning
Hearing assessment solutions include the breakthrough 3D digital ear scanning solutions Otoscan® that gives hearing care professionals innovative ways to attract and convert more clients while delivering customized hearing care in an efficient way. Otoscan enables hearing care professionals to make digital impressions for custom in-the-ear pieces such as earmolds and hearing aids. The scanner solution applies breakthrough technology to transform images of the ear into 3D digital files that are uploaded to the cloud service, Otocloud, for immediate use in production of custom products, delivering significant efficiency and quality gains in the production of hearing aids. Otocloud is a web-based portal supported by a dedicated Microsoft Azure server domain.
Audiometric Sound Rooms
Otometrics manufacturersWe manufacture and marketsmarket a wide range of sound room solutions specifically designed for audiometric testing. OtometricsHearing & Balance Genie sound rooms are built to deliver a quality audiometry testing environment while providing efficiency for staff and comfort for patients. Certified staff help in the planning, choice and installation of each sound room so it becomes an integrated part of the clinic, equipment and workflow. OtometricsHearing & Balance Genie sound rooms deliver unique features such as the Cam-Lock assembly system, high performance/low profile floor, window in the door, and excellent attenuation and acoustic capabilities to ensure acoustic performance, efficient workflow and maximum testing comfort.
Balance Assessment
Professionals who evaluate patients with balance disorders use Otometrics'our vestibular diagnostic and ENG/VNG (elecrtonystagmography/(electronystagmography/videonystamography) systems and services. These solutions are used by audiologists, otolaryngologists, otologists and neurologists for identifying auditory and vestibular abnormalities. OtometricsOur balance care solutions are compact and include the world's first portable, gold standard video head impulse test (“vHIT”) and offer modular functionality to support vHIT, video frenzel, postional,positional, oculomotor and SHIMP (suppression head impulse) testing. OtometricsWe also manufacturersmanufacture and marketsmarket a broad line of supplies, disposable face cushions, and accessories for balance assessment.


Segment and Geographic Information
We determine our reportable segments by first identifying our operating segments, and then by assessing whether any components of these segments constitute a business for which discrete financial information is available and where segment management regularly reviews the operating results of that component. Historically, our operating segments were based on three strategic business units. In January 2019, we announced the transition of our operating structure from three strategic business units to a single, unified company with globally-led operational teams in Sales and Marketing, Manufacturing, Research and Development, Quality, and General and Administrative functions.
Following the reorganization, we operate inas one operating segment and one reportable segment, which we have presented as the aggregation of our neurology, newborn care, and otometrics product families. Within this reportable segment we are organized on the basis of theprovides healthcare products, and services we provide which are usedfocused on the diagnosis and treatment of central nervous and sensory system disorders for patients of all ages. Financial information is reviewed on a consolidated basis for purposes of making operating decisions and assessing financial performance. Consolidated financial information is accompanied by disaggregated information about revenues by end market and geographic region. We do not assess the screening, detection, treatment, monitoring and tracking of common medical ailments in newborn care, hearing impairment, neurological dysfunction, epilepsy, and sleep disorders.
Our end-user customer base includes hospitals, clinics, laboratories, physicians, nurses, audiologists, and governmental agencies. Mostperformance of our international sales areend markets or geographic regions on measures of profit or loss, or asset-based metrics. We have disclosed the revenues for each of our end markets and geographic regions to distributors, who in turn resellprovide the reader of the financial statements transparency into our products to end users or sub-distributors.operations.
Information regarding our salesrevenues and long-lived assets in the U.S. and in countries outside the U.S. is contained in Note 19—20—Segment, Customer and Geographic Information of our Consolidated Financial Statements included in this report and is incorporated in this section by this reference.
Revenue by Product FamilyMarket and Product Category
For the years ended December 31, 2017, 20162019, 2018 and 2015,2017, revenue from our product familiesmarkets as a percent of total revenue was approximately as follows:

Year Ended December 31,Year Ended December 31,
2017 2016 20152019 2018 2017
Neurology48% 62% 63%
Neuro58% 53% 49%
Newborn Care29% 38% 37%22% 25% 31%
Otometrics23% % %
Hearing & Balance20% 22% 20%
Total100% 100% 100%100% 100% 100%
We also look at revenue as either being generated from sales of Devices and Systems, which are generally non-recurring, or related Supplies and Services, which are generally recurring. The products that are attributable to these categories are described above. Revenue from Devices and Systems, Supplies and Services as a percent of total revenue for the years ending December 31, 2017, 20162019, 2018 and 20152017 is as follows:
Year Ended December 31,Year Ended December 31,
2017 2016 20152019 2018 2017
Devices and Systems67% 63% 64%74% 72% 67%
Supplies26% 28% 29%22% 22% 26%
Services7% 9% 7%4% 6% 7%
Total100% 100% 100%100% 100% 100%
In 2017, 20162019, 2018 and 2015,2017, no single end-user customer comprised more than 10% of our revenue.
Backlog
ForIn general, we do not manufacture our products against a backlog of orders and do not consider backlog to be a significant indicator of the years ended December 31, 2017, 2016level of future sales activity. Production and 2015,inventory levels are based on the level of incoming orders as well as projections of future demand. Therefore, we believe that backlog was approximately as follows (in thousands):
 Year Ended December 31,
 2017 2016 2015
Backlog$13,849
 $10,555
 $9,359
information is not meaningful to understanding our overall business and should not be considered a reliable indicator of our ability to achieve any particular level of revenue or financial performance.
Marketing and Sales
Marketing
Our marketing strategy differentiates our productsstrategies differ by their levelproduct market, incorporating market dynamics, trends and competition in the positioning, promotion and pricing of each product. The value proposition that we communicate is focused on the quality, clinical performance, and customer benefit. We educateinvest in educating our customers worldwide about our products through trade conferences and direct presentations to healthcare professionals.
Domestic Direct and Distributor Sales
We sell our products in North America primarily through a direct sales organization. We believe this direct sales organization allows us to maintain a higher level of customer service and satisfaction than would otherwise be possible by other distribution methods. We also sell certain products under private label and distribution arrangements.
For the years ended December 31, 2017, 20162019, 2018 and 2015,2017, domestic revenue as a percent of total revenue was approximately as follows:
 Year Ended December 31,
 2017 2016 2015
Domestic revenue54.1% 65.6% 64.4%
 Year Ended December 31,
 2019 2018 2017
Domestic revenue59.0% 56.7% 54.1%
International Direct and Distributor Sales
We sell some of our products outside the U.S. through direct sales channels in Australia, Canada, China, Denmark, France, Germany, Italy, the Netherlands, New Zealand, the Nordics (Finland, Sweden, Norway), Spain, and the United Kingdom and parts of Latin America;Kingdom; we sell other products in those regions and into more than 100 other countries through a distributor sales channel.
For the years ended December 31, 2017, 20162019, 2018 and 2015,2017, international revenue as a percent of total revenue was approximately as follows:

 Year Ended December 31,
 2017 2016 2015
International revenue45.9% 34.4% 35.6%
 Year Ended December 31,
 2019 2018 2017
International revenue41.0% 43.3% 45.9%
We sell products to our distributors under substantially the same terms as sales through our direct sales channels. Terms of sales to international distributors are generally “ex works,” where title and risk of loss are assumed by the distributor at the shipping point. Distributors are generally given exclusive rights in their territories to purchase products from Natus and to resell to end users or sub-distributors.sub-distributors in their respective markets. Our distributors typically perform marketing, sales, and technical support functions in their respective markets. Each distributor may sell Natus products to their customer directly, via other distributors or resellers, or both. We actively train our distributors in product marketing, selling, and technical service techniques.
Seasonality in Revenue
We experience seasonality in our revenue. Demand for our products is historically higher in the second half of the year compared to the first. Our seasonality results from the purchasing habits of our hospital-based customers, whose purchases are often governed by calendar year budgets.
Group Purchasing Organizations
More than 90% of the hospitals in the U.S. are members of group purchasing organizations (“GPO”s), which negotiate volume purchase agreements for member hospitals, group practices, and other clinics.
For the years ended December 31, 2019, 2018 and 2017, 2016 and 2015,revenue from direct purchases byunder a GPO memberscontract as a percent of total revenue werewas approximately as follows:

 Year Ended December 31,
 2017 2016 2015
Direct purchases by GPO members14.5% 12.3% 9.3%
 Year Ended December 31,
 2019 2018 2017
Direct purchases by GPO members18.7% 13.3% 14.5%

Third-Party Reimbursement
In the U.S., healthcare providers generally rely on third-party payors, including private health insurance plans, federal Medicare, state Medicaid, and managed care organizations, to reimburse all or part of the cost of the procedures they perform. Third-party payors can affect the pricing or the relative attractiveness of our products by regulating the maximum amount of reimbursement these payors provide for services utilizing our products. In addition, our Peloton hearing screening service and GND services are dependent on third-party payors to reimburse us for services provided.
Customer Service and Support
We generally provide a one-year warranty on our medical device and system products. We also sell extended service agreements on our medical device and system products. Service, repair, and calibration services for our domestic customers are provided by Company-owned service centers and our field service specialists. Service for international customers is provided by a combination of Company-owned facilities and vendors on a contract basis.
Manufacturing
Other companies manufactureWe procure a significant portion of the components used in our products;products from other manufacturers; however, we perform final assembly, testing, and packaging of many of the devices ourselves to control quality and manufacturing efficiency.efficiency and we are the manufacture of record. We also use contract vendorsmanufacturers to manufacture some of our disposable supply and medical device products. We perform regular quality assessments of these vendors,contract manufacturers, which include on-site quality audits.
We purchase materials and components from qualified suppliers that are subject to our quality specifications and inspections. We conduct quality audits of our key suppliers, several of which are experienced in the supply of components to manufacturers of finished medical devices, or supplies for use with medical devices. Most of our purchased components are available from more than one supplier.
Our manufacturing, service, and repair facilities are subject to periodic inspection by local and foreign regulatory authorities. Our quality assurance system is subject to regulation by the U.S. Food and Drug Administration (“FDA”) and other government agencies. We are required to conduct our product design, testing, manufacturing, and control activities in conformance with the FDA’s quality system regulations and to maintain our documentation of these activities in a prescribed manner. In addition, our production facilities have received International Organization for Standardization (“ISO”) 13485 certification. ISO 13485 certification standards for quality operations have been developed to ensure that medical device companies meet the standards of quality on a worldwide basis. We have also received the EC Certificate pursuant to the European Union Medical Device Directive 93/42/EEC, which allows us to place a CE mark on our products.

Research and Development
We are committed to introducing new products and supporting current product offerings in our markets through a combination of internal as well as external efforts that are consistent with our corporate strategy.
Internal product development capabilities.    We believe that product development capabilities arethe ability to develop innovative products is essential to provideproviding our customers with new product offerings. We plan to leverage our core technologies by introducing product line extensions as well as new product offerings.
Partnerships that complement our expertise.    We continue to seek strategic partners in order to develop products that may not otherwise be available to us. By taking advantage of our core competencies, we believe that we can bring acquired or distributed products to market in an efficient manner and leverage our distribution channels.
New opportunities through technology acquisition.    We continue to evaluate new, emerging, and complementary technologies in order to identify new product opportunities. With our knowledge of our current markets we believe that we can effectively develop acquired technologies into successful new products.
Our research and development expenses were $51.8 million or 10.3% of total revenue in 2017, $33.4 million or 8.8% of total revenue in 2016, and $30.4 million or 8.1% of total revenue in 2015.
Proprietary Rights
We protect our intellectual property through a combination of patent, copyright, trade secret, and trademark laws. We attempt to protect our intellectual property rights by filing patent applications for new features and products we develop. We enter into confidentiality or license agreements with our employees, consultants, and corporate partners, and seek to control access to our

intellectual property, distribution channels, documentation, and other proprietary information. However, we believe that these measures afford only limited protection.
The intellectual rights to some of the original patents for technology incorporated into our products are now in the public domain. However, we do not consider these patents, or any currently viable patent or related group of patents, to be of such importance that their expiration or termination would materially affect our business.
We capitalize the cost of purchased technology and intellectual property, as well as certain costs incurred in obtaining patent rights, and amortize these costs over the estimated economic lives of the related assets.
We have severalnumerous registered trademarks and service marks. Our marks are pending or registered trademarks in the United States and several foreign countries. We intend to file for additional trademarks to strengthen our trademark rights, but we cannot be certain that our trademark applications will result in registration or that our trademarks will be enforceable.
Competition
We sell our products in competitive and rapidly evolving markets. We face competition from other companies in all of our product lines. Our competitors range from small privately-held companies to multinational corporations and their product offerings vary in scope and breadth. We do not believe that any single competitor is dominant in any of our product lines.
We derive a significant portion of our revenue from the sale of disposable supplies that are used with our medical devices. In the U.S., we sell our supply products in a mature market and we expect that our products could face increasing competition, including competitors offering lower prices, which could have an adverse effect on our revenue and profit margins.
Integra LifeSciences continues to offer products and services that compete with the neurosurgery product lines we acquired in the Integra Asset Acquisition, and we expect significant competition from Integra LifeSciences as we seek to maintain and expand this business.
We believe the principal factors that will draw clinicians and other buyers to our products, include:
LevelThe clinical performance of our products including the level of specificity, sensitivity, and reliability of the product;
Time required to obtain results with the product, such as to test for or treat a clinical condition;
Relative ease of use of the product;
DepthOur level of expertise in these fields which produces the depth and breadth of the products features;
Quality of customer support for the product;
Frequency of product updates;
Extent of third-party reimbursement of the cost of the product or procedure;
Extent to which the products conform to standard of care guidelines; and
Price of the product.
We believe that our primary competitive strength relates to the clinical functionality and reliability of our products. Different competitors may have competitive advantages in one or more of the categories listed above and they may be able to devote greater resources to the development, promotion, and sale of their products.
Government Regulation
FDA’s Premarket Clearance and Approval Requirements

Unless an exemption applies, the medical devices we sell in the United States, must first receive one of the following types of FDA premarket review authorizations under the Food, Drug, and Cosmetics Act, as amended:
Clearance via Section 510(k); or
Premarket approval via Section 515 if the FDA has determined that the medical device in question poses a greater risk of injury.
The FDA’s 510(k) clearance process usually takes from three to six months, but can take longer. The process of obtaining premarket approval via Section 515 is much more costly, lengthy, and uncertain. Premarket approval generally takes from one to three years, but can take longer. We cannot be sure that the FDA will ever grant either 510(k) clearance or premarket approval for any product we propose to market in the United States.
The FDA decides whether a device must undergo either the 510(k) clearance or premarket approval process based upon statutory criteria. These criteria include the level of risk that the FDA perceives to be associated with the device and a determination

of whether the product is a type of device that is substantially equivalent to devices that are already legally marketed. The FDA places devices deemed to pose relatively less risk in either Class I or Class II, which requires the manufacturer to submit a premarket notification requesting 510(k) clearance, unless an exemption applies. The premarket notification under Section 510(k) must demonstrate that the proposed device is substantially equivalent in intended use and in safety and effectiveness to a previously cleared 510(k) device or a device that was in commercial distribution before May 28, 1976 for which the FDA has not yet called for the submission of premarket approval applications.
The FDA places devices deemed to pose the greatest risk, such as life-sustaining, life-supporting or implantable devices, or devices deemed to be not substantially equivalent to a predicate device, in its Class III classification. The FDA requires these devices to undergo the premarket approval process via Section 515 in which the manufacturer must prove the safety and effectiveness of the device. A premarket approval application must provide extensive pre-clinical and clinical trial data.
The FDA may require results of clinical trials in support of a 510(k) submission and generally requires clinical trial results for a premarket approval application. In order to conduct a clinical trial on a significant-risk device, the FDA requires manufacturers to apply for and obtain, in advance, an investigational-device exemption. The investigational-device exemption application must be supported by appropriate data, such as animal and laboratory testing results. If the FDA and the Institutional Review Boards at the clinical trial sites approve the investigational-device exemption application for a significant-risk device, the manufacturer may begin the clinical trial. An investigational-device exemption approval provides for a specified clinical protocol, including the number of patients and study sites. If the manufacturer deems the product a non-significant risk device, the product will be eligible for more abbreviated investigational-device exemption requirements. If the Institutional Review Boards at the clinical trial sites concur with the non-significant risk determination, the manufacturer may begin the clinical trial.
Most of our products have been cleared by the FDA as Class II devices.
FDA Regulation
Numerous FDA regulatory requirements apply to our products. These requirements include:
FDA quality system regulations which require manufacturers to create, implement, and follow design, testing, control, documentation, and other quality assurance procedures;
Medical device reporting regulations, which require that manufacturers report to the FDA certain types of adverse and other events involving their products; and
FDA general prohibitions against promoting products for unapproved uses.
Class II and III devices may also be subject to special controls applied to them, such as performance standards, post-market surveillance, patient registries, and FDA guidelines that may not apply to Class I devices. We believe we are in compliance with applicable FDA guidelines, but we could be required to change our compliance activities or be subject to other special controls if the FDA changes existing regulations or adopts new requirements.
We are subject to inspection and market surveillance by the FDA to determine compliance with regulatory requirements. If the FDA finds that we have failed to adequately comply, the FDA can institute a wide variety of enforcement actions, including:
Issuance of a Form 483 citation;
Fines, injunctions, and civil penalties;
Recall or seizure of our products;
Issuance of public notices or warnings;
Imposition of operating restrictions, partial suspension, or total shutdown of production;

Refusal of our requests for 510(k) clearance or pre-market approval of new products;
Withdrawal of 510(k) clearance or pre-market approval already granted; or
Criminal prosecution.
The FDA also has the authority to require us to repair or replace any misbranded or adulterated medical device manufactured or distributed by us.
Other Regulations
We also must comply with numerous additional federal, state, and local laws relating to matters such as safe working conditions, manufacturing practices, environmental protection, biohazards, fire hazard control, and hazardous substance disposal. We believe we are currently in compliance with such regulations.

Countries outside of the U.S. regulate medical devices in a manner similar to that of the FDA. Our manufacturing facilities are subject to audit and have been certified to be ISO 13485:2003,2016, Medical Device Directive 93/42/EEC, and CMDCASMDSAP compliant, which allows us to sell our products in Europe, Canada, Europe, and other territories around the world. All of our manufacturing facilities are subject to inspection by our notified bodies or other competent authorities, and in some cases without advance notice. We plan to seek approval to sell our products in additional countries, while maintaining our current approvals. The time and cost of obtaining new, and maintaining existing, market authorizations from countries outside of North America, and the requirements for licensing products in these countries may differ significantly from FDA requirements.
In 2017, the European Union ("EU") adopted the EU Medical Device Regulation (Council Regulations 2017/745) which imposes stricter requirements for the marketing and sale of medical devices, including new quality system and post-market surveillance requirements. The regulation has a three-year implementation period ending in May 2020 and will replace the existing directives on medical devices in the EU. After May 2020, medical devices marketed in the EU will require certification according to these new requirements, except that devices with valid CE certificates, issued pursuant to the Medical Device Directive before May 2020, may be placed on the market until 2024. Complying with this new regulation requires us to incur significant costs on product design history file remediation and transition. Failure to meet the requirements of the regulation could adversely impact our business in the European Union and other countries that utilize or rely on European Union requirements for medical device registrations.
Employees
On December 31, 2017,2019, we had approximately 1,7261,484 full time employees worldwide. In Argentina, some of our productionOur employees in Germany are represented by labor unions and our employees in Germany have established a works council.Works Council. We have not experienced any work stoppages, and we consider our relations with our employees to be good.
Executives
The following table lists our executive officers and their ages as of March 1, 2018:2, 2020:
Name Age Position(s)
James B. HawkinsJonathan A. Kennedy 6249

 President and Chief Executive Officer
Jonathan KennedyB. Drew Davies 4754

 Executive Vice President and Chief Financial Officer
D. Christopher Chung, M.D.


 5456
Vice President Medical Affairs, Quality & Regulatory

Carsten Buhl44
President & CEO, Otometrics SBU
Leslie McDonnell45

 Vice President of Quality, Regulatory Affairs and General Manager, Newborn CareChief Medical Officer
Austin F. Noll, III


 5453

 
Executive Vice President and General Manager, Neurology SBUChief Commercial Officer


James B. HawkinsJonathan A. Kennedy has served as Chief Executive Officer, and as a member of the Board of Directors since joining Natus in April 2004, and as President from April 2004 through January 2011 and from June 2013 to present. In addition, he currently serves on the Board of Directors for Eldorado Resorts, Inc. and OSI Systems.  Prior to joining Natus,July 2018. Mr. Hawkins was President, Chief Executive Officer and a Director of Invivo Corporation, a developer and manufacturer of multi-parameter vital sign monitoring equipment, and its predecessor, from August 1985 through January 2004. Mr. Hawkins also served as Secretary of Invivo from July 1986 until January 2004. He earned his undergraduate degree in Business Commerce from Santa Clara University and holds a Masters of Business Administration degree from San Francisco State University.
Jonathan A. Kennedy joined Natus as Senior Vice President and Chief Financial Officer in April 2013 and was appointed Executive Vice President and Chief Financial Officer in September 2016. In addition, he currently serves on the Board of Directors for IRadimed Corporation. Before joining Natus, Mr. Kennedy was Senior Vice President and Chief Financial Officer of Intersil Corporation, a global semiconductor manufacturer, since 2009. Prior to that, he was Intersil’s Corporate Controller since 2005 and Director of Finance since 2004. Before joining Intersil, Mr. Kennedy held management roles in Finance and Information Technology with Alcon Inc. and Harris Corporation. He holds a Bachelor of Science degree in Business Administration and a Master of Science degree in Accounting from the University of Central Florida.
B. Drew Davies joined Natus as Executive Vice President and Chief Financial Officer in October 2018. Mr. Kennedy isDavies most recently served as Executive Vice President and Chief Financial Officer of Extreme Networks since June 2016. Before joining Natus, Mr. Davies served as Vice President and Corporate Controller at Marvell Semiconductor Inc. from December 2015 until May 2016. Prior to that, Mr. Davies was the Senior Vice President, Corporate Controller at Spansion, Inc. from August 2012 to December 2015. Prior to Spansion, Mr. Davies was Corporate Controller at Intersil Corporation from April 2009 to August 2012, and served as Operations Controller from March 2008 to April 2009. Mr. Davies also served as Chief Financial Officer of Nanoconduction, Inc. from March 2007 to March 2008, Director of Finance and Administration for STATSChipPac from September

1999 to March 2007, held various finance roles at Micron Custom Manufacturing Services from November 1992 to September 1999. Mr. Davies holds a Certified Public Accountant.Master of Business Administration degree from Santa Clara University and a Bachelor of Science, Business Accounting degree from the University of Idaho.
D. Christopher Chung, M.D.,joined Natus in 2000 as the Medical Director. He has also served as ourVice President of R&D and most recently since 2011 as Vice President Medical Affairs, Quality and Regulatory since June 2003, and has served as our Vice President Medical Affairs since February 2003. Dr. Chung also served as our Medical Director from October 2000 to February 2003.Regulatory. From 2000 to 2007, Dr. Chung also served as a Pediatric Hospitalist at the California Pacific Medical Center in San Francisco.Francisco providing patient care in the Neonatal Intensive Care Unit and Newborn Nursery. From 1997 to 2000, Dr. Chung trained as a pediatric resident at Boston Children’s Hospital and Harvard Medical School. From 1986 to 1993, Dr. Chung worked as an EngineerR&D engineer at Nellcor Incorporated, a medical device company.company that pioneered the development of pulse oximetry. Dr. Chung holds a Bachelor of Arts degree in Computer Mathematics from the University of Pennsylvania and a Doctor of Medicine degree from the Medical College of Pennsylvania-Hahnemann University School of Medicine. He is board certified in Pediatrics and is a Fellow of the American Academy of Pediatrics.
Carsten Buhl joined Natus in February 2018 and is acting as President for Natus' strategic business unit Otometrics. Mr. Buhl Dr. Chung has more than 15 years experiencealso been awarded nine U.S. Patents in the medical device industry and has a proven track record within commercial execution and global leadership positions. Prior to joining natus, Mr. Buhl acted as Executive Vice President and Chief Commercial Officer at Ambu, a successful medtech company within the fields of anesthesia, patient monitoring and emergency care. Previously, Mr. Buhl held various management positions at GN Hearing, which is one of the world's largest providers of hearing instruments, most recently as Senior Vice President of Europe and Strategic Accounts. Mr. Buhl holds a Master of Law from Copenhagen University and an E*MBA from SIMI/CBS Copenhagen supplemented by graduate diplomas in Finance and Accounting from CBS Copenhagen.field.

Leslie McDonnell joined Natus in February 2018 as the Vice President and General Manger, Newborn Care. Ms. McDonnell is a healthcare business executive with 17 years of global experience in medical devices and supplies. Prior to joining Natus, Ms. McDonnell served as Global Business Vice-President for the Critical & Chronic Care Solutions of 3M Healthcare. Prior to joining 3M Healthcare, Ms. McDonnell held leadership positions at Medtronic over a 12 year period in corporate M&A, business development, new therapy and product development, and marketing and business management in the Neuromodulation and Cardiac Rhythm Disease Management business. Ms. McDonnell holds a Bachelor of Science in Business and Masters of Busines Administration as an International Business Fellow from the Carlson School of Management at the University of Minnesota. In 2009, Ms. Donnell was selected as a 40 Under Forty honoree for business and community leadership by the Minneapolis/St. Paul Business Journal.
Austin F. Noll, III joined Natus in August 2012 as the Vice President and General Manager, Neurology.Neuro. Prior to joining Natus, Mr. Noll served as the President and CEO of Simpirica Spine, a California-based start-up company that developed and commercialized a novel device for spinal stabilization. Prior to joining Simpirica Spine, Mr. Noll served as the President and CEO of NeoGuide Systems, a medical robotics company acquired by Intuitive Surgical. Prior to joining NeoGuide Systems, Mr. Noll held numerous management positions at Medtronic over a 13-year period, where he served as the Vice President and General Manager of the Powered Surgical Solutions and the Neurosurgery businesses. Before Medtronic, he held sales positions at C.R. Bard and Baxter Healthcare. He received a bachelor’sBachelor of Science degree in business administrationBusiness Administration from Miami University and a master’sMaster of business administrationBusiness Administration degree from the University of Michigan.
Other Information
Natus was incorporated in California in May 1987 and reincorporated in Delaware in August 2000.
We maintain corporate offices at 6701 Koll Center Parkway Suite 120, Pleasanton, California 94566. Our telephone number is (925) 223-6700. We maintain a corporate website at www.natus.com. References to our website address do not constitute incorporation by reference of the information contained on the website, and the information contained on the website is not part of this document.
We make available, free of charge on our corporate website, copies of our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, Proxy Statements, and all amendments to these reports, as soon as reasonably practicable after such material is electronically filed with or furnished to the Securities and Exchange Commission pursuant to Section 13(a) or 15(d) of the Securities Exchange Act. We also show detail about stock trading by corporate insiders by providing access to SEC Forms 3, 4 and 5. This information may also be obtained from the SEC’s on-line database, which is located at www.sec.gov. Our common stock is traded on the Nasdaq Stock Market under the symbol “BABY”“NTUS”.


Item 1A.    Risk Factors
We have completedRisks Related to Our Business and Industry
Our business results depend on our ability to successfully manage ongoing organizational change and business transformation and achieve cost savings and operating efficiency initiatives.
On January 15, 2019 Natus announced the implementation of a numbernew organizational structure, “One Natus,” designed to improve operational performance and make it a stronger, more profitable company. While the implementation is substantially complete, there can be no assurance that we will realize, in full or in part, the anticipated benefits of acquisitionsthis new structure. Our financial goals assume a level of increased productivity. If we are unable to deliver these expected improvements, or continue to invest in business growth, or if the volume and expectnature of change require additional resources, our business operations and financial results could be materially and adversely impacted. Our ability to complete additional acquisitionssuccessfully manage and execute these initiatives and realize expected savings and benefits in the future. There are numerous risks associated withamounts and at the times anticipated is important to our business success. Any failure to do so, which could result from our inability to successfully execute organizational change and business transformation plans, changes in global or regional economic conditions, competition, changes in the industries in which we compete, unanticipated costs or charges, loss of key personnel and other factors described herein, could have a material adverse effect on our businesses, financial condition and results of operations.
Our growth in prior years has depended substantially on the completion of acquisitions and we may not achieve the expected benefit of any of our acquisitions
Ourbe able to complete acquisitions of products, technology assets,the same nature or businesses may have a negative impact on our business if we fail to achieve the anticipated financial, strategic, and other benefits of acquisitions or investments, and our operating results may suffer because of this.
We expect to continue to pursue opportunities to acquire other businessesrelative size in the future. future to support a similar level of growth.
The acquisitions that we have completed may not resulthave contributed to our growth in improved operating results for us, orprior years. We have expended considerable effort in our achieving a financial condition superiorseeking to that which we would have achieved had we not completed them. Our results of operations may be adversely impacted by costs associated with our acquisitions, including one-time charges associated with restructurings. Further, our acquisitions could fail to produce the benefits that we anticipate, or could have other adverse effects that we currently do not foresee. In addition, some of the assumptions that we have relied upon, such as achievement of operating synergies, may not be realized. In this event, one or more of the acquisitions could result in reduced earnings as compared to the earnings that would have been achieved by us if theidentify attractive acquisition had not occurred.
Previously we have assumed,candidates, and may in the future enter into, contingent obligations associated with earnout provisions in some of our acquisitions. We believe these provisions help usultimately, to negotiate mutually agreeable purchase terms between usacquisition terms.

The market for attractive acquisitions is competitive and the sellers. However, a disagreement between us and a seller about the terms of an earnout provision could result in our paying more for an acquisitionothers with different strategic objectives or greater financial resources than we intended.
Ifhave may be better positioned than we are required to seek additional external financing to support our need for cash to fund future acquisitions,acquire desirable targets. Further, we may not have accessbe able to financing onnegotiate acquisition terms with target companies that arewill allow us to achieve acceptable to us, or at all. Alternatively, we may feel compelled to access additional financing on terms that are dilutive to existing holders of our common stock or that include covenants that restrict our business, or both.

In January 2017 we completedfinancial returns from the acquisition of GN Otometrics, which is our largest acquisition to date in terms of purchase price and size of business acquired. Accordingly, the risks described above are potentially more material to us than would have otherwise been the case.transaction.
If we do not remediate a material weakness in our internal control over financial reporting, the accuracy and timeliness of our financial reporting may be adversely affectedaffected.
Under Section 404 of the Sarbanes-Oxley Act of 2002 and rules promulgated by the SEC, companies are required to conduct an annual comprehensive evaluation of their internal control over financial reporting. As part of this internal control over financial reporting; andFurther, each year our independent registered public accounting firm is required to attest to and report on the effectiveness of our internal control over financial reporting. Management’s assessmentManagement concluded that as of December 31, 2019, our internal control over financial reporting as of December 31, 2017, identified a control was not effective becauseeffective. Immaterial errors identified as part of the closing of our books for the fourth quarter 2019 indicated certain deficiencies existed in the Company’s internal control over financial reporting. Specifically, we did not performhave controls designed to identify and properly account for certain research and development activities related to an effective risk assessment relatingarrangement with a third party. Additionally, insufficient training provided to significant acquisitions,a new control operator and the design of one of our controls over payroll accounts contributed to an error in the period end accrual. The Company has concluded that these deficiencies could have resulted in a material misstatement of the consolidated financial statements that would not have been prevented or detected on a timely basis, and as asuch, these control deficiencies result we did not adequately design control activities over the accounting for the acquisition of Otometrics. The first fiscal year exemption for internal controls over financial reporting does not apply to controls over purchase price accounting, which constitutedin a material weakness in our internal control over financial reporting. A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of our annual or interim consolidated financial statements will not be prevented or detected on a timely basis. This material weakness is more fully described in Item 9A. Controls and Procedures-Management’s Report on Internal Control Over Financial Reporting.Reporting. The existence of this material weakness and of any other ineffective controls over our financial reporting could result in one or allmore of the following:
Revision of previously filed financial statements;
Failure to meet our reporting obligations;
Loss of investor confidence; and
Negative impact on the trading price of our common stock.
If we are not able to maintain effective internal control over financial reporting in the future, the accuracy and timeliness of our financial reporting may be adversely affected.
A material weakness is defined under the standards issued by the Public Company Accounting Oversight Board as a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of our financial statements will not be prevented or detected and corrected on a timely basis.
We reported a material weakness in our internal control over financial reporting for the year ended December 31, 2017 related to missing controls over a significant business combination, which we remediated in 2018. Separate from the material weakness identified for the year ended December 31, 2017, during the fourth quarter of 2018, in connection with a change in control owner, management identified an existing control that was not designed at a sufficient precision to adequately review our analysis of separate reporting units, which could have resulted in a material misstatement. Although we took steps to remediate both these issues in 2018 and believe both material weaknesses were remediated as of December 31, 2018, these measures may not be sufficient to avoid similar weaknesses or other deficiencies in the future.
During the fourth quarter of 2019, we identified errors as part of closing our books and concluded that certain deficiencies existed in the Company’s internal control over financial reporting. Specifically, we did not have controls designed to identify and properly account for certain research and development activities related to an arrangement with a third party. Additionally, insufficient training provided to a new control operator and the design of one of our controls over payroll accounts contributed to an error in the period end accrual. The Company has concluded that these deficiencies could have resulted in a material misstatement of the consolidated financial statements that would not have been prevented or detected on a timely basis, and as such, these control deficiencies resulted in a material weakness in our internal control over financial reporting. We plan to make substantive changes to enhance our design of controls intended to identify and assess contracts that include research and development and to aid in confirming the accuracy of the payroll accrual accounts. There can be no assurances that these remediation steps will be successful.
The Sarbanes-Oxley Act requires, among other things, that we assess the effectiveness of our internal control over financial reporting annually and disclosure controls and procedures quarterly. In particular, we must perform system and process evaluation and testing of our internal control over financial reporting to allow management to report on, and our independent registered public accounting firm to attest to, the effectiveness of our internal control over financial reporting, as required by Section 404 of the Sarbanes-Oxley Act. If other material weaknesses are identified in the future or we are not able to comply with the requirements of Section 404 in a timely manner, our reported financial results could be materially misstated or could be restated, we could receive an adverse opinion regarding our controls from our independent registered accounting firm and we could be subject to

investigations or sanctions by regulatory authorities, which would require additional financial and management resources, and the market price of our stock could decline.
Our operating results may decline if we do not succeed in developing, acquiring, and marketing additional products or improving our existing products.
We intend to develop additional products and technologies, including enhancements of existing products, for the screening, detection, treatment, monitoring and tracking of common medical ailments. Developing new products and improving our existing products to meet the needs of current and future customers requires significant investments in research and development. Healthcare products typically receive regulatory approval based on data obtained in controlled clinical trials, which can be time consuming and expensive. Unfavorable or inconsistent clinical data from existing or future clinical trials may adversely affect our ability to secure marketing authorization for certain products. Furthermore, all results, even positive ones, are subject to the interpretation of FDA and other regulatory agencies. If we fail to sell new products, update existing products, or timely react to changes in technology, our operating results may decline as our existing products reach the end of their commercial life cycles.
Adverse economic conditions in markets in which we operate may harm our businessbusiness.
Unfavorable changes in U.S. and international economic environments may adversely affect our business and financial results. Concerns over the economic stability, the level of U.S. national debt, currency fluctuations and volatility, the rate of growth of Japan, China, and other Asian economies, unemployment, the availability and cost of credit, inflation levels, trade relations, energy costs and geopolitical uncertainty have contributed to increased volatility and diminished expectations for the economy and the markets. During challenging economic times, and in tight credit markets, our customers may delay or reduce capital expenditures. This could result in reductions in sales of our products, longer sales cycles, difficulties in collection of accounts receivable, slower adoption of new technologies, and increased price competition, all of which could impact our results of operations and financial condition. In addition, we expect these factors will cause us to be more cautious in evaluating potential acquisition opportunities, which could hinder our ability to grow through acquisition while these conditions persist.
In addition, we are susceptible to risks related to the outbreak of a novel strain of coronavirus (“COVID-19”) in China and its spread to other countries. In particular, the continued spread of COVID-19 globally could adversely affect our operations, including our manufacturing and supply chain and sales and marketing. Parts of our direct and indirect supply chain are in China, and are accordingly subject to disruption or product contamination. Additionally, our results of operations could be adversely affected to the extent that COVID-19 or any other epidemic harms our business or the economy in general either in China or in any other region in which we do business. For example, our customers may delay, cancel or redirect planned capital expenditures in order to focus resources on COVID-19 or in response to economic disruption related to COVID-19. The extent to which COVID-19 affected our operations will depend on future developments, which are highly uncertain and cannot be predicted with confidence, including the duration of the outbreak, new information that may emerge concerning the severity of COVID-19 and the actions to contain COVID-19 or treat its impact, among others, and could have an adverse effect on our business and financial condition.
Further, the U.S. federal government has called for, or enacted, substantial changes to healthcare, trade, fiscal, and tax policies, which may include changes to existing trade agreements and may have a significant impact on our operations. For example, the current administration has initiated the imposition of tariffs on certain foreign products, including from China, that have resulted in and may result in future retaliatory tariffs on U.S. goods and products. We cannot predict the impact, if any, that these changes could have on our business. If economic conditions worsen or new legislation is passed related to the healthcare system, trade, fiscal or tax policies, customer demand may not materialize to levels we require to achieve our anticipated financial results, which could have a material adverse effect on our business, financial condition and results of operations.
Uncertain credit markets and concerns regarding the availability of credit could impact consumer and customer demand for our products, as well as our ability to manage normal commercial relationships with our customers, suppliers and creditors, including financial institutions. If the current situation continues to deteriorate or does not improve, our business could be negatively affected by factors such as reduced demand for our products resulting from a slow‑down or volatility in the general economy, supplier or customer disruptions and/or temporary interruptions in our ability to conduct day‑to‑day transactions through our financial intermediaries involving the payment to or collection of funds from our customers, vendors and suppliers.
The United Kingdom's withdrawal from the European Union may have a negative effect on global economic conditions, financial markets and our business and operations.
In 2016 voters in the United Kingdom approved "Brexit," calling for the United Kingdom to withdraw from the European Union and there is speculation that this exit could have adverse consequences for(often referred to as “Brexit”). The U.K. exited from the economies ofEuropean Union on January 31, 2020. Under the current withdrawal agreement between the United Kingdom and other European countries. We have a significant amount of sales in the European Union, and this business couldthe United Kingdom will be adversely affected by these developments.
In October 2015, we announcedsubject to a contracttransition period until December 31, 2020, during which European Union rules will continue to apply. The relationship between our Argentinian subsidiary, Medix I.C.S.A,the United Kingdom and the MinistryEuropean Union after the transition period has not been determined yet. As a result, the impact of HealthBrexit is not yet known and depends on any

agreements the United Kingdom may make to retain access to European Union or other markets after the transition period. The withdrawal could potentially disrupt the free movement of Venezuela undergoods, services and people between the U.K. and the European Union, undermine bilateral cooperation in key geographic areas and significantly disrupt trade between the U.K. and the European Union or other nations as the U.K. pursues independent trade relations. In addition, Brexit could lead to legal uncertainty and potentially divergent national laws and regulations as the U.K. determines which European Union laws to replace or replicate. Any of these events, along with any political, economic and regulatory changes that may occur, could cause political and economic uncertainty in Europe and internationally and harm our subsidiary would deliver productsbusiness and services, including third party products, overfinancial results. Natus has not identified any trends or potential changes to critical accounting estimates as a three year period pursuant to prepayments received from the Venezuelan Ministryresult of Health. Following the announcement ofBrexit at this contract, there have been elections in both Venezuela and Argentina leading to significant political changes in those countries. Further, Venezuela is experiencing a highly inflationary economy and recessionary economic conditions. These developments may impact the likelihood of the Venezuelan Ministry of Health’s following through with orders under the agreement. While Medix has received the first installment under this contract, the remainder of the contract will not be fulfilled until the outstanding consideration is received. If, for these or any other reasons, the Venezuelan Ministry of Health does not make the additional prepayments required to initiate deliveries under the Medix agreement,time, however, we will not receive any additional benefit from it.continue to assess the potential impact of Brexit on our business and operations, and on accounting and reporting considerations. The effects of Brexit could adversely affect our business, financial condition or future results.
Our operating results may suffer because of our exposure to foreign currency exchange rate fluctuationsfluctuations.
Substantially all of our sales contracts with our U.S. based customers provide for payment in U.S. dollars. With the exception of our Canadian operations, substantially all of the revenue and expenses of our foreign subsidiaries are denominated in the applicable foreign currency. Our exposure to the currency fluctuations is enhanced as a result of the Otometrics acquisition. To date we have executed only limited foreign currency contracts to hedge these currency risks. Our future revenue and expenses may be subject to volatility due to exchange rate fluctuations that could result in foreign exchange gains and losses associated with foreign currency transactions and the translation of assets and liabilities denominated in foreign currencies.
Substantially all our sales from our U.S. operations to our international distributors provide for payment in U.S. dollars. A strengthening of the U.S. dollar relative to other foreign currencies could increase the effective cost of our products to our

international distributors as their functional currency is typically not the U.S. dollar. This could have a potential adverse effect on our ability to increase or maintain average selling prices of our products to our foreign-based customers.
Healthcare reforms, changesThe interest rates on our revolving credit facility are priced using a spread over LIBOR.
LIBOR, the London interbank offered rate, is the basic rate of interest used in healthcare policies,lending between banks on the London interbank market and changesis widely used as a reference for setting the interest rate on loans globally. We typically use LIBOR as a reference rate in our term loans such that the interest due to third-party reimbursementsour creditors pursuant to a term loan extended to us is calculated using LIBOR. Most of our term loan agreements contain a stated minimum value for our products may affect demand for our productsLIBOR.
In March 2010Our credit facility permits interest on the U. S. government signed into lawoutstanding principal balance to be calculated based on LIBOR. On July 27, 2017, the Patient Protection and Affordable Care Act and the Health Care & Education Reconciliation Act (collectively, the “ACA”U.K. Financial Conduct Authority (the "FCA"). The ACA contains many provisions designed announced that it will no longer require banks to generate the revenues necessary to fund the coverage expansions and to reduce costs of Medicare and Medicaid, including imposing a 2.3% excise tax on domestic sales of many medical devices by manufacturers and importers. The Medical Device Excise Tax (“MDET”) went into effect on January 1, 2013 but was suspendedsubmit rates for the period January 1, 2016 to December 31, 2017 with the signingcalculation of The Consolidated Appropriations Act, 2016 (Pub.L. 114-113).
No action by Congress was taken before the moratorium was set to expire on December 31, 2017. Therefore, MDET was reinstated on January 1, 2018. On January 22, 2018 the U.S. government signed funding bill HR 195 to extend an additional two-year moratorium on the MDET. The moratorium was retroactive to January 1, 2018. Unless there is legislative action prior to 2020, the MDET will automatically reinstate in 2020.
Uncertainty surrounding the ACALIBOR after 2021, and the U.S. healthcare systemFederal Reserve and the Bank of England have begun publishing a Secured Overnight Funding Rate and a reformed Sterling Overnight Index Average, respectively, which are currently intended to serve as alternative reference rates to LIBOR. Considerable uncertainty exists around what will replace LIBOR and how it will be implemented. At this time, it is not possible to predict the effect of any such changes, any establishment of alternative reference rates or any other reforms to LIBOR that may impact the way our customers spend on medical devices, supplies, and servicesbe implemented in the future. If we failUnited Kingdom or elsewhere. Actions in the meantime, by the FCA, other regulators, or law enforcement agencies are expected to effectively reactinfluence the method by which LIBOR is calculated. At this time, it is not possible to predict the effect of any such changes or any other reforms to LIBOR that may be enacted in the U.K. or elsewhere. Uncertainty as to the implementation of healthcare reform, our business may be adversely affect.
We have initiated changes to our information systems that could disrupt our business and our financial results
We plan to continuously improve our information systems to support the form, functionality, and scale of our business. These types of transitions frequently prove disruptive to the underlying business of an enterprise and may cause us to incur higher costs than we anticipate. Failure to manage a smooth transition to the new systems and the ongoing operations and support of the new systems could materially harm our business operations.
For example, beginning in 2012 we implemented the rollout of a world-wide, single-platform enterprise resource planning (“ERP”) application including customer relationship management, product lifecycle management, demand management, consolidation and financial statement generation, and business intelligence, and in 2015 we completed the final implementation of the ERP. In 2017 we completed a portion of the implementation of the ERP application for our Otometrics operations. We may fail to gain the efficiencies the implementation is designed to produce within the anticipated timeframe. We will continue to incur additional costs associated with stabilization and ongoing development of the new platform. The ongoing development and stabilization could also be disruptive to our operations, including the ability to timely ship and track product orders to customers, project inventory requirements, manage our supply chain and otherwise adequately service our customers. As we integrate the Otometrics operations and implement the ERP to cover its operations, we will incur costs and face challenges that could disrupt our operations.
Future changes in technology or market conditions could result in adjustments to our recorded asset balance for intangible assets, including goodwill, resulting in additional charges that could significantly impact our operating results
Our balance sheet includes significant intangible assets, including goodwill and other acquired intangible assets. The determination of related estimated useful lives and whether these assets are impaired involves significant judgment. Our ability to accurately predict future cash flows related to these intangible assets might be hindered by events over which we have no control. Due to the highly competitive nature of the medical device industry, new technologies could impair the value of our intangible assets if they create market conditions thatsuch potential changes, alternative reference rates or other reforms may adversely affect the competitiveness of our products. Further, declines in our market capitalization may be an indicatorindebtedness that our intangible assets or goodwill carrying values exceed their fair values which could leadbear interest at a floating rate determined by reference to potential impairment charges that could impact our operating results. In the past we have recorded charges for goodwill impairment and impairments of our trade names.
We may not be able to preserve the value of our intellectual property because we may not be able to protect access to it or we may lose our intellectual property rights due to expiration of our licenses or patents
If we fail to protect our intellectual property rights or if our intellectual property rights do not adequately cover the technology we employ, other medical device companies could sell products with features similar to ours, and this could reduce demand for our products. We protect our intellectual property through a combination of patent, copyright, trade secret and trademark laws. Despite our efforts to protect our proprietary rights, others may attempt to copy or otherwise improperly obtain and use our products or technology. Policing unauthorized use of our technology is difficult and expensive, and we cannot be certain that the steps we have taken will prevent misappropriation. Our means of protecting our proprietary rights may be inadequate. Enforcing our intellectual property rights could be costly and time consuming and may divert our management’s attention and resources. Failing to enforce our intellectual property rights could also result in the loss of those rights.

If we are not able to maintain effective internal control over financial reporting in the future, the accuracy and timeliness of our financial reporting may be adversely affected.
The Sarbanes-Oxley Act requires, among other things, that we assess the effectiveness of our internal control over financial reporting annually and disclosure controls and procedures quarterly. In particular, we must perform system and process evaluation and testing of our internal control over financial reporting to allow management to report on, and our independent registered public accounting firm to attest to, the effectiveness of our internal control over financial reporting, as required by Section 404 of the Sarbanes-Oxley Act. If we are not able to maintain effective internal control over financial reporting and otherwise comply with the requirements of Section 404 in a timely manner, our reported financial results could be materially misstated or could be restated, we could receive an adverse opinion regarding our controls from our accounting firm and we could be subject to investigations or sanctions by regulatory authorities, which would require additional financial and management resources, and the market price of our stock could decline.
If health care providers are not adequately reimbursed for procedures conducted with our devices or supplies, or if reimbursement policies change adversely, we may not be successful marketing and selling our products or technologies
Clinicians, hospitals, and government agencies are unlikely to purchase our products if they are not adequately reimbursed for the procedures conducted with our devices or supplies. Unless a sufficient amount of conclusive, peer-reviewed clinical data about our products has been published, third-party payors, including insurance companies and government agencies, may refuse to provide reimbursement. Furthermore, even if reimbursement is provided, it may not be adequate to fully compensate the clinicians or hospitals. Some third-party payors may impose restrictions on the procedures for which they will provide reimbursement. If health care providers cannot obtain sufficient reimbursement from third-party payors for our products or the screenings conducted with our products, we may not achieve significant market acceptance of our products. Acceptance of our products in international markets will depend upon the availability of adequate reimbursement or funding within prevailing healthcare payment systems. Reimbursement, funding, and healthcare payment systems vary significantly by country. We may not obtain approvals for reimbursement in a timely manner or at all.
Adverse changes in reimbursement policies in general could harm our business. We are unable to predict changes in the reimbursement methods used by third-party health care payors, particularly those in countries and regions outside the U.S. For example, some payors are moving toward a managed care system in which providers contract to provide comprehensive health care for a fixed cost per person. In a managed care system, the cost of our products may not be incorporated into the overall payment for patient care or there may not be adequate reimbursement for our products separate from reimbursement for other procedures.
Our Peloton hearing screening service and our GND EEG service are dependent on third-party payors to reimburse us for services provided to patients. We have encountered challenges in obtaining reimbursement from third parties and are dedicating resources to the education of third-party payors to the benefits of these services. Our inability to obtain reimbursement for these services, and any adverse changes in reimbursement policies or amounts for either of these services, or other products or services that we provide, could harm our business.
Our business would be harmed if the FDA determines that we have failed to comply with applicable regulations governing the manufacture of our products and/or we do not pass an inspection
We and our suppliers are required to demonstrate and maintain compliance with the FDA’s Quality System Regulation. The Quality System Regulation sets forth the FDA’s requirements for good manufacturing practices of medical devices and includes requirements for, among other things, the design, testing, production processes, controls, quality assurance, labeling, packaging, storage and shipping of such products. In addition, we and our suppliers must engage in extensive recordkeeping and reporting and must make available our manufacturing facility and records for periodic unscheduled inspections by federal, state and foreign agencies, including the FDA. We cannot assure you that we and our suppliers are or will continue to be in full compliance with the Quality System Regulation, and that we will not encounter any manufacturing difficulties.
In 2014 and 2016 we received formal communications from the FDA regarding deficiencies in our manufacturing processes in our Seattle facility. As a result, we imposed ship-holds on certain of our products produced there and have discontinued certain other products produced in that facility. We are dedicating substantial resources to the resolution of the conditions identified by the FDA. These actions had an adverse effect on our results of operations in 2016 and 2017.
Our inability to address issues that have been raised by the FDA, or failure of us or our third party suppliers and manufacturers to comply with applicable regulations could result in sanctions being imposed on us, including, among other things, fines, injunctions, civil penalties, failure of regulatory authorities to grant marketing approval of our products, delays, suspension or withdrawal of approvals, seizures or recalls of products and manufacturing restrictions, any of which could harm our business.LIBOR.
If we fail in our efforts to educate clinicians, government agency personnel, and third-party payors about the effectiveness of our products, we may not achieve future sales growth

growth.
It is critical to the success of our sales efforts that we educate a sufficient number of clinicians, hospital administrators, and government agencies about our products and the costs and benefits of their use. The commercial success of our products depends upon clinician, government agency, and other third-party payerpayor confidence in the economic and clinical benefits of our products as well as their comfort with the efficacy, reliability, sensitivity and specificity of our products. We believe that clinicians will not use our products unless they determine, based on published peer-reviewed journal articles and experience, that our products provide an accurate and cost-effective alternative to other means of testing or treatment. Our customers may choose to use competitive products, which may be less expensive or may provide faster results than our devices. Clinicians are traditionally slow to adopt new products, testing practices and clinical treatments, partly because of perceived liability risks and the uncertainty of third-party reimbursement. If clinicians, government agencies and hospital administrators do not adopt our products, we may not maintain profitability. Factors that may adversely affect the medical community’s acceptance of our products include:
Publication of clinical study results that demonstrate a lack of efficacy or cost-effectiveness of our products;
Changing governmental and physician group guidelines;
Actual or perceived performance, quality, price, and total cost of ownership deficiencies of our products relative to other competitive products;
Our ability to maintain and enhance our existing relationships and to form new relationships with leading physicians, physician organizations, hospitals, state laboratory personnel, and third-party payers;payors;

Changes in federal, state and third-party payerpayor reimbursement policies for our products; and
Repeal of laws requiring universal newborn hearing screening and metabolic screening.
Sales throughto members under group purchasing organizationsagreements and sales to high volume purchasers may reduce our average selling prices, which could reduce our operating marginsmargins.
We have entered and expect in the future to enter into agreements with customers who purchase a high volume of our products. Our agreements with these customers may contain discounts from our normal selling prices and other special pricing considerations, which could cause our operating margins to decline. In addition, we have entered into agreements to sell our products to members of GPOs, which negotiate volume purchase prices for medical devices and supplies for member hospitals, group practices and other clinics. While we make sales directly to GPO members, the GPO members receive volume discounts from our normal selling price and may receive other special pricing considerations from us. Sales to members of all GPOs accounted for approximately 14.5%18.7%, 12.3%13.3% and 9.3%14.5% of our total revenue during 2017, 20162019, 2018 and 2015,2017, respectively. Certain other existing customers may be members of GPOs with which we do not have agreements. Our sales efforts through GPOs may conflict with our direct sales efforts to our existing customers. If we enter into agreements with new GPOs and some of our existing customers begin purchasing our products through those GPOs, our operating margins could decline.
Consolidation in the healthcare industry could have an adverse effect on our revenues and results of operationsoperations.
Many healthcare industry companies, includeincluding our customers and competitors, are consolidating to create new companies with greater market power. As the healthcare industry consolidates, competition to provide goods and services to our customers could become more intense. Our customers may try to use their market power to negotiate price concessions and our competitors may utilize their size and broad product lines to offer cheaper alternatives to our products. If we are forced to reduce our prices because of consolidation in the healthcare industry, our revenues would decrease and our consolidated earnings, financial condition, or cash flow would suffer.
Demand for some of our products depends on the capital spending policies of our customers, and changes in these policies could harm our businessbusiness.
A majority of customers for our products are hospitals, physician offices, and clinics. Many factors, including public policy spending provisions, available resources, and economic cycles have a significant effect on the capital spending policies of these entities and therefore the amount that they can spend on our equipment products. If budget resources limit the capital spending of our customers, they will be unlikely to either purchase any new equipment from us or upgrade to any of our newer equipment products. Lack of liquidity in credit markets and uncertainty about future economic conditions can have an adverse effect on the spending patterns of our customers. These factors can have a significant adverse effect on the demand for our products.
Our markets are very competitive and in the United States we sell certain of our products in a mature marketmarket.
We face competition from other companies in all of our product lines. Our competitors range from small privately held companies to multinational corporations and their product offerings vary in scope and breadth. We do not believe that any single competitor is dominant in any of our product lines.
The markets for certain of our products in the U.S.,United States, including the newborn hearing screening and EEG monitoring markets, are mature and we are unlikely to see significant growth for such products in the U.S.United States. The market for newborn care products is

affected by birthrates, and a declining U.S. birthrate has adversely affected our operating results in recent periods. In the U.S.United States we derive a significant portion of our revenue from the sale of disposable supplies that are used with our hearing screening devices.supplies. Our hearing disposable supply products could face increasing competition, including competitors offering lower prices, which could have an adverse effect on our revenue and margins.
Our competitors may have certain competitive advantages, which include the ability to devote greater resources to the development, promotion, and sale of their products. Consequently, we may need to increase our efforts, and related expenses for research and development, marketing, and selling to maintain or improve our position.
We expect recurring sales to our existing customers to generate a majority of our revenue in the future, and if our existing customers do not continue to purchase products from us, our revenue may decline.
In October 2017 we completed the acquisition of our neurosurgery business from Integra LifeSciences. We are relying on Integra LifeSciences for certain transition services to support the acquired business and at the same time we are competing with them in the sale of neurosurgery products. Integra LifeSciences may face conflicting interests in performing required services for us and this may results in adverse effects on the acquire business.
Our operating results may decline if we do not succeed in developing, acquiring, and marketing additional products or improving our existing products
We intend to develop additional products and technologies, including enhancements of existing products, for the screening, detection, treatment, monitoring and tracking of common medical ailments. Developing new products and improving our existing products to meet the needs of current and future customers requires significant investments in research and development. If we fail to successfully sell new products, update our existing products, or timely react toFuture changes in technology or market conditions could result in adjustments to our recorded asset balance for intangible assets, including goodwill, resulting in additional charges that could significantly impact our operating results may decline as our existing products reach the end of their commercial life cycles.results.
Our growthbalance sheet includes significant intangible assets, including goodwill and other acquired intangible assets. The determination of related estimated useful lives and whether these assets are impaired involves significant judgment. Our ability to accurately predict future cash flows related to these intangible assets might be hindered by events over which we have no control. Due to the highly competitive nature of the medical device industry, new technologies could impair the value of our intangible assets if they create market conditions that adversely affect the competitiveness of our products. Further, declines in recent years has depended substantially onour market capitalization may be an indicator that our intangible assets or goodwill carrying values exceed their fair values which could lead

to potential impairment charges that could impact our operating results. In the completionpast we have recorded charges for goodwill impairment and impairments of acquisitions andour trade names.
If healthcare providers are not adequately reimbursed for procedures conducted with our devices or supplies, or if reimbursement policies change adversely, we may not be ablesuccessful marketing and selling our products or technologies.
Clinicians, hospitals, and government agencies are unlikely to complete acquisitions of this nature or of a relative size in the future to support a similar level of growth
The acquisitions that we have completed have contributed topurchase our growth in recent years. We expend considerable effort in seeking to identify attractive acquisition candidates and ultimately, to negotiate mutually agreeable acquisition terms. If weproducts if they are not successful in these efforts inadequately reimbursed for the future,procedures conducted with our growth rate will not increase atdevices or supplies. Unless a rate corresponding to that which we have achieved in recent years. Further, as we grow larger it will be necessary to complete the acquisitionsufficient amount of largerconclusive, peer-reviewed clinical data about our products has been published, third-party payors, including insurance companies and product linesgovernment agencies, may refuse to support a growth similarprovide reimbursement. Furthermore, even if reimbursement is provided, it may not be adequate to thatfully compensate the clinicians or hospitals. Some third-party payors may impose restrictions on the procedures for which we have achieved inthey will provide reimbursement. If healthcare providers cannot obtain sufficient reimbursement from third-party payors for our products or the past. The market for attractive acquisitions is competitive and othersscreenings conducted with greater financial resources than we have may be better positioned than we are to acquire desirable targets. Further,our products, we may not be able to negotiate acquisition terms with target companies that will allow us to achieve positive financial returns from the transaction.
We have substantial international operations which are subject to numerous risks; if our international operations are not successful, our business will be adversely affected
In 2017, approximately 45.9%significant market acceptance of our sales were made outside the U.S. We plan to expand our international sales and marketing efforts to increase salesproducts. Acceptance of our products in foreign countries.international markets will depend upon the availability of adequate reimbursement or funding within prevailing healthcare payment systems. Reimbursement, funding, and healthcare payment systems vary significantly by country. We may not realize corresponding growthobtain approvals for reimbursement in revenue from growtha timely manner or at all.
Adverse changes in international unit sales, duereimbursement policies in general could harm our business. We are unable to predict changes in the lower average selling prices we receive on salesreimbursement methods used by third-party healthcare payors, particularly those in countries and regions outside the United States. For example, some payors are moving toward a managed care system in which providers contract to provide comprehensive healthcare for a fixed cost per person. In a managed care system, the cost of our products may not be incorporated into the U.S. Even if we are able to successfully expand our international selling efforts, we cannotoverall payment for patient care or there may not be certain that we will be able to create or increase demandadequate reimbursement for our products outside of the U.S. Our international operations are subject toseparate from reimbursement for other risks, which include:
Impact of possible recessions in economies outside the U.S.;
Political and economic instability, including instability related to war and terrorist attacks and to political and diplomatic matters such as the BREXIT of the United Kingdom from the European Union;
Contractual provisions governed by foreign law, such as local law rights to sales commissions by terminated distributors;
Decreased healthcare spending by foreign governments that would reduce international demand for our products;
Strengthening of the U.S. dollar relative to foreign currencies that could make our products less competitive because approximately half of our international sales are denominated in U.S. dollars;
Greater difficulty in accounts receivable collection and longer collection periods;
Difficulties of staffing and managing foreign operations;
Reduced protection for intellectual property rights in some countries and potentially conflicting intellectual property rights of third parties under the laws of various foreign jurisdictions;
Difficulty in obtaining and maintaining foreign regulatory approval;

Attitudes by clinicians, and cost reimbursement policies, towards use of disposable supplies that are potentially unfavorable to our business;
Complying with U.S. regulations that apply to international operations, including trade laws, the U.S. Foreign Corrupt Practices Act, and anti-boycott laws, as well as international laws such as the U.K. Bribery Act;
Loss of business through government tenders that are held annually in many cases; and
Potentially negative consequences from changes in tax laws, including legislative changes concerning taxation of income earned outside of the U.S.
In particular, our international sales could be adversely affected by a strengthening of the U.S. dollar relative to other foreign currencies, which makes our products more costly to international customers for sales denominated in U.S. dollars.
U.S Tax Reform
The Tax Cuts and Jobs Act was signed into law in December 2017. The new law made numerous changes to federal corporate tax law that we expect will impact our effective tax rate in future periods. The changes included in the Tax Act are broad and complex. The final transition impacts of the Tax Act may differ from our current estimates, possibly materially, due to, among other things, changes in interpretations of the Tax Act, any legislative action to address questions that arise because of the Tax Act, any changes in accounting standards for income taxes or related interpretations in response to the Tax Act, or any updates or changes to estimates the Company has utilized to calculate the transition impacts.
If guidelines mandating universal newborn hearing screening do not continue to develop in foreign countries and governments do not mandate testing of all newborns as we anticipate, or if those guidelines have a long phase-in period, our sales of newborn hearing screening products may not achieve the revenue growth we have achieved in the past
We estimate that approximately 95% of the children born in the U.S. are currently being tested for hearing impairment prior to discharge from the hospital. To date, there has been only limited adoption of newborn hearing screening prior to hospital discharge by foreign governments, and when newborn hearing screening programs are enacted by foreign governments there can be a phase-in period spanning several years. The widespread adoption of guidelines depends, in part, on our ability to educate foreign government agencies, neonatologists, pediatricians, third-party payors, and hospital administrators about the benefits of universal newborn hearing screening as well as the use of our products to perform the screening and monitoring. Our revenue from our newborn hearing screening product lines may not grow if foreign governments do not require universal newborn hearing screening prior to hospital discharge, if physicians or hospitals are slow to comply with those guidelines, or if governments provide for a lengthy phase-in period for compliance.procedures.
Because we rely on distributors or sub-distributors to sell our products in most of our markets outside of the U.S.,United States, our revenue could decline if our existing distributors reduce the volume of purchases from us, or if our relationship with any of these distributors is terminatedterminated.
We currently rely on our distributors or sub-distributors for a majority of our sales outside the U.S.United States. Some distributors also assist us with regulatory approvals and education of clinicians and government agencies. Our contracts with our distributors or sub-distributors do not assure us significant minimum purchase volume. If a contract with a distributor or sub-distributor is terminated for cause or by us for convenience, the distributor or sub-distributor will have no obligation to purchase products from us. We intend to continue our efforts to increase our sales in Europe, Japan, and other developed countries.markets. If we fail to sell our products through our international distributors, we would experience a decline in revenue unless we begin to sell our products directly in those markets. We cannot be certain that we will be able to attract new international distributors to market our products effectively or provide timely and cost-effective customer support and service. Even if we are successful in selling our products through new distributors, the rate of growth of our revenue could be harmed if our existing distributors do not continue to sell a large dollar volume of our products. None of our existing distributors are obligated to continue selling our products.
We may be subject to foreign laws governing our relationships with our international distributors. These laws may require us to make payments to our distributors if we terminate our relationship for any reason, including for cause. Some countries require termination payments under local law or legislation that may supersede our contractual relationship with the distributor. Any required payments would adversely affect our operating results.
We are subject to a variety of operational risks inherent in our business which may disrupt our business and negatively impact our results of operations.
We are exposed to many types of operational risks, including business continuity, direct or indirect loss resulting from inadequate or failed internal and external processes, systems or human error, the effects of natural or man-made catastrophic events (such as natural disasters, pandemics, cyber-attacks, acts of terrorism, civil unrest and other catastrophes) or from other external events. For example, we conduct a significant portion of our activities, including administration and data processing, at facilities located in California which has experienced major earthquakes in the past, as well as other natural disasters. In addition, the ongoing outbreak of COVID-19 since December 2019 has resulted in increased travel restrictions and extended shutdown of certain businesses in the region, as well as reports of dramatically reduced economic activity in the region, which may negatively affect our operation particularly in Asia. Exposure to such events could disrupt our systems and operations significantly, which may result in financial loss and reputational damage.
If we lose our relationship with any supplier of key product components or our relationship with a supplier deteriorates or key components are not available in sufficient quantities, our manufacturing could be delayed and our business could suffersuffer.
We contract with third parties for the supply of some of the components used in our products and the production of our disposable products. Some of our suppliers are not obligated to continue to supply us. We have relatively few sources of supply for some of the components used in our products and in some cases we rely entirely on sole-source suppliers. In addition, the lead-time involved in the manufacturing of some of these components can be lengthy and unpredictable. If our suppliers become

unwilling or unable to supply us with components meeting our requirements, it might be difficult to establish additional or replacement suppliers in a timely manner, or at all. This would cause our product sales to be disrupted and our revenue and operating results to suffer.
Replacement or alternative sources might not be readily obtainable due to regulatory requirements and other factors applicable to our manufacturing operations. Incorporation of components from a new supplier into our products may require a new or supplemental filing with applicable regulatory authorities and clearance or approval of the filing before we could resume product sales. This process may take a substantial period of time, and we may not be able to obtain the necessary regulatory clearance or approval. This could create supply disruptions that would harm our product sales and operating results.
We have substantial international operations which are subject to numerous risks; if our international operations are not successful, our business will be adversely affected.
In 2019, approximately 41.0% of our sales were made outside the United States. We plan to expand our international sales and marketing efforts to increase sales of our products in foreign countries. We may not realize corresponding growth in revenue from growth in international unit sales, due to the lower average selling prices we receive on sales outside of the United States. Even if we are able to successfully expand our international selling efforts, we cannot be certain that we will be able to create or increase demand for our products outside of the United States. Our international operations are subject to other risks, which include:
Impact of possible recessions in economies outside the United States;
Political and economic instability, including instability related to war and terrorist attacks and to political and diplomatic matters such as Brexit;
Adverse changes in tariffs and trade protection measures;
Difficulty in obtaining and maintaining foreign regulatory approval and complying with foreign regulations, including the EU Medical Device Regulation;
An outbreak of a contagious disease, such as COVID-19, which may cause us or our distributors, vendors and/or customers to temporarily suspend our or their respective operations in the affected city or country;
Contractual provisions governed by foreign law, such as local law rights to sales commissions by terminated distributors;
Decreased healthcare spending by foreign governments that would reduce international demand for our products;
Strengthening of the U.S. dollar relative to foreign currencies that could make our products less competitive because approximately half of our international sales are denominated in U.S. dollars;
Changes in capital and exchange controls affecting international trade;
Greater difficulty in accounts receivable collection and longer collection periods;
Difficulties of staffing and managing foreign operations;
Reduced protection for intellectual property rights in some countries and potentially conflicting intellectual property rights of third parties under the laws of various foreign jurisdictions;
Attitudes by clinicians, and cost reimbursement policies, towards use of disposable supplies that are potentially unfavorable to our business;
Complying with U.S. regulations that apply to international operations, including trade laws, the U.S. Foreign Corrupt Practices Act, and anti-boycott laws, as well as international laws such as the U.K. Bribery Act;
Loss of business through government tenders that are held annually in many cases; and
Potentially negative consequences from changes in tax laws, including legislative changes concerning taxation of income earned outside of the United States.
In particular, our international sales could be adversely affected by a strengthening of the U.S. dollar relative to other foreign currencies, which makes our products more costly to international customers for sales denominated in U.S. dollars.
We depend upon key employees in a competitive market for skilled personnel, and, without additional employees, we cannot grow or maintain profitabilityprofitability.
Our products and technologies are complex, and we depend substantially on the continued service of our senior management team. The loss of any of our key employees could adversely affect our business and slow our product development process. Our future success also will depend, in part, on the continued service of our key management personnel, software engineers, and other research and development employees, and our ability to identify, hire, and retain additional personnel, including customer service, marketing, and sales staff. Demand for these skilled employees in our industry is very competitive due to the limited number of people available with the necessary technical skills and understanding of our product technologies. We may be unable to attract and retain personnel necessary for the development of our business.
We have experienced seasonality in the sale of our products.
We experience seasonality in our revenue. For example, our sales typically decline from the second half of our fiscal year to the first half of the fiscal year, due to patterns in the capital budgeting and purchasing cycles of our customers, many of which

are government agencies, and the compensation arrangements of our direct sales employees, as those arrangements are tied to calendar-year sales plans. We anticipate that we will continue to experience seasonal fluctuations, which may lead to fluctuations in our quarterly operating results. We believe that you should not rely on our results of operations for interim periods as an indication of our expected results in any future period.
We have initiated changes to our information systems that could disrupt our business and our financial results.
We plan to continuously improve our information systems to support the form, functionality, and scale of our business. These types of transitions frequently prove disruptive to the underlying business of an enterprise and may cause us to incur higher costs than we anticipate. Failure to manage a smooth transition to the new systems and the ongoing operations and support of the new systems could materially harm our business operations.
Risks Related to Our Compliance and Regulatory Environment
Our ability to market and sell products depends upon receipt of domestic and foreign regulatory approval of our products and manufacturing operations. Our failure to obtain or maintain regulatory approvals and compliance could negatively affect our businessbusiness.
Our products and manufacturing operations are subject to extensive regulation in the United States by the FDA and by similar regulatory agencies in other countries. Our products are classified as medical devices. Medical devices are subject to extensive regulation by the FDA pursuant to regulations that are wide ranging and govern, among other things: design and development; manufacturing and testing; labeling; storage and record keeping; advertising, promotion, marketing, sales distribution and export; and surveillance and reporting of deaths or serious injuries.
Unless an exemption applies, each medical device that we propose to market in the U.S.United States must first receive one of the following types of FDA premarket review authorizations:
Clearance via Section 510(k) of the Food, Drug, and Cosmetics Act of 1938, as amended; or
Premarket approval via Section 515 of the Food, Drug, and Cosmetics Act if the FDA has determined that the medical device in question poses a greater risk of injury.
The FDA will clear marketing of a medical device through the 510(k) process if it is demonstrated that the new product is substantially equivalent to other 510(k)-cleared products. The premarket approval application process is much more costly, lengthy and uncertain than the 510(k) process, and must be supported by extensive data from preclinical studies and human clinical trials. The FDA may not grant either 510(k) clearance or premarket approval for any product we propose to market. Further, any modification to a 510(k)-cleared device that could significantly affect its safety or effectiveness, or that would constitute a major change in its intended use, design or manufacture, requires a new 510(k) clearance or, possibly, approval of a premarket approval application. The FDA requires every manufacturer to make this determination in the first instance, but the FDA may review any manufacturer’s decision. If the FDA requires us to seek 510(k) clearance or premarket approval for modification of a previously cleared product for which we have concluded that new clearances or approvals are unnecessary, we may be required to cease marketing or to recall the modified product until we obtain clearance or approval, and we may be subject to significant regulatory fines or penalties. Further, our products could be subject to recall if the FDA determines, for any reason, that our products are not safe or effective.
Delays in receipt of, or failure to receive, clearances or approvals, the loss of previously received clearances or approvals, or the failure to comply with existing or future regulatory requirements could adversely impact our operating results. If the FDA finds that we have failed to comply with these requirements, the FDA can institute a wide variety of enforcement actions, ranging from a public warning letter to more severe sanctions such as:
Fines, injunctions and civil penalties;
Recall or seizure of our products;
Issuance of public notices or warnings;
Imposition of operating restrictions, partial suspension, or total shutdown of production;
Refusal of our requests for Section 510(k) clearance or premarket approval of new products;

Withdrawal of Section 510(k) clearance or premarket approvals already granted;
Criminal prosecution; or
Domestic regulation of our products and manufacturing operations, other than that which is administered by the FDA, includes the Environmental Protection Act, the Occupational Safety and Health Act, and state and local counterparts to these Acts.Acts; or
Foreign governments and regulatory authorities have, and may continue to, propose and implement regulations that apply to our products and operations. For example, in 2017 the European Union adopted the EU Medical Device Regulation, which imposes stricter requirements for the marketing and sale of medical devices, including new quality system and post-market surveillance requirements once it is fully implemented in 2020. Penalties for regulatory non-compliance could be severe, including

fines and revocation or suspension of a company's business license, mandatory price reductions, and criminal sanctions. Future laws and regulations may have a material adverse effect on our business.
Our business would be harmed if the FDA determines that we have failed to comply with applicable regulations governing the manufacture of our products and/or we do not pass an inspection.
We and our suppliers are required to demonstrate and maintain compliance with the FDA’s Quality System Regulation. The Quality System Regulation sets forth the FDA’s requirements for good manufacturing practices of medical devices and includes requirements for, among other things, the design, testing, production processes, controls, quality assurance, labeling, packaging, storage and shipping of such products. In addition, we and our suppliers must engage in extensive recordkeeping and reporting and must make available our manufacturing facility and records for periodic unscheduled inspections by federal, state and foreign agencies, including the FDA. We cannot assure you that we and our suppliers are or will continue to be in full compliance with the Quality System Regulation, nor that we will not encounter any manufacturing difficulties.
In 2014 and 2016 we received formal communications from the FDA regarding deficiencies in our manufacturing processes in our Seattle facility. As a result, we imposed ship-holds on certain of our products produced there and have discontinued certain other products produced in that facility. We are dedicating substantial resources to the resolution of the conditions identified by the FDA. These actions had an adverse effect on our results of operations in 2016 and 2017.
Our inability to address issues that have been raised by the FDA, or failure of us or our third party suppliers and manufacturers to comply with applicable regulations could result in sanctions being imposed on us, including, among other things, fines, injunctions, civil penalties, failure of regulatory authorities to grant marketing approval of our products, delays, suspension or withdrawal of approvals, seizures or recalls of products and manufacturing restrictions, any of which could harm our business.
Our business may suffer if we are required to revise our labeling or promotional materials, or if the FDA takes an enforcement action against us for off-label usesuses.
We are prohibited by the FDA from promoting or advertising our medical device products for uses not within the scope of our clearances or approvals, or from making unsupported promotional claims about the benefits of our products. If the FDA determines that our claims are outside the scope of our clearances, or are unsupported, it could require us to revise our promotional claims or take enforcement action against us. If we were subject to such an action by the FDA, our sales could be delayed, our revenue could decline, and our reputation among clinicians could be harmed. Likewise, if we acquire new products, either through the purchase of products, technology assets, or businesses, that are subsequently deemed to have inadequate supporting data, we may be required to (i) obtain adequate data, which could be costly and impede our ability to market these products, or (ii) modify the labeling on these products, which could impair their marketability, as described above.
We are subject to data privacy laws and our failure to comply with them may require us to make significant changes to our products or incur penalties or other liabilities.
Our business relies on the secure electronic transmission, storage and hosting of sensitive information, including personally identifiable information (“PII”), personal health information, financial information, intellectual property and other sensitive information related to our customers and workforce. The collection, maintenance, protection, use, transmission, disclosure and disposal of certain personal information and the security of medical devices are regulated at the U.S. federal and state, international and industry levels. U.S. federal and state laws, such as the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), protect the confidentiality of certain patient health information, including patient medical records, and restrict the use and disclosure of patient health information. We sign business associate agreements with certain customers for which we perform services as business associates under HIPAA, and therefore we are directly subject to certain provisions of HIPAA that are applicable to business associates. Noncompliance with laws and regulations relating to privacy and security of personal information, including HIPAA, or with contractual obligations under any business associate agreement may lead to significant fines, civil and criminal penalties, or liabilities.  We also may be required to report breaches of protected health information that we experience. The U.S. Department of Health and Human Services (“HHS”), audits the compliance of business associates and enforces HIPAA privacy and security standards. HHS enforcement activity has become more significant over the last few years and HHS has signaled its intent to continue this trend.
In addition to the regulation of personal health information, a number of states have also adopted laws and regulations that may affect our privacy and data security practices for other kinds of PII, such as state laws that govern the use, disclosure and protection of personal information, such as social security numbers, or that are designed to protect credit card account data. State consumer protection laws, including the California Consumer Privacy Act of 2018 (“CCPA”), which became effective on January 1, 2020, may also establish privacy and security standards for use and management of PII, including information related to customers, suppliers and care providers. The CCPA provides individuals certain rights regarding the collection or processing of personal data related to California residents, which may restrict our ability to use personal data, of California residents. Failure to comply with the CCPA could result in penalties of up to $7,500 per violation.

Outside the United States, we are impacted by the privacy and data security requirements at the international, national and regional level, and on an industry specific basis. We serve customers across the globe. Legal requirements in these countries relating to the collection, storage, handling and transfer of personal data and potentially intellectual property continue to evolve with increasingly strict enforcement regimes. More privacy and security laws and regulations are being adopted, and more are be enforced, with potential for significant financial penalties. In the European Union, increasingly stringent data protection and privacy rules that will have substantial impact on the use of patient data across the healthcare industry became effective in May 2018. The European Union General Data Protection Regulation (“GDPR”) applies uniformly across the European Union and to businesses in other countries that target European Union residents and includes, among other things, a requirement for prompt notice of data breaches to data subjects and supervisory authorities in certain circumstances and significant fines for non-compliance. The GDPR also requires companies processing personal data of individuals, including employees, residing in the European Union to comply with European Union privacy and data protection rules. Other international jurisdictions, have issued privacy laws that mirror many of the requirements of GDPR. As we expand our international operations, we may be required to expend significant time and resources to put in place additional mechanisms to ensure compliance with multiple data privacy laws. Failure to comply with these laws may result in significant fines and other administrative penalties and harm our business.
Compliance with these laws and regulations may require significant additional costs or changes in our business, which could adversely affect our results of operations or financial condition. Noncompliance with these laws and regulations could result in the imposition of fines and penalties or could result in significant civil and other liabilities. Additionally, the restrictions imposed by these laws and regulations may limit the use and adoption of our products, reduce overall demand for our products, require us to modify our data handling practices and impose additional costs and burdens.
An interruption in or breach of security of our information or manufacturing systems, including the occurrence of a cyber-incident or a vulnerability in our cybersecurity, or disclosure of private patient health information, may result in a loss of business or damage to our reputation.
We rely on communications, information and manufacturing systems to conduct our business. Any failure, interruption or cyber incident affecting these systems could result in failures or disruptions in our customer relationship management or product manufacturing. Similarly, there can be no assurance that our third-party collaborators, distributors and other contractors and consultants will be successful in protecting our data that is stored on their systems. A cyber incident is an intentional attack or an unintentional event that can include an unauthorized actor gaining access to our systems to disrupt operations, corrupt data, or steal confidential information. The occurrence of any failures, interruptions or cyber incidents could result in a loss of customer business or reputation and have a material effect on our business, financial condition, results of operations and cash flows. In addition, our products are used in customer networks transmitting a range of sensitive information and any actual or perceived exposure of our products used in customer networks to malicious software or cyber-attacks could adversely affect our business and results of operations.
In the course of performing our business we obtain, from time to time, confidential patient health information. For example, we may learn patient names and be exposed to confidential patient health information when we provide training on our products to our customers’ staff. Complying with federal and state privacy and security requirements imposes compliance related costs, subjects us to potential regulatory audits, and may restrict our business operations. These various laws may be subject to varying interpretations by courts and government agencies creating potentially complex compliance issues for our business. If we were to violate any of our legal obligations to safeguard any confidential patient health information or protected health information against improper use and disclosure, we could lose customers and be exposed to liability, and our reputation and business could be harmed. Concerns or allegations about our practices with regard to the privacy or security of personal health information or other privacy-related matters, even if unfounded, could damage our reputation and harm our business.
We are also subject to new U.S. laws as well as laws and regulations in foreign countries covering data privacy and other protection of health and employee information that may be more onerous than previous corresponding U.S. laws. These laws and regulations impose technical and organizational measures to ensure the security of personal data and may require that we notify regulatory agencies, individuals or the public about any data security breaches. In particular, in the United States, the newly passed CCPA imposes a private right of action with damages of up to $750 per person in the event of certain data breaches. Other states are considering similar laws. As these laws and regulations develop in the United States and we expand our international operations, we may be required to expend significant time and resources to put in place additional mechanisms to ensure compliance with multiple cybersecurity laws. Failure to comply with these laws may result in significant fines and other administrative penalties and harm our business, and could expose us to significant civil damages.
The FDA has issued guidance advising manufacturers to take cybersecurity risks into account in product design for connected medical devices and systems, to assure that appropriate safeguards are in place to reduce the risk of unauthorized access or modification to medical devices that contain software and reduce the risk of introducing threats into hospital systems that are connected to such devices. The FDA also issued guidance on post market management of cyber security in medical devices. Compliance with these requirements may require changes in business practices, complicate our operations, and add complexity and additional management and oversight needs. They also may complicate our clinical research activities, as well as product

offerings that involve transmission or use of clinical data. Failure to comply with these laws could result in vulnerabilities that would make us susceptible to hackers and other cyber attacks, as well as fines or administrative penalties that, if imposed, would harm our business.
Healthcare reforms, changes in healthcare policies, and changes to third-party reimbursements for our products may affect demand for our products.
Uncertainty in the U.S. healthcare system may influence the way our customers spend on medical devices, supplies, and services in the future. The U.S. Patient Protection and Affordable Care Act and the Healthcare and Education Reconciliation Act of 2010 (“ACA”) may be modified, repealed, or otherwise invalidated, in whole or in part. Future rulemakings could affect rebates, prices, or the rate of price increase for healthcare products and services. Cost-containing measures implemented by healthcare providers worldwide could harm our profitability. If we fail to effectively react to healthcare reforms, our business may be adversely affected.
Regulations related to “conflict minerals” may force us to incur additional expenses, may result in damage to our business reputation and may adversely impact our ability to conduct our business.
The Dodd‑Frank Wall Street Reform and Consumer Protection Act and the rules promulgated by the SEC thereunder require companies, including Natus, to disclose the existence in their products of certain metals, known as “conflict minerals,” which are metals mined from the Democratic Republic of the Congo and adjoining countries. These rules requires investigative efforts, which has and will continue to cause us to incur associated costs, could adversely affect the sourcing, availability and pricing of minerals used in our products and may cause reputational harm if we determine that certain of our components contain such conflict minerals or if we are unable to alter our processes or sources of supply to avoid using such materials, all of which could adversely impact sales of our products and results of operations.
Risks Related to our Intellectual Property and Potential Litigation
We may not be able to preserve the value of our intellectual property because we may not be able to protect access to it or we may lose our intellectual property rights due to expiration of our licenses or patents.
If we fail to protect our intellectual property rights or if our intellectual property rights do not adequately cover the technology we employ, other medical device companies could sell products with features similar to ours, and this could reduce demand for our products. We protect our intellectual property through a combination of patent, copyright, trade secret and trademark laws. Despite our efforts to protect our proprietary rights, others may attempt to copy or otherwise improperly obtain and use our products or technology. Policing unauthorized use of our technology is difficult and expensive, and we cannot be certain that the steps we have taken will prevent misappropriation. Our means of protecting our proprietary rights may be inadequate. Enforcing our intellectual property rights could be costly and time consuming and may divert our management’s attention and resources. Failing to enforce our intellectual property rights could also result in the loss of those rights.
U.S. tax reform legislation could materially affect our business and financial condition.
The Tax Cuts and Jobs Act (the “Tax Act”) was signed into law in December 2017. The new law made numerous changes to federal corporate tax law that we expect will impact our effective tax rate in future periods. The changes included in the Tax Act were broad and complex and included, among others, reducing the corporate tax rate from a top marginal rate of 35% to a flat rate of 21%, limiting the tax deduction for interest expense to 30% of adjusted earnings, eliminating net operating loss carrybacks, imposing a one-time tax on offshore earnings at reduced rates regardless of whether they are repatriated, allowing immediate deductions for certain new investments instead of deductions for depreciation expense over time, and modifying or repealing many business deductions and credits. The final impacts of the Tax Act may differ from our current estimates, possibly materially, due to, among other things, changes in interpretations of the Tax Act, any legislative action to address questions that arise because of the Tax Act, any changes in accounting standards for income taxes or related interpretations in response to the Tax Act, or any updates or changes to estimates we have utilized to calculate the transition impacts.
If guidelines mandating universal newborn hearing screening do not continue to develop in foreign countries and governments do not mandate testing of all newborns as we anticipate, or if those guidelines have a long phase-in period, our sales of newborn hearing screening products may not achieve the revenue growth we have achieved in the past.
We estimate that approximately 95% of the children born in the United States are currently being tested for hearing impairment prior to discharge from the hospital. To date, there has been only limited adoption of newborn hearing screening prior to hospital discharge by foreign governments, and when newborn hearing screening programs are enacted by foreign governments there can be a phase-in period spanning several years. The widespread adoption of guidelines depends, in part, on our ability to educate foreign government agencies, neonatologists, pediatricians, third-party payors, and hospital administrators about the benefits of universal newborn hearing screening as well as the use of our products to perform the screening and monitoring. Our revenue from our newborn hearing screening product lines may not grow if foreign governments do not require universal newborn

hearing screening prior to hospital discharge, if physicians or hospitals are slow to comply with those guidelines, or if governments provide for a lengthy phase-in period for compliance.
If we deliver products with defects, we may incur costs to repair and, possibly, recall that product and market acceptance of our products may decrease.
The manufacturing and marketing of our products involve an inherent risk of our delivering a defective product or products that do not otherwise perform as we expect. We may incur substantial expense to repair any such products and may determine to recall such a product, even if not required to do so under applicable regulations. Any such recall would be time consuming and expensive. Product defects or recalls may adversely affect our customers’ acceptance of the recalled and other of our products.
If we fail to comply with healthcare regulations, we could face substantial penalties and our business, operations and financial condition could be adversely affected.
We could be subject to healthcare fraud regulation and enforcement by both the federal government and the states in which we conduct our business. The laws that may affect our ability to operate include: (i) the federal healthcare programs Anti-Kickback Law, which prohibits, among other things, persons from knowingly and willfully soliciting, receiving, offering or paying remuneration, directly or indirectly, in exchange for or to induce either the referral of an individual for, or the purchase, order or recommendation of, any good or service for which payment may be made under federal healthcare programs such as Medicare or Medicaid, (ii) federal false claims laws which prohibit, among other things, individuals or entities from knowingly presenting, or causing to be presented, claims for payment from Medicare, Medicaid, or other third-party payors that are false or fraudulent, and which may apply to entities like us which provide coding and billing advice to customers, and/or (iii) state law equivalents of each of the above federal laws, such as anti-kickback and false claims laws which may apply to items or services reimbursed by any third-party payor, including commercial insurers, many of which differ from their federal counterparts in significant ways, thus complicating compliance efforts.
If our operations are found to be in violation of any of the laws described above or any other governmental regulations that apply to us, we may be subject to penalties, including civil and criminal penalties, damages, fines and the curtailment or restructuring of our operations. Any penalties, damages, fines, curtailment or restructuring of our operations could adversely affect our ability to operate our business and our financial results. The risk of our being found in violation of these laws is increased by the fact that their provisions are open to a variety of interpretations. Any action against us for violation of these laws, even if we successfully defend against it, could cause us to incur significant legal expenses and divert our management’s attention from the operation of our business.
Our operating results would suffer if we were subject to a protracted infringement claimclaim.
The medical technology industry is characterized by a substantial amount of litigation and related administrative proceedings regarding patents and intellectual property rights. We expect that medical screening and diagnostic products may become increasingly subject to third-party infringement claims as the number of competitors in our industry grows and the functionality of products overlap. Third parties such as individuals, educational institutions, or other medical device companies may claim that we infringe their intellectual property rights. Any claims, with or without merit, could have any of the following negative consequences:
Result in costly litigation and damage awards;
Divert our management’s attention and resources;
Cause product shipment delays or suspensions; or

Require us to seek to enter into royalty or licensing agreements.
We are currently subject to cases based on third-party patent infringement claims. A successful claim of infringement against us from any current or future claim could result in a substantial damage award and materially harm our financial condition. Our failure or inability to license the infringed or similar technology, or design and build non-infringing products, could prevent us from selling our products and adversely affect our business and financial results.
We may also find it necessary to bring infringement actions against third parties to seek to protect our intellectual property rights. Litigation of this nature, even if successful, is often expensive and disruptive of our management’s attention, and in any event may not lead to a successful result relative to the resources dedicated to any such litigation.
We license intellectual property rights from third parties and would be adversely affected if our licensors do not appropriately defend their proprietary rights or if we breach any of the agreements under which we license commercialization rights to products or technology from othersothers.
We license rights from third parties for products and technology that are important to our business. If our licensors are unsuccessful in asserting and defending their proprietary rights, including patent rights and trade secrets, we may lose the competitive advantages we have through selling products that we license from third parties. Additionally, if it is found that our licensors infringe on the proprietary rights of others, we may be prohibited from marketing our existing products that incorporate

those proprietary rights. Under our licenses, we are subject to commercialization and development, sublicensing, royalty, insurance and other obligations. If we fail to comply with any of these requirements, or otherwise breach a license agreement, the licensor may have the right to terminate the license in whole or to terminate the exclusive nature of the license.
Product liability suits against us could result in expensive and time consuming litigation, payment of substantial damages, and an increase in our insurance ratesrates.
The sale and use of our products could lead to the filing of a product liability claim by someone claiming to have been injured using one of our products or claiming that one of our products failed to perform properly. We are currently subject to one such lawsuit. A product liability claim could result in substantial damages and be costly and time consuming to defend, either of which could materially harm our business reputation or financial condition. Our product liability insurance may not protect our assets from the financial impact of defending a product liability claim. Any product liability claim brought against us, with or without merit, could increase our product liability insurance rates or prevent us from securing any coverage in the future.
We have experienced seasonality in the sale of our products
We experience seasonality in our revenue. For example, our sales typically decline from the second half of our fiscal year to the first half of the fiscal year, due to patterns in the capital budgeting and purchasing cycles of our customers, many of which are government agencies, and the compensation arrangements of our direct sales employees, as those arrangements are tied to calendar-year sales plans. We anticipate that we will continue to experience seasonal fluctuations, which may lead to fluctuations in our quarterly operating results. We believe that you should not rely on our results of operations for interim periods as an indication of our expected results in any future period.
An interruption in or breach of security of our information or manufacturing systems, including the occurrence of a cyber-incident or a deficiency in our cybersecurity, or disclosure of private patient health information, may result in a loss of business or damage to our reputation.
We rely on communications, information and manufacturing systems to conduct our business. Any failure, interruption or cyber incident of these systems could result in failures or disruptions in our customer relationship management or product manufacturing. A cyber incident is an intentional attack or an unintentional event that can include gaining unauthorized access to information systems to disrupt operations, corrupt data, or steal confidential information. The occurrence of any failures, interruptions or cyber incidents could result in a loss of customer business or reputation and have a material effect on our business, financial condition, results of operations and cash flows.
In the course of performing our business we obtain, from time to time, confidential patient health information. For example, we may learn patient names and be exposed to confidential patient health information when we provide training on our products to our customers’ staff. Complying with federal and state privacy and security requirements imposes compliance related costs, subjects us to potential regulatory audits, and may restrict our business operations. These various laws may be subject to varying interpretations by courts and government agencies creating potentially complex compliance issues for our business. If we were to violate any of our legal obligations to safeguard any confidential patient health information or protected health information against improper use and disclosure, we could lose customers and be exposed to liability, and our reputation and business could be harmed. Concerns or allegations about our practices with regard to the privacy or security of personal health information or other privacy-related matters, even if unfounded, could damage our reputation and harm our business.
We are also subject to laws and regulations in foreign countries covering data privacy and other protection of health and employee information that may be more onerous than corresponding U.S. laws. These regulations may require that we obtain

individual consent before we collect or process any personal data, restrict our use or transfer of personal data, impose technical and organizational measures to ensure the security of personal data, and require that we notify regulatory agencies, individuals or the public about any data security breaches. As we expand our international operations, we may be required to expend significant time and resources to put in place additional mechanisms to ensure compliance with multiple data privacy laws. Failure to comply with these laws may result in significant fines and other administrative penalties and harm our business.
Our stock price may be volatile, which may cause the value of our stock to decline or subject us to a securities class action litigation.
The trading price of our common stock price may be volatile and could be subject to wide fluctuations in price in response to various factors, many of which are beyond our control, including:
general economic, industry and market conditions;
actions by institutional or other large stockholders;
the depth and liquidity of the market for our common stock;
volume and timing of orders for our products;
developments generally affecting medical device companies;
the announcement of new products or product enhancements by us or our competitors;
changes in earnings estimates or recommendations by securities analysts;
investor perceptions of us and our business, including changes in market valuations of medical device companies; and
our results of operations and financial performance.
In addition, the stock market in general, and the NASDAQNasdaq Stock Market and the market for medical devices in particular, have experienced substantial price and volume volatility that is often seemingly unrelated to the operating performance of particular companies. These broad market fluctuations may cause the trading price of our common stock to decline. In the past, securities class action litigation has often been brought against a company after a period of volatility in the market price of its common stock. We may become involved in this type of litigation in the future. Any securities litigation claims brought against us could result in substantial expense and the diversion of management’s attention from our business.

ITEM 1B.    Unresolved Staff Comments.
None.
ITEM 2.    Properties
Our corporate headquarters areis located in Pleasanton, California, in a facility covering 8,200 square feet pursuant to a lease that expires in October 2019.January 2025.
We also utilize the following properties:
Company-owned Facilities:
116,00062,400 square feet in Buenos Aires, Argentina,Gort, Ireland, utilized substantially for manufacturing;
44,900 square feet in Oakville, Ontario, Canada, primarily utilized substantially for research and development;
42,600 square feet in Gort, Ireland, utilized substantially for manufacturing;
26,000 square feet in Mundelein, Illinois, previously utilized substantially for manufacturing. Currently held for sale;development and technical support; and
6,400 square feet in Old Woking, England, utilized substantially for research and development.
Leased Facilities:
Following is a listing of our most significant leased properties; we have a number of smaller facilities under lease in various countries where we operate.
124,000 square feet in Middleton, Wisconsin, pursuant to a lease that expires in April 2024, that is primarily utilized for manufacturing;manufacturing, technical support, customer service, marketing and research and development;

65,000 square feet in Seattle, Washington, pursuant to a lease that expires in December 2020, that is utilized substantially for manufacturing;
52,000 square feet in Taastrup, Denmark, pursuant to a lease that expires inwith the option to terminate with six months-notice beginning January 2032,2022, that is utilized for manufacturing, research and development, marketing and sales, and general and administrative;

43,000 square feet in Planegg, Germany, pursuant to a lease that expires in December 2021 that is utilized substantially for sales and marketing and a large portion is subleased to third parties;
37,28237,200 square feet in San Diego, California, pursuant to a lease that expires in June 2019,2022, that is utilized substantially for manufacturing;
25,12825,100 square feet in Schaumberg,Schaumburg, Illinois, pursuant to a lease that expires in July 2021,November 2026, that is utilized substantially for marketing and sales; and
23,86023,800 square feet in Quebec, Canada, pursuant to a lease that expires in December 2023,2024, that is utilized substantially for manufacturing; andmanufacturing.
14,300 square feet in Skovlunde, Denmark, pursuant to a lease that expires with six-month notice that is utilized for research and development.
ITEM 3.    Legal Proceedings
We may from time to time become a party to various legal proceedings or claims that arise in the ordinary course of business. We are not currently involved in any legal or administrative proceedings that we believe are likely to have a material effect on our business, financial condition, or results of operations, although we cannot be assured of the outcome of such matters.
In January 2017, a putative class action lawsuit (Badger v. Natus Medical Incorporation, et al., No. 17-cv-00458-JSW) alleging violations of federal securities laws was filed in the United States District Court for the Northern District of California, naming as defendants the Company and certain officers and a director. In July 2017, plaintiffs filed an amended complaint with a new lead plaintiff (Costabile v. Natus Medical Incorporation, et al., No. 17-cv-00458-JSW) alleging violations of federal securities laws based on allegedly false and misleading statements. The defendants moved to dismiss the Amended Complaint, and in February 2018 the motion to dismiss was granted with leave to amend. The Company believes that the plaintiffs’ allegations are without merit, and intends to vigorously defend against the claims.  In July 2017, a putative shareholder derivative action was filed in California Superior Court (Mortman v. Gunst, et. al., No. RG17867679) against certain of the Company’s officers and directors and naming the Company as a nominal defendant. The action is based on allegations similar to those in the securities class action litigation described above.


ITEM 4.    Mine Safety Disclosures
The disclosure required by this item is not applicable.


PART II
ITEM 5.    Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities
Our common stock trades on the Nasdaq Global Select Market under the symbol “BABY”“NTUS”. The following table sets forth, for the periods indicated, the high and low sale price per share of our common stock, as reported on the Nasdaq Global Select Market.
High LowHigh Low
Fiscal Year Ended December 31, 2017:   
Fiscal Year Ended December 31, 2019:   
Fourth Quarter$43.60
 $37.10
$34.89
 $29.67
Third Quarter39.50
 31.65
32.85
 22.25
Second Quarter41.25
 33.28
27.90
 23.54
First Quarter39.75
 33.55
34.63
 24.88
Fiscal Year Ended December 31, 2016:   
Fiscal Year Ended December 31, 2018:   
Fourth Quarter$43.85
 $33.15
$36.85
 $27.69
Third Quarter44.39
 36.80
37.90
 31.05
Second Quarter39.81
 29.54
37.95
 31.10
First Quarter47.24
 32.00
39.25
 28.00
As of February 21, 2018,24, 2020, there were 33,160,42834,105,116 shares of our common stock issued and outstanding and held by approximately 23101 stockholders of record. We estimate that there are approximately 22,71214,518 beneficial owners of our common stock.
In December 2019, the Board of Directors approved a share repurchase program, which authorized the repurchase from time to time of up to a maximum of $50 million of our outstanding common stock. The program is scheduled to expire on December 12, 2021. No shares have been repurchased as of February 28, 2020.
Dividends

We have never declared or paid cash dividends on our capital stock and do not anticipate paying any cash dividends in the foreseeable future.
Stock Performance Graph
The following information of Part II Item 5 is being furnished and shall not be deemed to be “soliciting material” or to be “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, or otherwise subject to the liabilities of that Section, nor will it be deemed incorporated by reference into any filing under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except to the extent that we specifically incorporate such information by reference thereto.
The following graph shows a comparison, from January 1, 20122015 through December 31, 2017,2019, of cumulative total return for our common stock, the Nasdaq Composite Index and the Standard & Poor’s 500 Health Care Equipment Index. Such returns are based on historical results and are not intended to suggest future performance. Data for the Nasdaq Composite Index and the Standard & Poor’s 500 Health Care Equipment Index assumes reinvestment of dividends.
chart-73c62e9208d152b1b2b.jpgchart-5bdaf063b6f2531ead0.jpg
 2012 2013 2014 2015 2016 2017 2014 2015 2016 2017 2018 2019
Natus Medical Inc. Return %   101.61
 60.18
 33.32
 (27.58) 9.77
 Return %   33.32
 (27.58) 9.77
 (10.92) (3.06)
 Cum $ 100.00
 201.61
 322.94
 430.56
 311.83
 342.29
 Cum $ 100.00
 133.32
 96.56
 105.99
 94.42
 91.53
NASDAQ Composite-Total Returns Return %   40.12
 14.75
 6.96
 8.87
 29.64
 Return %   6.96
 8.87
 29.64
 (2.84) 36.69
 Cum $ 100.00
 140.12
 160.78
 171.97
 187.22
 242.71
 Cum $ 100.00
 106.96
 116.45
 150.96
 146.67
 200.49
S&P 500 Health Care Equipment Index Return %   27.69
 26.28
 5.97
 6.48
 30.90
 Return %   5.97
 6.48
 30.90
 16.24
 29.32
 Cum $ 100.00
 127.69
 161.24
 170.88
 181.96
 238.17
 Cum $ 100.00
 105.97
 112.85
 147.71
 171.70
 222.04


Purchases of Equity Securities by the Issuer


In June 2014, the Board of Directors authorized the repurchase of up to $10 million of common stock pursuant to a stock repurchase program. In June 2015, the program was expanded to include up to an additional $20 million of our common stock. In June 2016, the program was again expanded to include an additional $20 million of our common stock, for an aggregate purchase amount of $50 million. The expiration date for the program was June 1, 2017. On February 22, 2018, the Board of Directors authorized the repurchase of up to $30 million in common stock with an expiration date of February 26, 2018.None.


ITEM 6.    Selected Financial Data
The following tables set forth certain selected consolidated financial data for each of the years in the five-year period ended December 31, 2017,2019, and is derived from the Consolidated Financial Statements of Natus Medical Incorporated and its subsidiaries. The Consolidated Financial Statements for each of the years in the three-year period ended December 31, 20172019 are included elsewhere in this report. The selected consolidated balance sheet data as of December 31, 2015, 20142017, 2016 and 20132015 and the consolidated statements of operations data for the years ended December 31, 20142016 and 20132015 are derived from our Consolidated Financial Statements, which are not included in this report. The selected consolidated financial data set forth below is qualified in its entirety by, and should be read in conjunction with, the Consolidated Financial Statements and Notes thereto and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included elsewhere in this report.
Year ended December 31,Year ended December 31,
2017 2016 2015 2014 20132019 2018 2017 2016 2015
(in thousands, except per share amounts)(in thousands, except per share amounts)
Consolidated Statement of Operations Data (a) (b):        
Consolidated Statement of Operations Data (a)(b):Consolidated Statement of Operations Data (a)(b):        
Revenue$500,970
 $381,892
 $375,865
 $355,834
 $344,112
$495,175
 $530,891
 $500,970
 $381,892
 $375,865
Cost of revenue213,376
 144,632
 145,492
 138,480
 138,788
196,551
 217,952
 213,376
 144,632
 145,492
Intangibles amortization6,380
 2,327
 2,836
 2,967
 2,912
6,916
 8,924
 6,380
 2,327
 2,836
Gross profit281,214
 234,933
 227,537
 214,387
 202,412
291,708
 304,015
 281,214
 234,933
 227,537
Operating expenses:                  
Marketing and selling126,166
 84,834
 87,675
 85,729
 83,138
129,109
 136,680
 126,166
 84,834
 87,675
Research and development51,822
 33,443
 30,434
 30,100
 30,786
58,733
 61,482
 51,822
 33,443
 30,434
General and administrative74,424
 50,877
 46,363
 45,444
 43,380
59,649
 70,599
 74,424
 50,877
 46,363
Intangibles amortization19,171
 8,983
 7,447
 3,025
 5,681
15,144
 22,585
 19,171
 8,983
 7,447
Restructuring914
 1,536
 2,145
 4,238
 4,767
44,739
 37,231
 914
 1,536
 2,145
Total operating expense272,497
 179,673
 174,064
 168,536
 167,752
307,374
 328,577
 272,497
 179,673
 174,064
Income from operations8,717
 55,260
 53,473
 45,851
 34,660
(15,666) (24,562) 8,717
 55,260
 53,473
Other income (expense), net(3,567) (357) (1,064) 158
 (2,716)
Income before provision for income tax5,150
 54,903
 52,409
 46,009
 31,944
Provision for income tax25,443
 12,309
 14,485
 13,531
 8,797
Other expense, net(5,591) (7,698) (3,567) (357) (1,064)
Income (loss) before provision (benefit) for income tax(21,257) (32,260) 5,150
 54,903
 52,409
Provision (benefit) for income tax(5,586) (9,325) 25,443
 12,309
 14,485
Net income (loss)$(20,293) $42,594
 $37,924
 $32,478
 $23,147
$(15,671) $(22,935) $(20,293) $42,594
 $37,924
Earnings per share:         
Earnings (loss) per share:         
Basic$(0.62) $1.31
 $1.17
 $1.03
 $0.77
$(0.47) $(0.69) $(0.62) $1.31
 $1.17
Diluted$(0.62) $1.29
 $1.14
 $1.00
 $0.75
$(0.47) $(0.69) $(0.62) $1.29
 $1.14
Weighted average shares used in the calculation of earnings per share:                  
Basic32,564
 32,460
 32,348
 31,499
 29,993
33,696
 33,111
 32,564
 32,460
 32,348
Diluted32,564
 33,056
 33,241
 32,568
 30,821
33,696
 33,111
 32,564
 33,056
 33,241
December 31,December 31,
2017 2016 2015 2014 20132019 2018 2017 2016 2015
(in thousands)(in thousands)
Consolidated Balance Sheet Data:                  
Cash, cash equivalents, and short-term investments$88,950
 $247,750
 $82,469
 $66,558
 $56,106
$63,297
 $56,373
 $88,950
 $247,750
 $82,469
Working capital213,491
 325,858
 164,248
 148,665
 118,585
126,928
 152,329
 213,491
 325,858
 164,248
Total assets709,919
 649,012
 479,496
 434,821
 429,457
622,527
 638,140
 709,919
 649,012
 479,496
Long-term debt (including current portion) and short-term borrowings154,283
 140,000
 
 
 38,017
54,665
 104,474
 154,283
 140,000
 
Total stockholders’ equity422,097
 417,374
 390,710
 352,715
 308,214
416,123
 398,444
 422,097
 417,374
 390,710

(a)Results of operations and financial position of the businesses we have acquired are included from their acquisition dates as follows: Grass in February 2013, Peloton in January 2014, GND and NicViewNICVIEW in January 2015, Monarch in November 2015, NeuroQuest in March 2016, RetCam in July 2016, Otometrics in January 2017, and Integra Asset Acquisitionasset acquisition in October 2017.
(b)Data for 2014Results of operations and 2013 reflects reclassificationsfinancial position of the businesses we have divested or exited are not included from Cost of revenue to Intangibles amortization, from Marketingtheir exited dates as follows: GND and selling, ResearchNeurocom in January 2019, and development, and General and administrative to Intangible amortization, and from General and administrative to Restructuring.Medix in April 2019.
ITEM 7.    Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following Management’s Discussion and Analysis of Financial Condition and Results of Operations (“MD&A”) should be read in conjunction with the Consolidated Financial Statements and the accompanying footnotes. MD&A includes the following sections:
Business
Natus isWe are a leading provider of newborn care, neurology,medical device solutions focused on the diagnosis and hearingtreatment of central nervous and balance assessment healthcare products and services usedsensory system disorders for the screening, diagnosis, detection, treatment, monitoring and trackingpatients of common medical ailments in newborn care, hearing impairment, neurological dysfunction, epilepsy, sleep disorders, neuromuscular diseases and balance and mobility disorders.
We have completed a number of acquisitions since 2003, consisting of either the purchase of a company, substantially all of the assets of a company, or individual products or product lines. In 2017 we completed two acquisitions, Otometrics in January and the Integra Asset Acquisition in October. We expect to continue to pursue opportunities to acquire other businesses in the future.ages.
Year 20172019 Overview
In 2017, we completed the acquisitions mentioned above for total cash consideration of $191.0 million. These acquisitions allowed us to expand our hearing diagnostic and balance assessment target market as well as enter into the neurosurgery business.
Our consolidated revenue increaseddecreased by $119.1$35.7 million for the year ended December 31, 20172019 compared to the year ended December 31, 2016.2018. This increasedecrease was driven by acquisitions, organic growththe exit of GND and Neurocom businesses, the sale of our Medix business in Argentina, the impact of product discontinuations in our Newborn care business, partially offset by weakness in our NeurologyCare market, and ship holds within Newborn Care and Hearing & Balance markets.
Net loss was $20.3$15.7 million, or ($0.62)$0.47 per share in the year ended December 31, 2017,2019, compared with net incomeloss of $42.6$22.9 million, or $1.29$0.69 per diluted share in 2016.the prior year. This decreaseincrease in income was primarily driven by our restructuring initiative announced in 2019. While we experienced a net loss driven by our reorganization efforts, we generated cash flow from operations of $60.1 million.
Reorganization
On January 15, 2019, we announced the resultimplementation of a one-time tax cost of $20.5 million relatingnew organizational structure designed to the transition tax on the deemed repatriation of all foreign subsidiary earnings (excluding stateimprove operational performance and FIN 48 tax impacts)make us a stronger, more profitable company. We consolidated our three business units, Neuro, Newborn Care and Hearing & Balance, formerly Otometrics, into “One Natus." This initiative was designed to create a non-cash chargesingle, unified company with globally led operational teams in Sales & Marketing, Manufacturing, R&D, Quality, and General and Administrative functions. We expect to establish a valuation allowance against a significant portion of the U.S. deferred tax assets related to carryforward of foreign tax credits, each due to the enactment in December 2017 of Tax Cuts and Jobs Act of 2017 (the “Act”). We incurred $0.9 million of restructuring charges in 2017, as compared to $1.5 million in 2016, as we continue to eliminate redundant costs.see increased transparency, efficiency and cross-functional collaboration across common technologies, processes and customer channels.
Application of Critical Accounting Policies
We prepare our financial statements in accordance with accounting principles generally accepted in the United States of America (“GAAP”). In so doing, we must often make estimates and use assumptions that can be subjective and, consequently,

our actual results could differ from those estimates. For any given individual estimate or assumption we make, there may also be other estimates or assumptions that are reasonable.
We believe that the following critical accounting policies require the use of significant estimates, assumptions, and judgments. The use of different estimates, assumptions, and judgments could have a material effect on the reported amounts of assets, liabilities, revenue, expenses, and related disclosures as of the date of the financial statements and during the reporting period.
Revenue recognition
Revenue net of discounts, is recognized from saleswhen obligations under the terms of medicala contract with a customer are satisfied; generally this occurs with the transfer of control of devices, supplies, or services. Revenue is measured as the amount of consideration we expect to receive in exchange for transferring goods or providing services.
For the majority of devices and supplies, including saleswe transfer control and recognizes revenue when products ship from the warehouse to distributors, when the following conditions have been met: a purchase order has been received, title has transferred, the selling price is fixed or determinable,customer. We generally do not provide rights of return on devices and collection of the resulting receivable is reasonably assured. Terms of sale for most domestic sales are FOB origin, reflecting that title and risk of loss are assumed by the purchaser at the shipping point; however, terms of sale for some neurology, sleep-diagnostic, and head cooling systems are FOB destination, reflecting that title and risk of loss are assumed by the purchaser upon delivery. Terms of sales to international distributors are generally EXW, reflecting that goods are shipped “ex works,” in which title and risk of loss are assumed by the distributor at the shipping point. For products shipped under FOB origin or EXW terms, delivery is generally considered to have occurred when the product is shipped.supplies. Freight charges billed to customers are included in revenue and freight-related expenses are charged to cost of revenue. We generally

Depending on the terms of the arrangement, we may also defer the recognition of a portion of the consideration received because we have to satisfy a future obligation (e.g. installation). Judgment is required to determine the standalone selling price (“SSP”) for each distinct performance obligation. Our estimate of SSP is a point estimate.  The estimate is calculated annually for each performance obligation that is not sold separately. In instances where SSP is not directly observable, such as when we do not provide rightssell the product or service separately, the SSP is determined using information that may include market conditions and other observable inputs.
We sell separately-priced service contracts that extend maintenance coverages for both medical devices and data management systems beyond the base agreements to customers. The separately priced service contracts range from twelve (12) months to sixty (60) months. We receive payment at the inception of return on products.the contract and recognize revenue ratably over the service period.
For products containing embedded software, we have determined thatdetermine the hardware and software components function together to deliver the products’products' essential functionality and therefore, the revenue from the sale of these products does not fall within the scope of the software revenue recognition rules. Our revenueare considered a combined performance obligation. Revenue recognition policies for sales of these products are substantially the same as for our other tangible products.
Revenue from sales of certain of our products that remain within the scope of the software revenue recognition rules under ASC Subtopic 985-605 is not significant.
Revenue from extended service and maintenance agreements, for both medical devices and data management systems, is recognized ratably over the service period. Revenue from installation or training services is deferred until such time service is provided. Hearing screening and ambulatory EEG monitoring revenue is recorded when the procedure is performed at the estimated net realizable value based on contractual agreements with payers and historical collections.
Certain revenue transactions include multiple element arrangements. We allocate revenue in these arrangements to each unit of accounting using the relative selling price method. The selling prices used during the allocation process are based on vendor specific objective evidence (“VSOE”) if available, third-party evidence (“TPE”) if VSOE is not available, or estimated selling price (“ESP”) if neither VSOE or TPE is available.
GPOs negotiate volume purchase prices for member hospitals, group practices, and other clinics. Our agreements with GPOs typically contain preferential terms for the GPO and its members, including provisions for some, if not all, of the following:
Payment of marketing fees by Natus to the GPO, usually based on purchasing experience of group members; and
Non-recourse cancellation provisions.
We do not sell products to GPOs. Hospitals, group practices, and other clinics that are members of a GPO purchase products directly from us under the terms negotiated by the GPO. Negotiated pricing and discounts are recognized as a reduction of the selling price of products at the time of the sale. Revenue from sales to members of GPOs is otherwise consistent with general revenue recognition policies as previously described.
Allowance for Doubtful Accounts
We maintain an allowance for doubtful accounts for estimated losses resulting from potential uncollectible accounts receivable. We estimate the allowance for all receivable risks by reviewing the status of each matter and recording reserves based on our experience and knowledge of the particular client and historical collection patterns. However, our actual experience may vary from our estimates. If the financial condition of our clients were to deteriorate or resulting in their inability or unwillingness to pay our fees, we may need to record additional allowances or write-offs in future periods. This risk related to a client’s inability to pay may be partially mitigated to the extent that we may receive retainers from some of our clients prior to performing services.
Inventory

Inventories are carried at the lower of cost or market, with cost being determined using the first-in, first-out method. The carrying value of our inventories is reduced for any difference between cost and estimated market value of inventories that is determined to be obsolete or unmarketable, based upon assumptions about future demand and market conditions. Adjustments to the value of our inventory establish a new cost basis and are considered permanent even if circumstances later suggest that increased carrying amounts are recoverable. Decreases in demand may result in further impairment of inventory, while increases in demand may result in the sale of inventory that had previously been written down.
Acquisition Accounting
We have made a number of acquisitions in the past and may continue to make acquisitions in the future. We account for acquired business combinations using the acquisition method of accounting. The assets acquired and liabilities assumed are recorded based on their respective fair values at the date of acquisition, with limited exceptions.acquisition. Valuations are generally completed for business acquisitions using a discounted cash flow analysis. The most significant estimates and assumptions inherent in a discounted cash flow analysis include the amount and timing of projected future cash flows, the discounted rate used to measure the risks inherent in the future cash flows, the assessment of the asset's life cycle, and the competitive and other trends impacting the asset, including consideration of technical, legal, regulatory, economic and other factors. Each of these factors and assumptions can significantly affect the value of the intangible asset. The excess of the fair value of consideration transferred over the fair value of the net assets acquired is recorded as goodwill.

Determining the useful life of an intangible asset also requires judgment, as different types of intangibles assets will have different useful lives and certain assets may even be considered to have indefinite useful lives. Useful life is the period over which the intangible asset is expected to contribute directly and indirectly to our future cash flows. We determine the useful lives of intangible assets based on a number of factors, such as legal, regulatory, or contractual provisions that may limit the useful life, and the effects of obsolescence, anticipated demand, existence or absence of competition, and other economic factors on useful life.
Carrying value of intangible assets and goodwillInventory Valuation
We amortize intangible assets with finite lives over their useful lives; any future changes that would limit their useful lives or any determination that these assetsInventories are carried at amounts greater than their estimated fairthe lower of cost or net realizable value, could result in additional charges.
Duringwith cost being determined using the second quarter of 2015, we initiated a strategy to increase the brand strength of Natus by replacing acquired product trade names with Natus branded products over time.first-in, first-out method. The implementation of this strategy places definite expected future lives on our acquired trade names which previously had indefinite lives. We assigned these trade names lives of seven years based on the timeline of our branding strategy. We will continue to assess the lives of these assets based on the timing and execution of this strategy. Amortization expense for trade names is recorded as a component of operating expense.
Goodwill is not amortized but is subject to an annual impairment analysis, which is performed as of October 1st; this assessment is also performed whenever there is a change in circumstances that indicates the carrying value of these assets may be impaired.
In 2017, 2016our inventory is reduced for any difference between cost and 2015, we performed a qualitative assessment to test goodwill for impairment. Qualitative factors considered in this assessment include industry and market considerations, overall financial performance and other relevant events and factors affecting each reporting unit. Based on our qualitative assessment, we determined that the fair value was more likely than not to be greater than its carrying amount, and no further analysis was needed.
If the fair value was less than its carrying amount, the Company would perform a two-step impairment test on goodwill. The first step of the goodwill impairment test, used to identify potential impairment, compares the fair value of a reporting unit to its carrying value, including goodwill. We use a projected discounted cash flow model to determine the fair value of a reporting unit. If the fairestimated net realizable value of the reporting unit exceedsinventory. We determine net realizable value by evaluating ending inventories for excess quantities, obsolescence, and other factors that could impact our ability to consume inventory for its carrying amount, goodwill of the reporting unit is considered not impaired, and the second step of the impairment test is not required. The second step, if required, compares the implied fair value of the reporting unit goodwill with the carrying amount of that goodwill. The fair value of a reporting unit is allocated to all of the assets and liabilities of that unit (including any unrecognized intangible assets) as if the reporting unit had been acquired in a business combination and the fair value of the reporting unit was the price paid to acquire the reporting unit. If the carrying amount of the reporting unit’s goodwill exceeds its implied fair value,intended use. Our evaluation includes an impairment charge is recognized in an amount equal to that excess.
Goodwill impairment analysis and measurement is a process that requires significant judgment. Future changes in the judgments and estimates underlying our analysis of goodwill for possible impairment, including expected future cash flows and

discount rate, could result in a significantly different estimate of the fair value of the reporting units and could result in additional impairment of goodwill.
Long lived assets
We continually monitor events and changes in circumstances that could indicate that carrying amounts of its long-lived assets, including property and equipment and intangible assets that may not be recoverable. When such events or changes in circumstances occur, we assess the recoverabilityhistorical sales by determining whether the carrying value of such assets or asset groups will be recovered through their undiscounted expected future cash flows. If the future undiscounted cash flows are less than the carrying amount of these assets, we will recognize an impairment loss based on the excess of the carrying amount over the fair value of the assets.
Liability for product, warranties
We provide a warranty with our products that is generally one year in length and in some cases, regulations may require us to provide repair or remediation beyond our typical warranty period. If any of our products contain defects, we may be required to incur additional repair and remediation costs. Service for domestic customers is provided by Company-owned service centers that perform all service, repair, and calibration services. Service for international customers is provided by a combination of Company-owned facilities and vendors on a contract basis.
A warranty reserve is included in accrued liabilities for the expected future costs of servicing products. Additions to the reserve are based on management’s best estimate of probable liability. We consider a combination of factors including material and labor costs, regulatory requirements, and other judgments in determining the amount of the reserve. The reserve is reduced as costs are incurred to honor existing warranty and regulatory obligations.
Income Taxes
We account for income taxes under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases, and for tax losses and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized.
As part of the process of preparing our consolidated financial statements, we must estimate our income tax expense for each of the jurisdictions in which we operate. This process requires significant management judgments and involves estimating our current tax exposures in each jurisdiction including the impact, if any, of additional taxes resulting from tax examinations as well as judging the recoverability of deferred tax assets. To the extent recovery of deferred tax assets is not likely based on our estimationprojections of future taxable income in each jurisdiction, a valuation allowance is established. Tax exposures can involve complex issuesdemand by product, and may require an extended periodanalysis of obsolescence by product. Adjustments to resolve. Frequent changes in tax laws in each jurisdiction complicate future estimates. To determine the tax rate, we are required to estimate full-year taxable income or loss and the related income tax expense or benefit in each jurisdiction. We update the estimated effective tax rate for the effect of significant unusual items as they are identified. Changes in the geographic mix or estimated level of annual pre-tax income can affect the overall effective tax rate, and such changes could be material.
Regarding accounting for uncertainty in income taxes, we recognize the benefit from a tax position only if it is more likely than not that the position would be sustained upon audit based solely on the technical merits of the tax position. We measure the income tax benefits from the tax positions that are recognized, assess the timing of the derecognition of previously recognized tax benefits and classify and disclose the liabilities within the consolidated financial statements for any unrecognized tax benefits based on the guidance in the interpretation of related accounting guidance for income taxes. The interpretation also provides guidance on how the interest and penalties related to tax positions may be recorded and classified within our Consolidated Statement of Income and presented in the Consolidated Balance Sheet. We classify interest and penalties related to uncertain tax positions as additional income tax expense.
Share-based compensation
We recognize share-based compensation expense associated with employee stock options under the single-option straight line method over the requisite service period, which is generally a four-year vesting period and ten-year contractual term pursuant to ASC Topic 718, Compensation-Stock Compensation. See Note 14 of our Consolidated Financial Statements.

For employee stock options, the value of each optioninventory establish a new cost basis and are considered permanent even if circumstances later suggest that increased carrying amounts are recoverable. If demand is estimated on the date of grant using the Black-Scholes option pricing model, which was developed for use in estimating the value of freely traded options. Similar to other option pricing models, the Black-Scholes method requires the input of highly subjective assumptions, including stock price volatility. Changes in the subjective input assumptions can materially affect the estimated fair value of our employee stock options.higher than expected, we may sell inventory that had previously been written down.
We recognize share-based compensation associated with Restricted Stock Awards (“RSA”) and Restricted Stock Units (“RSU”). RSAs and RSUs vest ratably over a three-year period for employees. RSAs and RSUs for executives vest over a four-year period; 50% on the second anniversary of the vesting start date and 25% on each of the third and fourth anniversaries of the vesting date. RSAs and RSUs for non employees (Board of Directors) vest over a one-year period; 100% on the first anniversary. The value is estimated based on the market value of our stock on the date of issuance pursuant to ASC Topic 718, Compensation-Stock Compensation.
We issue new shares of common stock upon the exercise of stock options and the vesting of RSAs and RSUs.
Forfeitures of employee stock options and awards are estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from initial estimates. Share-based compensation expense is recorded net of estimated forfeitures, such that expense is recorded only for those share-based awards that are expected to vest.


Results of Operations
The following table sets forth for the periods indicated selected consolidated statement of income data as a percentage of total revenue. Our historical operating results are not necessarily indicative of the results for any future period.
 
 
Percent of Revenue
Years Ended December 31,
 2017 2016 2015
Revenue100.0 % 100.0 % 100.0 %
Cost of revenue42.6 % 37.9 % 38.7 %
Intangibles amortization1.3 % 0.6 % 0.8 %
Gross profit56.1 % 61.5 % 60.5 %
Operating expenses:     
Marketing and selling25.2 % 22.2 % 23.3 %
Research and development10.3 % 8.8 % 8.1 %
General and administrative14.9 % 13.3 % 12.3 %
Intangibles amortization3.8 % 2.4 % 2.0 %
Restructuring0.2 % 0.4 % 0.6 %
Total operating expenses54.4 % 47.0 % 46.3 %
Income from operations1.7 % 14.5 % 14.2 %
Other income (expense), net
(0.7)% (0.1)% (0.3)%
Income before provision for income tax1.0 % 14.4 % 13.9 %
Provision for income tax expense5.1 % 3.2 % 3.9 %
Net income(4.1)% 11.2 % 10.1 %

Comparison of 2017 and 2016
Revenue
 Year ended December 31,
 2017 2016 Change
Neuro     
Devices and Systems$171,315
 $168,200
 2 %
Supplies59,955
 58,681
 2 %
Services11,886
 11,641
 2 %
Total Neurology Revenue243,156
 238,522
 2 %
Newborn Care     
Devices and Systems77,573
 72,562
 7 %
Supplies43,732
 47,674
 (8)%
Services22,325
 23,134
 (3)%
Total Newborn Care Revenue143,630
 143,370
  %
Otometrics     
Devices and Systems$86,920
 $
  %
Supplies27,264
 
  %
Services
 
  %
Total Otometrics Revenue114,184
 
  %
Total Revenue$500,970
 $381,892
 31 %
 
Percent of Revenue
Years Ended December 31,
 2019 2018 2017
Revenue100.0 % 100.0 % 100.0 %
Cost of revenue39.7 % 41.1 % 42.6 %
Intangibles amortization1.4 % 1.7 % 1.3 %
Gross profit58.9 % 57.3 % 56.1 %
Operating expenses:     
Marketing and selling26.1 % 25.7 % 25.2 %
Research and development11.9 % 11.6 % 10.3 %
General and administrative12.0 % 13.3 % 14.9 %
Intangibles amortization3.1 % 4.3 % 3.8 %
Restructuring9.0 % 7.0 % 0.2 %
Total operating expenses62.1 % 61.9 % 54.4 %
Income (loss) from operations(3.2)% (4.6)% 1.7 %
Other expense, net
(1.1)% (1.5)% (0.7)%
Income (loss) before provision (benefit) for income tax(4.3)% (6.1)% 1.0 %
Provision (benefit) for income tax expense(1.1)% (1.8)% 5.1 %
Net loss(3.2)% (4.3)% (4.1)%
Comparison of 2019 and 2018
Revenue
 Years ended December 31,
 2019 2018 Change
Neuro     
Devices and Systems$220,306
 $200,762
 10 %
Supplies66,059
 67,025
 (1)%
Services871
 12,000
 (93)%
Total Neuro Revenue287,236
 279,787
 3 %
Newborn Care     
Devices and Systems53,465
 72,807
 (27)%
Supplies38,264
 40,669
 (6)%
Services19,183
 20,396
 (6)%
Total Newborn Care Revenue110,912
 133,872
 (17)%
Hearing & Balance     
Devices and Systems$92,050
 $110,597
 (17)%
Supplies4,977
 6,635
 (25)%
Services
 
  %
Total Hearing & Balance Revenue97,027
 117,232
 (17)%
Total Revenue$495,175
 $530,891
 (7)%
For the year ended December 31, 2017, Neurology2019, Neuro revenue increased by 2% compared to the prior year with the growth in our international markets partly offset by a decline in our domestic market. Devices and Systems revenue increased by 2% for the year ended December 31, 2017 compared to the prior year due mainly to the addition of acquired Neurosurgery products partly offset by declines in core Neurology products. Supplies revenue for 2017 increased 2%. Services revenue increased by 2% compared to the prior year due mainly to growth in existing markets for GND.
For the year ended December 31, 2017, Newborn Care revenue remained flat3% compared to the prior year. Devices and Systems revenue increased by 7% due primarily from revenue generated from our RetCam acquisition in July 2016 and sales to the Venezuela Ministry of Health in the first quarter of 2017. Supplies revenue decreased 8% compared to the prior year on lower demand due to lower birth rates and supplies customers converting to our Peloton screening service. Services revenue decreased by 3%10% compared to the prior year due primarily to the completion of services performedgrowth in EEG sales. Supplies revenue for the Venezuela Ministry of Health in 2016 and the completion of certain contracted services2019 decreased 1%, which was driven by declines in our Neometrics Data Management business.international markets. Services revenue from GND decreased 93% compared to the prior year due to our exit from this business in January 2019.
For the year ended December 31, 2017, all Otometrics2019, Newborn Care revenue was incremental as we acquired this business on January 3, 2017.
No single customer accounted for more than 10% of our revenue in either 2017 or 2016. Revenue from domestic sales increased 8% to $270.9 million in 2017, from $250.7 million in 2016 duedecreased by 17% compared to the acquisition of Otometricsprior year. Devices and growth in our Newborn care business. Revenue from international sales increased 75% in 2017 to $230.1 million from $131.2 million in 2016Systems revenue decreased by 27%. The decrease is primarily due to the 2017 acquisitiondivestiture of Otometrics. RevenueMedix, exit from domestic sales was 54% of totalour balance and mobility product line, and planned product line rationalization. Supplies revenue in 2017decreased 6% compared to 66%the prior year related to divestiture of totalMedix business and product line rationalization. Services revenue in 2016, and revenue from international sales was 46% of total revenue in 2017decreased by 6% compared to 34% of total revenue in 2016.
Cost of Revenue and Gross Profit
 Year ended December 31,
 2017 2016
Revenue$500,970
 $381,892
Cost of revenue213,376
 144,632
Intangibles amortization6,380
 2,327
Gross profit281,214
 234,933
Gross profit percentage56.1% 61.5%
the prior year

primarily due to a lower collection per screen and decrease in screening volume on our Peloton hearing screening service, which was exited as of December 31, 2019.
For the year ended December 31, 2017,2019, Hearing & Balance revenue decreased 17% compared to the prior year. Revenue from Devices and Systems decreased 17% and revenue from Supplies decreased 25% in 2019 compared to 2018. The overall decline in Hearing & Balance was driven by the impact of product rationalization and ship holds on some products.
Cost of Revenue and Gross Profit
 Years ended December 31,
 2019 2018
Revenue$495,175
 $530,891
Cost of revenue196,551
 217,952
Intangibles amortization6,916
 8,924
Gross profit291,708
 304,015
Gross profit percentage58.9% 57.3%
For the year ended December 31, 2019, our gross profit as a percentage of sales decreasedincreased by 5.4%160 basis points compared to the prior year. This decreaseincrease was primarily attributable to cost reductions in gross profit was driven by the acquisitionour operations overhead and our exit from lower margin businesses as a result of Otometrics whose products have lower margins than our neurolcorporate reorganization announced in January 2019 and newborn care products, higher warranty reserve for our NeoBLUE® phototherapy system recall,a reduction in intangible amortization and unfavorable geographic mix as we sold more product through our international distributor channels which yield low gross margin than our direct sales.restructuring costs incurred in 2018 related to business line exits.
Operating Costs
Year ended December 31,Years ended December 31,
2017 20162019 2018
Marketing and selling$126,166
 $84,834
$129,109
 $136,680
Percentage of revenue25.2% 22.2%26.1% 25.7%
Research and development$51,822
 $33,443
$58,733
 $61,482
Percentage of revenue10.3% 8.8%11.9% 11.6%
General and administrative$74,424
 $50,877
$59,649
 $70,599
Percentage of revenue14.9% 13.3%12.0% 13.3%
Intangibles amortization$19,171
 $8,983
$15,144
 $22,585
Percentage of revenue3.8% 2.4%3.1% 4.3%
Restructuring$914
 $1,536
$44,739
 $37,231
Percentage of revenue0.2% 0.4%9.0% 7.0%
Marketing and Selling
Marketing and selling expenses increasedas a percentage of revenue remained relatively flat in 2017the year ended December 31, 2019 as compared to 2016. Thisthe prior year. The decrease in expense is primarily driven bymainly attributable to the benefits of our acquisition of Otometrics.corporate reorganization initiated in January 2019.
Research and Development
Research and development expenses increaseddecreased during the year ended December 31, 20172019 compared to the prior year. This is primarily driven by activitiesThe decrease relates to lower compensation related primarilyexpenses due to the remediation of certain deficiencies identified by the FDA in our Newborn Care business as well as the Otometrics acquisition.corporate reorganization initiatives.
General and Administrative
General and administrative expenses decreased during the year ended December 31, 2019 compared to the prior year. This decrease was due to a reduction in employee expenses, consulting fees and travel expenses due to our corporate reorganization and exit from non-core businesses.
Intangibles Amortization

Intangibles amortization decreased in the year ended December 31, 2019 compared to the prior year. The decrease is related to our restructuring initiatives, which included an impairment charge of $5.6 million in 2018 related to the end of life of our Bio-Logic core technology that did not recur in 2019.
Restructuring
Restructuring costs increased during the year ended December 31, 20172019 compared to the prior year. This increase was driven by the restructuring initiatives announced in January 2019. We recorded an impairment related to the sale of Medix, which included the recognition of deferred foreign currency related adjustments in accumulated other comprehensive income, of $24.8 million, net of tax, and an adjustment of $4.6 million for assets with a book value in excess of their fair market value. The increase is related primarily to the Otometrics acquisition.
Intangibles Amortization
Intangibles amortization increased in 2017 compared to 2016. The increase is mainlywas also driven by additional intangible amortization from the acquisition of Otometrics and, to a lesser extent, the Integra Asset Acquisition as well as the 2016 NeuroQuest and RetCam acquisitions.
Restructuring
Restructuring costs decreased during the year ended December 31, 2017 compared to the prior year. In the prior year we experienced higherrestructuring expenses incurred related to facilities consolidationexiting the GND business and severance expense to reduce redundant costs as well asour restructuring charges related mostly to the abandonment of two facilities.initiatives.
Other Income (Expense), net
Other income (expense), net consists of interest income, interest expense, net currency exchange gains and losses, and other miscellaneous income and expense. We reported other expense, net of $3.6$5.6 million in 2017,the year ended December 31, 2019, compared to $0.4$7.7 million in 2016.the prior year. We reported $1.0$0.8 million of foreign currency exchange gainslosses in 2017the year ended December 31, 2019 versus $0.3$0.8 million of foreign currency losses in 2016.This increase was driven primarily by the changing value of foreign currencies in which we transact. prior year.Interest expense was $5.1$4.9 million in 2017the year ended December 31, 2019 compared to $0.4$6.8 million in 2016 due tothe prior year. The reduction in interest expense was driven by accelerated payments on our $155.0 million debt outstanding while interestdebt. Interest income of $0.4 million in 2017 was $0.3 million more thanin both the amount reported for 2016.year ended December 31, 2019 and the prior year.
Provision for Income Tax

The effective tax rate (“ETR”) for 2017the year ended December 31, 2019 was 494.0%26.3% as compared to 22.4%28.9% for 2016. The significantly higherthe prior year. Significant items that impact the effective tax rate in 2017 compared with 2016 is primarily due toare the impacts of the 2017 Tax Act, including the repatriation tax on accumulated foreign earnings and re-measurement of net deferred tax assets. Other increases include withholding taxes from distribution of income and additional tax expense related to the settlement of tax audits in foreign jurisdictions, offset by change in geographic mix of income, adjustments and utilizationreversals of certainuncertain tax creditspositions and SAB 118 adjustments arising from the 2017 Tax Act that were recorded in domestic and foreign jurisdictions.2018.
Comparison of 20162018 and 20152017
Revenue
Year ended December 31,Years ended December 31,
2016 2015 Change2018 2017 Change
Neuro          
Devices and Systems$168,200
 $168,776
  %$200,762
 $171,315
 17 %
Supplies58,681
 60,205
 (3)%67,025
 59,955
 12 %
Services11,641
 8,320
 40 %12,000
 11,886
 1 %
Total Neurology Revenue238,522
 237,301
 1 %
Total Neuro Revenue279,787
 243,156
 15 %
Newborn Care          
Devices and Systems72,562
 72,669
  %72,807
 89,027
 (18)%
Supplies47,674
 49,982
 (5)%40,669
 43,928
 (7)%
Services23,134
 15,913
 45 %20,396
 22,325
 (9)%
Total Newborn Care Revenue143,370
 138,564
 3 %133,872
 155,280
 (14)%
Hearing & Balance     
Devices and Systems110,597
 75,466
 47 %
Supplies6,635
 27,068
 (75)%
Services
 
  %
Total Hearing & Balance Revenue117,232
 102,534
 14 %
Total Revenue$381,892
 $375,865
 2 %$530,891
 $500,970
 6 %
For the year ended December 31, 2016, Neurology2018, Neuro revenue increased by 1% compared to the prior year with the growth in our domestic market partly offset by a decline in our international markets. Devices and Systems revenue remained constant for the year ended December 31, 201615% compared to the prior year. SuppliesDevices and Systems revenue for 2016 decreased 3%increased by 17% compared to the prior year due mainlyprimarily to softnessthe addition of acquired Neurosurgery products and growth in EEG sales. Supplies revenue for 2018 increased 12%, which was also driven by the addition of our Neurosurgery business and organic growth in our domestic market.Neurodiagnostic supply business. Services revenue from GND increased by 40%1% compared to the prior year due mainly to the acquisition of NeuroQuest in March 2016 to complement our GND and Monarch acquisitions.year.

For the year ended December 31, 2016,2018, Newborn Care revenue increaseddecreased by 3%14% compared to the prior year. Devices and Systems revenue decreased by 18%. The decrease is primarily due to the recognition of $10.0 million of revenue in the first half of 2017 from our contract with the government of Venezuela, which did not reoccur in 2018. We also experienced a one-

time shipment of neoBLUE blanket backlog in the first quarter of 2017 and a one-time shipment of hearing devices and supplies to China, Japan, and Australia in the second quarter of 2017. Supplies revenue decreased 7% compared to the prior year related to revenue contract with growth in both international and domestic markets. Devices and Systems revenue remained flat year over year, as revenue generated from the RetCam acquisition and thegovernment of Venezuela, contract was offset by lower revenue from hearing devices, due to Peloton cannibalization, voluntary ship holds, and lower revenue on Incubators and Warmers, due to exiting the U.S. market, and lower revenue from Brain Injury devices, due to higher revenue from China in 2015 thatwhich did not repeatreoccur in 2016. Supplies2018, as well as product line rationalization. Services revenue for the twelve-month period decreased 5%by 9% compared to the prior year mainly due to our ability to convert customers over to our Peloton screening service business. Services revenue increased by 45% compared to the prior year due mainly to the growth in Peloton and our Neometrics Data Management services.
No single customer accounted for more than 10% of our revenue in either 2016 or 2015. Revenue from domestic sales increased 4% to $250.7 million in 2016, from $242.1 million in 2015 primarily due to an increase ina lower collection per screen on our services business and continued strong demand for our devices and systems in the U.S. Revenue from international sales decreased 2% in 2016 to $131.2 million from $133.8 million in 2015 due to on-going weakness in our international markets due, in part, to the strong dollar against the Euro and Canadian dollar. Revenue from domestic sales was 66% of total revenue in 2016 compared to 64% of total revenue in 2015, and revenue from international sales was 34% of total revenue in 2016 compared to 36% of total revenue in 2015.Peloton hearing screening service.
Cost of Revenue and Gross Profit
 Year ended December 31,
 2016 2015
Revenue$381,892
 $375,865
Cost of revenue144,632
 145,492
Intangibles amortization2,327
 2,836
Gross profit234,933
 227,537
Gross profit percentage61.5% 60.5%

For the year ended December 31, 2016,2018, Hearing & Balance revenue increased 14% compared to the prior year. Revenue from Devices and Systems increased 47% and revenue from Supplies decreased 75% in 2018 compared to 2017. The overall growth in Hearing & Balances was driven by increased market share primarily in Europe and China. In addition to increased market share, Hearing & Balance also benefited from favorable exchanges rates and the launch of our new Otoscan product in 2018.
Cost of Revenue and Gross Profit
 Years ended December 31,
 2018 2017
Revenue$530,891
 $500,970
Cost of revenue217,952
 213,376
Intangibles amortization8,924
 6,380
Gross profit304,015
 281,214
Gross profit percentage57.3% 56.1%
For the year ended December 31, 2018, our gross profit as a percentage of sales increased by 1%1.2% compared to the prior year. This increase was primarily attributable to the improvement in Newborn Care gross profit, which was driven bylower in the prior year due to sales to the government of Venezuela which carry a $6.6 million charge in 2015 recorded to accrue for the estimated costs of bringing certain NeoBLUE® phototherapy products into U.S. regulatory compliance. These increases inlower gross margin. We also experienced an increase on gross profit were also driven byon our Neurosurgery products where we experienced higher domestic revenuessales in the U.S. which generally havecarry higher gross margins than international sales, as well as cost reduction initiatives which resulted in higher margins primarily in Neurology devices.margins.
Operating Costs
Year ended December 31,Years ended December 31,
2016 20152018 2017
Marketing and selling$84,834
 $87,675
$136,680
 $126,166
Percentage of revenue22.2% 23.3%25.7% 25.2%
Research and development$33,443
 $30,434
$61,482
 $51,822
Percentage of revenue8.8% 8.1%11.6% 10.3%
General and administrative$50,877
 $46,363
$70,599
 $74,424
Percentage of revenue13.3% 12.3%13.3% 14.9%
Intangibles Amortization$8,983
 $7,447
$22,585
 $19,171
Percentage of revenue2.4% 2.0%4.3% 3.8%
Restructuring$1,536
 $2,145
$37,231
 $914
Percentage of revenue0.4% 0.6%7.0% 0.2%
Marketing and Selling
Marketing and selling expenses decreasedas a percentage of revenue remained relatively flat in 2016the year ended December 31, 2018 as compared to 2015. Thisthe prior year. The increase in expense is primarily related to a favorable change in estimate in the GND earnout liability in 2016 based on projected GND annualfor incremental costs of payroll, commissions, and travel associated with higher revenue.
Research and Development
Research and development expenses increased during the year ended December 31, 20162018 compared to the prior year. The increase relates to increased spend on new product development, including Otoscan and RetCam products, and the addition of Neurosurgery products. These increases were partially offset by a reduction in spend related to remediation activities within our Newborn Care business.
General and Administrative

General and administrative expenses decreased during the year ended December 31, 2018 compared to the prior year. This is primarily driven by activitiesdecrease was due to a reduction in bad debt expense related to the remediation of certain deficiencies identifiedour GND and Peloton businesses.
Intangibles Amortization
Intangibles amortization increased in our Seattle quality system as well as the RetCam acquisition.
General and Administrative
General and administrative expenses increased during the year ended December 31, 20162018 compared to the prior year. The increase is related to the impairment charge incurred in 2018 in relation to an increaseend of $0.6 millionlife decision on our Bio-logic core technology of $5.6 million. This impairment charge was partially offset by purchase accounting adjustments in billing costs due2017 related to Peloton growth and the addition of $1.6 million expenses following the NeuroQuestour Integra and RetCam acquisitions.
Intangibles Amortization
Intangibles amortization increasedacquisitions which did not recur in 2016 compared to 2015. The increase is partly due to additional intangible amortization from the 2016 acquisitions of NeuroQuest and RetCam. Additionally, we assigned our previously indefinite lived trade names definite lives of seven years in the second quarter of 2015. As such, there is a full year of amortization for trade names in 2016 compared to a half year in 2015.2018.
Restructuring
Restructuring costs decreasedincreased during the year ended December 31, 20162018 compared to the prior year. This increase included costs associated with our executive management transition, which were approximately $10.0 million and were primarily comprised of accelerated vesting of stock compensation and severance expense. In 20152018 we experienced higher expensesimpairment charges associated with exiting two of our non-core businesses, GND and Neurocom, which were categorized as restructuring expenses. We recorded a $14.8 million goodwill impairment charge related to facilities consolidationGND. Impairment charges were also recorded for intangible and severance expense comparedfixed assets related to 2016GND and Neurocom, which totaled $2.8 million. Restructuring expenses were also incurred in which restructuring charges related mostly2018 in relation to the abandonmentannouncement of two facilities.our new organizational structure, "One Natus."
Other Income (Expense), net
Other income (expense), net consists of interest income, interest expense, net currency exchange gains and losses, and other miscellaneous income and expense. We reported other expense, net of $0.3$7.7 million in 2016,the year ended December 31, 2018, compared to $1.0$3.6 million in 2015.the prior year. We reported $0.3$0.8 million of foreign currency exchange losses in 2016the year ended December 31, 2018 versus $1.4$1.0 million of foreign currency gains in 2015.the prior year.This increase was driven primarily by the decliningchanging value of foreign currencies in which we transact. Interest expense was $0.4$6.8 million in 2016the year ended December 31, 2018 compared to $0.3$5.1 million in 2015. This was offset bythe prior year related to interest expense payments on our outstanding debt while interest income of $0.3 million in 2016 whichthe year ended December 31, 2018 was $0.3$0.1 million moreless than the amount reported for 2015.

the prior year.
Provision for Income Tax
The effective tax rate (“ETR”) for 2016the year ended December 31, 2018 was 22.4%28.9% as compared to 27.6%494.0% for 2015.the prior year. The significantly lower effective tax rate in 2016the year ended December 31, 2018 compared with 2015the prior year is primarily due to the effect from adoptionimpacts of ASU 2016-09 which resulted in excessthe 2017 Tax Act, including the repatriation tax benefits beingon accumulated foreign earnings and re-measurement of net deferred tax assets recorded in income tax expense as discrete items, lower state tax expense,the prior year, a reduction of certain uncertain tax positions, and the change in geographic mixwithholding taxes from distribution of income, offset by additional tax expense relatedand reduction in the U.S. Federal corporate rate from 35% to the settlement of a tax audit in a foreign jurisdiction.21%.


Liquidity and Capital Resources
Liquidity is our ability to generate sufficient cash flows from operating activities to meet our obligations and commitments. In addition, liquidity includes the ability to obtain appropriate financing and to raise capital. Therefore, liquidity cannot be considered separately from capital resources that consist of our current funds and the potential to increase those funds in the future. We plan to use these resources in meeting our commitments and in achieving our business objectives.
We believe that our current cash and cash equivalents and any cash generated from operations will be sufficient to meet our ongoing operating requirements for the foreseeable future.
As of December 31, 2017,2019, we had cash and cash equivalents outside the U.S. in certain of our foreign operations of $74.0$51.0 million. We intend to permanently reinvest this cash held by our foreign subsidiaries except for Excel-Tech and Natus Ireland subsidiaries, which we intend to repatriate. If, however, a portion of these permanently reinvested funds were needed and distributed to our operations in the United States, we may be subject to additional U.S. income taxes and foreign withholding taxes depending on facts and circumstances at the time of distribution. The amount of taxes due would depend on the amount and manner of repatriation, as well as the location from where the funds were repatriated.
On September 23, 2016, we entered into a Credit Agreement with JP Morgan Chase Bank (“JP Morgan”) and, Citibank, NA (“Citibank”) and Wells Fargo Bank, National Association (“Wells Fargo”). The Credit Agreement provides for an aggregate $150.0 million of secured revolving credit facility (the “Credit Facility”). On September 15, 2017, we exercised our right to increase the amount available under the facility by $75.0 million, bringing the aggregate revolving credit facility to $225.0 million. The Credit Agreement contains covenants, including covenants relating to maintenance of books and records, financial reporting and notification, compliance with laws, maintenance of properties and insurance, and limitations on guaranties,

investments, issuance of debt, lease obligations and capital expenditures. The Credit Agreement provides for events of default, including failure to pay any principal or interest when due, failure to perform or observe covenants, bankruptcy or insolvency events and the occurrence of a material adverse effect. The Company hasWe have no other significant credit facilities. As of December 31, 20172019 we had $155.0$55.0 million outstanding under the Credit Facility.
December 31, 2017 December 31, 2016 December 31, 2015December 31, 2019 December 31, 2018 December 31, 2017
Cash, cash equivalents, and investments$88,950
 $247,570
 $82,469
$63,297
 $56,373
 $88,950
Debt154,283
 140,000
 
54,665
 104,474
 154,283
Working capital213,491
 325,858
 164,248
126,928
 152,329
 213,491
Year EndedYear Ended
December 31, 2017 December 31, 2016 December 31, 2015December 31, 2019 December 31, 2018 December 31, 2017
Net cash provided by operating activities$19,726
 $72,687
 $36,852
$60,060
 $33,020
 $19,726
Net cash used in investing activities(160,935) (53,264) (19,478)(5,339) (8,389) (160,935)
Net cash provided by financing activities5,826
 118,417
 832
Net cash provided by (used in) financing activities(48,532) (49,512) 5,826
Comparison of 2017, 2016,2019, 2018, and 20152017
During 2019 cash generated from operating activities of $60.1 million was the result of $15.7 million of net loss, non-cash adjustments to net loss of $63.2 million, and net cash outflows of $12.5 million from changes in operating assets and liabilities. The non-cash adjustments were $30.7 million of depreciation and amortization expense, $24.6 million of impairment for the sale of Medix, $8.4 million from share-based compensation, $2.9 million of warranty reserves, and $1.6 million of accounts receivable reserves, offset by deferred taxes of $5.4 million. Cash used in investing activities during the period was $5.3 million and consisted of cash used to acquire other property and equipment. Cash used in financing activities during the year ended December 31, 2019 was $48.5 million and consisted of repayments of $50.0 million of our outstanding debt under the Credit Facility, $1.7 million for taxes paid related to net share settlement of equity awards, $0.5 million of principal payments of financing lease liability, offset by proceeds from stock option exercises and Employee Stock Purchase Program (“ESPP”) purchases of $3.6 million.
During 2018 cash generated from operating activities of $33.0 million was the result of $22.9 million of net loss, non-cash adjustments to net loss of $70.1 million, and net cash outflows of $14.1 million from changes in operating assets and liabilities. The non-cash adjustments were $33.9 million of depreciation and amortization expense, $17.1 million from share-based compensation, a $14.8 million goodwill impairment charge related to GND, $8.2 million from intangible impairments, $6.9 million of accounts receivable reserves, and $2.2 million of warranty reserves, offset by deferred taxes of $13.7 million. Cash used in investing activities during the period was $8.4 million and consisted primarily of cash used to acquire other property and equipment of $7.9 million. Cash used in financing activities during the year ended December 31, 2018 was $49.5 million and consisted of repayments of $50.0 million of our outstanding debt under the Credit Facility, $5.6 million for repurchases of common stock under our share repurchase program, $5.2 million for taxes paid related to net share settlement of equity awards, offset by proceeds from stock option exercises and Employee Stock Purchase Program purchases of $11.5 million.
During 2017 cash generated from operating activities of $19.7 million was the result of $20.3 million of net loss, non-cash adjustments to net loss of $53.5$60.6 million, and net cash outflows of $13.3$20.6 million from changes in operating assets and liabilities. The non-cash adjustments were $30.1 million of depreciation and amortization expense, $10.0 million of accounts receivable reserves, $9.4 million from share-based compensation, $5.4 million of warranty reserves, $4.0 of deferred taxes and $1.7 million from intangible impairments. The change in operating assets and liabilities was driven primarily by an increase in accounts receivable and lower collections during the year compared to the prior year, and a decrease in deferred revenue related to the Venezuelan contract, partially offset by an increase in accrued liabilities for the transition tax under the Act for the deemed repatriation of foreign earnings and decreases in inventories and other assets. Cash used in investing activities during the period was $161.1 million and consisted primarily of the acquisition of Otometrics for $143.6 million, net of cash, and the Integra Asset Acquisitionasset acquisition for $46.4

million, offset by sales of short-term investments of $34.0 million. Cash used to acquire other property and equipment was $4.1 million. Cash provided by financing activities during the year ended December 31, 2017 was $5.8 million and consisted of proceeds from borrowings under the Credit Facility of $60.0 million along with proceeds from stock option exercises and Employee Stock Purchase Program (“ESPP”) purchases of $3.5 million, offset by $45.0 million repayment of debt under the Credit Facility, $7.0 million for taxes paid related to net share settlement of equity awards, $3.0 million for contingent acquisition consideration, $2.3 million for repurchases of common stock under our share repurchase program, and $0.3 million of deferred debt issuance costs.
During 2016 cash generated from operating activities of $72.7 million was the result of $42.6 million of net income, non-cash adjustments to net income of $29.9 million, and net cash outflows of $0.1 million from changes in operating assets and liabilities. The change in operating assets and liabilities was driven primarily by a decrease in accounts receivable following increased collections efforts, an increase in deferred revenue following receipt of payment from the Ministry of Health of Venezuela, and an increase in prepaid expenses related to prepayments we made to our distribution partner for the Venezuelan contract. Cash used in investing activities during the period was $53.3 million and consisted primarily of purchases of short-term investments of $34.0 million, as well as cash used in the acquisitions of RetCam of $10.6 million and NeuroQuest of $4.6 million, in each case net of cash acquired. Cash used to acquire other property and equipment and intangible assets was $3.4 million. Cash provided by financing activities during the year ended December 31, 2016 was $118.4 million and consisted primarily of outstanding debt under the current Credit Facility of $140.0 million along with proceeds from stock option exercises and Employee Stock Purchase Program (“ESPP”) purchases and their related tax benefits of $3.6 million, offset by $19.3 million for repurchases of common stock under our share repurchase program, $4.1 million for taxes paid related to net share settlement of equity awards, $1.3 million for contingent acquisition consideration, and $0.5 million of deferred debt issuance costs. Under the prior credit facility that was terminated in connection with our entry into the new facility, the Company borrowed and repaid a total of $16.0 million as of December 31, 2016.
During 2015 cash generated from operating activities of $36.9 million was the result of $37.9 million of net income, non-cash adjustment to net income of $28.0 million, and net cash outflows of $29.1 million from changes in operating assets and liabilities. Cash used in investing activities during the period was $19.5 million and consisted primarily of cash used related to the acquisition of GND, Monarch and NicView. Cash used to acquire other property and equipment and intangible assets was $5.4 million. Cash provided by financing activities during the year ended December 31, 2015 was $0.8 million and consisted of proceeds from stock option exercises and ESPP purchases and their related tax benefits of $17.4 million, offset by $11.5 million for repurchases of common stock under our share repurchase program, $4.3 million for taxes paid related to net share settlement of equity awards, and $0.7 million for contingent acquisition consideration, which we acquired in 2014.
Future Liquidity

Our future liquidity and capital requirements will depend on numerous factors, including the:
Amount and timing of revenue;
Extent to which our existing and new products gain market acceptance;
Extent to which we make acquisitions;
Cost and timing of product development efforts and the success of these development efforts;
Cost and timing of marketing and selling activities; and
Availability of borrowings under line of credit arrangements and the availability of other means of financing.
Contractual Obligations
In the normal course of business, we enter into obligations and commitments that require future contractual payments. The commitments result primarily from purchase orders placed with contract vendors that manufacture some of the components used in our medical devices and related disposable supply products, purchase orders placed for employee benefits and outside services, as well as commitments for leased office space, leased equipment, and bank debt. The following table summarizes our contractual obligations and commercial commitments as of December 31, 20172019 (in thousands):

  Payments Due by Period  Payments Due by Period
Total 
Less than
1 Year
 1-3 Years 4-5 Years 
More than
5 Years
Total 
Less than
1 Year
 1-3 Years 4-5 Years 
More than
5 Years
Unconditional purchase obligations$50,035
 $47,842
 $2,193
 $
 $
$44,955
 $44,955
 $
 $
 $
Operating lease obligations30,078
 7,038
 10,340
 5,849
 6,851
Bank debt155,000
 
 
 155,000
 
55,000
 
 55,000
 
 
Interest payments14,813
 5,950
 7,726
 1,137
 
2,390
 1,907
 483
 
 
Repatriation tax12,135
 $971
 $1,942
 $1,942
 $7,280
9,113
 797
 1,751
 3,830
 2,735
Total$262,061
 $61,801
 $22,201
 $163,928
 $14,131
$111,458
 $47,659
 $57,234
 $3,830
 $2,735
Purchase obligations are defined as agreements to purchase goods or services that are enforceable and legally binding. Included in the purchase obligations category above are obligations related to purchase orders for inventory purchases under our standard terms and conditions and under negotiated agreements with vendors. We expect to receive consideration (products or services) for these purchase obligations. The purchase obligation amounts do not represent all anticipated purchases in the future, but represent only those items for which we are contractually obligated. The table above does not include obligations under employment agreements for services rendered in the ordinary course of business.
We have a Credit Agreement with JP Morgan Chase Bank, Citibank, and Wells Fargo which matures in 2021. We have recorded this obligation in the payments due in one to three years category in the table above based on the maturity date of the Agreement. As of December 31, 2019 we have classified $35.0 million out of the $55.0 million outstanding as short-term on our balance sheet due to our intent to repay this portion over the next twelve months.
We are not able to reasonably estimate the timing of any potential payments for uncertain tax positions under ASCAccounting Standards Codification ("ASC") 740, Accounting for Uncertainty in Income Taxes—an interpretation of FASB Statement 109. As a result, the preceding table excludes any potential future payments related to our ASC 740 liability for uncertain tax positions. See Note 17 of our Consolidated Financial Statements for further discussion on income taxes.
Quantitative and Qualitative Disclosures about Market Risk
We are exposed to various market risks, including changes in foreign currency exchange rates and interest rates that could adversely affect our results of operations and financial condition. We are exposed to interest rate risk on our LIBOR-indexed floating-rate debt. We have entered into an interest rate swap agreement to effectively covert a portion of our floating-rate debt to a fixed-rate. The principal objective of the swap contract is to reduce the variability of future earnings and cash flows associated with our floating-rate debt. We do not hold or issue derivative instruments for trading or other speculative purposes.

Foreign Exchange Rate Risk
We develop products in the U.S, Canada, Europe, and Argentina,Europe, and sell those products into more than 100 countries throughout the world. As a result, our financial results could be affected by factors such as changes in foreign currency exchange rates or weak economic conditions in foreign markets. Most of our sales in Europe and Asia are denominated in the U.S. Dollar and Euro, and with a portion of our sales denominated in the Canadian dollar Argentine peso and British pound. As our sales in currencies other than the U.S. dollar increase, our exposure to foreign currency fluctuations may increase.

In addition, changes in exchange rates also may affect the end-user prices of our products compared to those of our foreign competitors, who may be selling their products based on local currency pricing. These factors may make our products less competitive in some countries.
If the U.S. Dollar uniformly increased or decreased in strength by 10% relative to the currencies in which our sales were denominated, our net income would have correspondingly increased or decreased by an immaterial amount for the year ended December 31, 2017.
Our interest expense is sensitive to changes in interest rates and may vary with the federal funds rate and London Interbank Offered Rate (LIBOR). However, we may decrease interest rate risk by keeping our debt leverage low, as a hypothetical decrease of 10% in market interest rates would not result in a material decrease in interest expense paid on debt held at December 31, 2017.2019.
All of the potential changes noted above are based on sensitivity analyses performed on our financial position as of December 31, 2017.2019. Actual results may differ as our analysis of the effects of changes in interest rates does not account for, among other things, sales of securities prior to maturity and repurchase of replacement securities, the change in mix or quality of the investments in the portfolio, and changes in the relationship between short-term and long-term interest rates.
Off-Balance Sheet ArrangementsInterest Rate Risk
Under our bylaws,In 2018, we have agreed to indemnify our officers and directors for certain events or occurrences arisingentered into an interest rate swap agreement with a notional amount of $40.0 million, designated as a resultcash flow hedge, to hedge the variability of the officer or director’s servingcash flows in such capacity. We have a directorsinterest payments associated with our floating-rate debt. This interest rate swap agreement matures in September 2021 and officers' liability insurance policy that limits our exposure and enables us to recoverconverts a portion of any future amounts paid resulting from the indemnification of our officers and directors. In addition, we enter into indemnification agreements with other parties in the ordinary course of business. In some cases we have obtained liability insurance providing coverage that limits our exposure for these other indemnified matters. We have not incurred material costsLIBOR floating-Rate debt to defend lawsuits or settle claims related to these indemnification agreements. We believe the estimatedfixed-rate debt. The fair value of these indemnification agreementsthe interest rate swap agreement is minimalbased upon inputs corroborated by observable market data. Changes in the fair value of the interest rate swap agreement are recorded as a component of accumulated other comprehensive income (loss) within stockholders' equity and have not recorded a liability for these agreements asare amortized to interest expense over the term of the related debt.
As of December 31, 2017.2019, accumulated other comprehensive income (loss) related to the interest rate swap agreement included a net unrealized loss of approximately $143 thousand, net of tax, which will be recognized in interest expense after the following 12 months, at the then current values on a pre-tax basis. See Note 12 to these Condensed Consolidated Financial Statements for additional discussion on our financial instruments and derivatives.
Interest Rate Risk Sensitivity Analysis
Our remaining indebtedness is at variable rates of interest. Accordingly, changes in interest rates would impact our results of operations in future periods. Based on a sensitivity analysis on actual rates experienced during 2019, a hypothetical increase in interest rates of 50 basis points would have resulted in increased interest expense of $0.4 million during the year ended December 31, 2019.
Recently Issued Accounting Pronouncements
In June 2016, the FASB issued ASU 2016-13, Credit Losses (Topic 326). This update requires financial assets measured at amortized cost, such as trade receivables and contract assets, to be presented net of expected credit losses, which may be estimated based on relevant information such as historical experience, current conditions, and future expectation for each pool of similar financial assets. The new guidance requires enhanced disclosures related to trade receivables and associated credit losses. In May 2019, the FASB issued ASU 2019-05 which provides targeted transition relief guidance intended to increase comparability of financial statement information. The guidance for both updates is effective beginning January 1, 2020. We had no other off-balance sheet arrangements duringdo not believe adoption will have a material impact to our consolidated financial statements.
    In August 2018, the FASB issued ASU 2018-13 Fair Value Measurement (Topic 813), Disclosure Framework-Changes to the Disclosure Requirements for Fair Value Measurement. This update amends Topic 820 to add, remove, and clarify disclosure requirements related to fair value measurement disclosure. For calendar year-end entities, the update will be effective for annual periods beginning January 1, 2020, and interim periods within those fiscal years. Early adoption of the amendments is permitted, including adoption in any of fiscal 2017, 2016 or 2015 that had, or are reasonably likelyinterim period. As the standard relates only to disclosures, we do not expect the adoption to have a material effectimpact on our consolidated financial condition, resultsstatements.
In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740), Simplifying the Accounting for Income Tax. This update includes removal of operations, or liquidity.
Recent Accounting Pronouncements

See Note 1—Organization and Significant Accounting Policiescertain exceptions to the Consolidated Financial Statements contained hereingeneral principles of ASC 740, Income taxes, and simplification in several other areas such as accounting for a full descriptionfranchise tax (or similar tax) that is partially based on income. The ASU is effective for us on January 1, 2021. We are in the process of recent accounting pronouncements includingevaluating the respective expected datesimpact of adoption and effectsthis standard on results of our operations andconsolidated financial condition.statements.
Cautionary Information Regarding Forward Looking Statements
This report contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934 about Natus Medical Incorporated. These statements include, among other things, statements concerning our expectations, beliefs, plans, intentions, future operations, financial condition and prospects, and business strategies. The words “may,” “will,” “continue,” “estimate,” “project,” “intend,” “believe,” “expect,” “anticipate,” and other similar expressions generally identify forward-looking statements. Forward-looking statements in thiscan be identified by the words “expects”, “anticipates”, “believes”, “intends”, “estimates”, “plans”, “will”, “outlook” and similar expressions. Forward-looking statements are based on management's current plans, estimates, assumptions and projections, and speak only as of the date they are made. These forward-looking statements within Item 7 include, but are not limited to,without limitation, statements regarding the following: our ability to capitalize on improving market conditions, the sufficiency of our current cash, cash equivalents and short-termshort-

term investment balances, and any cash generated from operations to meet our ongoing operating and capital requirements for the foreseeable future, outcomes of new product development, improved operations performance and profitability as the result of restructuring activities, and our intent to acquire additional technologies, products or businesses.
Forward-looking statements are not guarantees of future performance and are subject to substantial risks and uncertainties that could cause the actual results predicted in the forward-looking statements as well as our future financial condition and results of operations to differ materially from our historical results or currently anticipated results. Investors should carefully review the information contained under the caption “Risk Factors” contained in Item 1A of this report for a description of risks and uncertainties. All forward-looking statements are based on information available to us on the date hereof, and we assume no obligation to update forward-looking statements.
ITEM 7A.     Quantitative and Qualitative Disclosures About Market Risk
The information required by this Item is set forth in the section entitled Management’s Discussion and Analysis of Financial Condition and Results of Operations—Quantitative and Qualitative Disclosures About Market Risk, and is incorporated by reference in this section.
ITEM 8.     Financial Statements and Supplementary Data
The Consolidated Financial Statements and Supplementary Data required by this Item are set forth where indicated in Item 15 of this report.
Selected Quarterly Financial Data (Unaudited)
The following table presents our operating results for each of the eight quarters in the period ending December 31, 2017.2019. The information for each of these quarters is unaudited and has been prepared on the same basis as our audited financial statements appearing elsewhere in this report.
In the opinion of our management all necessary adjustments, including normal recurring adjustments, have been included to present fairly the unaudited quarterly results when read in conjunction with our audited Consolidated Financial Statements and the related notes appearing elsewhere in this report. These operating results are not necessarily indicative of the results of any future period.




Quarters EndedQuarters Ended
December 31, 2017 September 30, 2017 June 30, 2017 March 31, 2017 December 31, 2016 September 30, 2016 June 30, 2016 March 31, 2016December 31, 2019 September 30, 2019 (1) June 30, 2019 (1) March 31, 2019 (1) December 31, 2018 September 30, 2018 June 30, 2018 March 31, 2018
(in thousands, except per amounts)(in thousands, except per amounts)
Revenue$131,440
 $122,643
 $122,227
 $124,660
 $107,699
 $90,906
 $95,958
 $87,329
$131,416
 $123,463
 $125,539
 $114,757
 $140,991
 $130,638
 $130,653
 $128,609
Cost of revenue(a)54,762
 47,112
 54,589
 56,913
 42,090
 32,194
 37,879
 32,469
49,259
 48,389
 52,393
 46,510
 58,103
 51,583
 52,897
 55,369
Intangibles amortization2,590
 1,290
 1,500
 1,000
 510
 612
 604
 601
1,679
 1,736
 1,746
 1,756
 2,689
 1,930
 2,717
 1,587
Gross profit74,088
 74,241
 66,138
 66,747
 65,099
 58,100
 57,475
 54,259
80,478
 73,338
 71,400
 66,491
 80,199
 77,125
 75,039
 71,653
Operating expenses:                              
Marketing and selling(b)31,060
 32,537
 30,354
 32,215
 23,255
 19,746
 21,237
 20,596
32,268
 30,787
 32,324
 33,729
 34,206
 33,200
 33,401
 35,872
Research and development(c)13,724
 11,632
 13,713
 12,753
 10,847
 7,689
 7,105
 7,802
17,567
 14,447
 13,324
 13,394
 15,296
 15,127
 15,616
 15,443
General and administrative(d)16,923
 17,329
 24,156
 16,016
 13,652
 12,821
 11,923
 12,481
15,261
 15,394
 12,690
 16,306
 13,632
 15,799
 23,721
 17,448
Intangibles amortization7,330
 3,882
 3,885
 4,074
 2,243
 2,409
 2,197
 2,134
3,844
 3,751
 3,763
 3,786
 9,151
 4,477
 4,151
 4,806
Restructuring
 321
 307
 286
 221
 197
 1,083
 35
3,592
 1,106
 2,668
 37,372
 23,049
 11,432
 1,938
 812
Total operating expenses69,037
 65,701
 72,415
 65,344
 50,218
 42,862
 43,545
 43,048
72,532
 65,485
 64,769
 104,587
 95,334
 80,035
 78,827
 74,381
Income from operations5,051
 8,540
 (6,277) 1,403
 14,881
 15,238
 13,930
 11,211
Income (loss) from operations7,946
 7,853
 6,631
 (38,096) (15,135) (2,910) (3,788) (2,728)
Other income (expense), net(2,300) 150
 (378) (1,039) 55
 (893) 25
 456
(670) (1,609) (1,200) (2,112) (2,754) (726) (2,398) (1,821)
Income before provision for income tax2,751
 8,690
 (6,655) 364
 14,936
 14,345
 13,955
 11,667
Provision for income tax9,845
 17,203
 (1,621) 16
 4,705
 1,032
 3,443
 3,129
Income (loss) before provision for (benefit from) income tax7,276
 6,244
 5,431
 (40,208) (17,889) (3,636) (6,186) (4,549)
Provision for (benefit from) income tax (e)4,266
 (1,987) 1,944
 (9,809) (6,256) 1,940
 (3,609) (1,401)
Net income (loss)$(7,094) $(8,513) $(5,034) $348
 $10,231
 $13,313
 $10,512
 $8,538
$3,010
 $8,231
 $3,487
 $(30,399) $(11,633) $(5,576) $(2,577) $(3,148)
Earnings per share:               
Earnings (loss) per share:               
Basic$(0.22) $(0.26) $(0.15) $0.01
 $0.32
 $0.41
 $0.32
 $0.26
$0.09
 $0.24
 $0.10
 $(0.91) $(0.35) $(0.17) $(0.08) $(0.10)
Diluted$(0.22) $(0.26) $(0.15) $0.01
 $0.31
 $0.40
 $0.32
 $0.26
$0.09
 $0.24
 $0.10
 $(0.91) $(0.35) $(0.17) $(0.08) $(0.10)
Weighted average shares used in the calculation of net earnings per share:               
Weighted average shares used in the calculation of net earnings (loss) per share:               
Basic32,648
 32,593
 32,529
 32,485
 32,405
 32,388
 32,438
 32,606
33,691
 33,655
 33,639
 33,590
 33,495
 33,321
 32,859
 32,760
Diluted32,648
 32,593
 32,529
 33,040
 33,009
 32,981
 32,983
 33,222
33,829
 33,738
 33,690
 33,590
 33,495
 33,321
 32,859
 32,760
(1) During the fourth quarter of 2019, we corrected certain previously reported financial information for the quarters ended March 31, 2019, June 30, 2019, and September 30, 2019 related to the accounting for certain research and development activities in an arrangement with a third party, certain invoice accruals, adjustments resulting from physical inventory observations, and the income tax impacts of these immaterial adjustments. The correction of the immaterial errors resulted in the following:
(a)Cost of revenue increased $0.1 million and $0.2 million for the quarters ended March 31, 2019 and June 30, 2019, respectively. Cost of revenue decreased $0.3 million for the quarter ended September 30, 2019.
(b)Marketing and selling expense increased $0.1 million for the quarter ended June 30, 2019 and decreased $0.1 million for the quarter ended September 30, 2019.
(c)Research and development expense increased $0.3 million, $0.6 million, and $0.3 million for the quarters ended March 31, 2019, June 30, 2019, and September 30, 2019 respectively.

(d)General and administrative expense increased $0.3 million for the quarter ended September 30, 2019.
(e)Provision for income tax decreased by $0.1 million, $0.2 million, and $6 thousand for the quarters ended March 31, 2019, June 30, 2019, and September 30, 2019, respectively.

ITEM 9.    Changes in and Disagreements With Accountants on Accounting and Financial Disclosure
None.
ITEM 9A.     Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Under the rules of the Securities and Exchange Commission, “disclosure controls and procedures” are controls and other procedures that are designed to ensure that information required to be disclosed in the reports that we file or submit under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the rules and forms of the Securities and Exchange Commission. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by us in our reports that we file or submit under the Securities Exchange Act of 1934 is accumulated and communicated to our management, including our chief executive officer and chief financial officer, as appropriate, to allow timely decisions regarding required disclosure.
We doOur management, including our chief executive officer and chief financial officer, does not expect that our disclosure controls and procedures or our internal control over financial reporting will prevent all errors and all fraud due to inherent limitations of internal controls. Because of such limitations, there is a risk that material

misstatements will not be prevented or detected on a timely basis by internal control over financial reporting. However, these inherent limitations are known features of the financial reporting process. Therefore, it is possible to design into the process safeguards to reduce, though not eliminate, this risk.
We haveOur management, with the participation of our chief executive officer and our chief financial officer, has evaluated the effectiveness of our disclosure controls and procedures as of the end of the period covered by this report. Based on that evaluation, we haveour management, including our chief executive officer and chief financial officer, has concluded that our disclosure controls and procedures were not effective as of December 31, 2017.2019. This conclusion was based solely on the material weakness in our internal control over financial reporting further described below.
However, giving full considerationIn light of the material weaknesses described below, management performed additional analysis and other procedures to the deficiency, we have concludedensure that our consolidated financial statements were prepared in accordance with U.S. generally accepted accounting principles (GAAP). Accordingly, management believes that the Consolidated Financial Statementsconsolidated financial statements included in this annual reportAnnual Report on Form 10-K fairly present, fairly, in all material respects, the Company'sour financial position, results of operations, and cash flows as of and for the periods disclosedpresented, in conformityaccordance with U.S. generally accepted accounting principles.GAAP.
Management’s Report on Internal Control Over Financial Reporting
Our management including our chief executive officer and chief financial officer, is responsible for establishing maintaining and reviewingmaintaining adequate internal control over financial reporting (asas defined in Rule 13a-15(f) under the Exchange Act). The Company'sAct. A company’s internal control over financial reporting is designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with accounting principles generally accepted in the United States of America and includes those policies and procedures that:
1.pertainsthat (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the Company
2.provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the Company are being made only in accordance with authorization of management and directors of the Company; and
3.provide reasonable assurance regarding prevention of timely detection of unauthorized acquisition, use or disposition of the Company's assets that could have a material effect on the financial statements
Because of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.
Internal control over financial reporting cannot provide absolute assurance of achieving financial reporting objectives because of the inherent limitations of any system of internal control. Internal control over financial reporting is a process that involves human diligence and compliance and is subject to lapses of judgment and breakdowns resulting from human failures. Internal control over financial reporting also can be circumvented by collusion or improper overriding of controls. As a result of such limitations, there is risk that material misstatements may not be prevented or detected on a timely basis by internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periodsreporting. However, these inherent limitations are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies and procedures may deteriorate.
We conducted an assessmentknown features of the effectiveness of our internal control over financial reporting as of December 31, 2017 basedprocess. Therefore, it is possible to design into the process safeguards to reduce, though not eliminate, this risk.
Based on our evaluation under the criteria set forth in Internal Control-Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission. In accordance with guidance issued by the Securities and Exchange Commission, companies are permitted to exclude acquisition from their final assessment ofour management concluded that we did not maintain effective internal control over financial reporting foras of December 31, 2019 due to a material weakness that existed in the first fiscal year in which the acquisition occurred. The first fiscal year exemption for internal controls over financial reporting does not apply to controls over purchase price allocation. Our evaluation ofCompany’s internal control over financial reporting excluded the internal control activities of Otometrics, which we acquired on January 3, 2017 and the internal control activities of our Neurosurgery acquisition which we acquired on October 6, 2017. Otometrics and Neurosurgery constituted 23% and 2% of consolidated revenue, respectively, and 8% and 2% of our total assets (excluding acquired intangible assets and goodwill) for the year ended December 31, 2017.
as further described below. A material weakness is a deficiency, or a combination of deficiencies, in internal

control over financial reporting, such that there is a reasonable possibility that a material misstatement of our annual or interim consolidated financial statements will not be prevented or detected on a timely basis.
Based onAs part of closing our assessment,books for the fourth quarter of 2019 we identified immaterial errors that indicated certain deficiencies existed in the Company’s internal control over financial reporting.  Specifically, we did not performhave controls designed to identify and properly account for certain research and development activities related to an effective risk assessment relatingarrangement with a third party. Additionally, insufficient training provided to significant acquisitions,a new control operator and asthe design of one of our controls over payroll accounts contributed to an error in the period end accrual. The Company has concluded that these deficiencies could have resulted in a result we did not adequately design control activities over the accounting for the acquisitionmaterial misstatement of Otometrics.
The control deficiencies described above did not result in material misstatements in the consolidated financial statements as of and for the fiscal year ended December 31, 2017. However, the control deficiencies create a reasonable possibility that a future material misstatement willwould not behave been prevented or detected on a timely basis. Accordingly, we have concluded that thebasis, and as such, these control deficiencies representresult in a material weakness in our internal control over financial reporting as of December 31, 2017.2019.
KPMG LLP, anOur independent registered public company accounting firm, KPMG LLP, has audited the Consolidated Financial Statementsconsolidated financial statements included in this Annual Report on Form 10-K, and, as part of its audit, has issued an adverse opinion on the effectiveness of our internal control over financial reporting. ThisKPMG LLP’s report appearsis included herein in Part II, Item 9A of this Annual Report on Form 10-K.
Remediation Efforts to Address Material Weakness
To remediate the material weakness in our internal control over financial reporting described above, we plan to make substantive changes to enhance our design of controls intended to identify and assess contracts that include research and development activities and to aid in confirming the accuracy of our payroll accounts.  Specifically, we plan to formalize a policy that provides guidance on proper identification, analysis and treatment of contracts that include research and development activities.  We also intend to provide training to the finance team to ensure the policy is communicated, understood and followed.  We intend to strengthen the control design for payroll accounts to require that specific review procedures be completed and to formalize the results of required review procedures in a checklist format including reviewer signoff. Additionally, we plan to institute a process to monitor changes to our control operators responsible for key controls over financial reporting and implement a control to verify that appropriate training is provided to new control operators to mitigate this risk of change in our system of control.
Changes in Internal Control over Financial Reporting
In addition toExcept for the material weakness identified above, there has been no change in our internal control deficiency described above,over financial reporting during the fourth quarter of 2017, we completed a substantial amount of the effort required2019 that has materially affected, or is reasonably likely to transition the critical information technology systems of Otometrics to Natus' legacy

information technology systems. The remaining information technology systems integration for Otometrics is expected to be completed during 2018.
Remediation Efforts to Address Material Weakness
We expect to remediate the material weakness during 2018 as we operatematerially affect, our redesigned purchase price allocation controls to account for the acquisition of our Neurosurgery business which we acquired during the fourth quarter of 2017. Our remediation actions will include:
improving the design of internal controls related to our review of key assumptions and data used to allocate acquisition purchase price by evaluating the specific financial reporting risks associated with each acquisition as they occur;
improving the design of internal controls related to the evidence and documentation of internal control procedures with respect to the process of determining purchase price allocation; andover financial reporting.
sufficiently distinguishing our internal controls from the process we undertake to allocate purchase price.


REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders and Board of Directors
Natus Medical Incorporated:
Opinion on Internal Control Over Financial Reporting
We have audited Natus Medical Incorporated and subsidiariessubsidiaries’ (the “Company”)Company) internal control over financial reporting as of December 31, 2017,2019, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission. In our opinion, because of the effect of the material weakness, described below, on the achievement of the objectives of the control criteria, the Company has not maintained effective internal control over financial reporting as of December 31, 2017,2019, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission.
We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (“PCAOB”)(PCAOB), the consolidated balance sheets of the Company as of December 31, 20172019 and 2016,2018, the related consolidated statements of operations, and comprehensive income stockholders'(loss), stockholders’ equity, and cash flows for each of the years in the three-year period ended December 31, 2017,2019, and the related notes and financial statement schedule II: Valuation and Qualifying Accounts (collectively, the “consolidatedconsolidated financial statements”)statements), and our report dated March 1, 20182, 2020 expressed an unqualified opinion on those consolidated financial statements.
A material weakness is a deficiency, or a combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the company'scompany’s annual or interim financial statements will not be prevented or detected on a timely basis. Management concluded that there was aThe following material weakness because thehas been identified and included in management’s assessment:
The Company did not performhave controls designed to identify and properly account for certain research and development activities related to an effective risk assessment relatingarrangement with a third party. Additionally, insufficient training provided to significant acquisitions,a new control operator and as a result, the Company did not adequately design control activitiesof one of the Company’s controls over payroll accounts contributed to an error in the accounting for the acquisition of Otometrics. period-end accrual.
The material weakness was considered in determining the nature, timing, and extent of audit tests applied in our audit of the 20172019 consolidated financial statements, and this report does not affect our report on those consolidated financial statements.
The Company acquired the Otometrics business on January 3, 2017 and the Neurosurgery business on October 6, 2017. Management excluded from its assessment of the effectiveness of the Company's internal control over financial reporting as of December 31, 2017, the internal control activities of Otometrics and Neurosurgery which represented 23% and 2%, respectively, of total revenue and 8% and 2%, respectively, of total assets (excluding acquired intangible assets and goodwill) of the related consolidated financial statement amounts of the Company as of and for the year ended December 31, 2017. Our audit of internal control over financial reporting of the Company also excluded an evaluation of the internal control over financial reporting of Otometrics and Neurosurgery.
Basis for Opinion
The Company'sCompany’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management’s Report on Internal Control Over Financial Reporting.Reporting in Item 9A. Our responsibility is to express an opinion on the Company’s internal control over financial reporting based on our audit. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects. Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. Our audit also included performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion.
Definition and Limitations of Internal Control Over Financial Reporting
A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.
(signed) KPMG LLP
San Francisco, California
March 1, 20182, 2020



ITEM 9B.    Other Information
None.

PART III

We will provide information that is responsive to this Part III in our Definitive Proxy Statement for our 2020 Annual Meeting of Stockholders (our “2020 Proxy Statement”) or in an amendment to this Annual Report not later than 120 days after the end of the fiscal year covered by this Annual Report. That information is incorporated into this Part III by reference.
ITEM 10.    Directors, Executive Officers, and Corporate Governance
Board of Directors
Our Board currently consists of six directors andWe will provide certain other information that is divided into three classes. Each class is elected for a term of three years, so thatresponsive to this Item 10 in our 2020 Proxy Statement or in an amendment to this Annual Report not later than 120 days after the term of one class of directors expires at each meeting. There are no family relationships among our executive officers and directors. Information regarding the business experience and age as of April 30, 2018 of each nominee and other membersend of the Boardfiscal year covered by this Annual Report. That information is provided below.

Doris E. Engibous
Director since 2004
Age 62
Ms. Engibous has served as a consultant and advisor to medical technology companies and executives since 2010. From 2004 to 2010, she served as President and CEO of Hemosphere Inc., an early commercialization stage, venture capital funded, medical technology company, prior to its acquisition by CryoLife Inc. (NYSE: CRY). Prior to 2004, Ms. Engibous served from 2000 through 2003 as President of Nellcor, a business of Tyco Healthcare Group/Tyco International Ltd. (now Covidien/Medtronic, NYSE: MDT). From 1986 through 2000, Ms. Engibous served in several executive capacities at Nellcor and its successors Nellcor Puritan Bennett Inc. and Mallinckrodt Inc., including as vice president, general manager and global business leader and senior director of marketing, and was responsible for the integration of Nellcorincorporated into Mallinckrodt and later Tyco Healthcare. Ms. Engibous has served on the board of directors of GI Supply, Inc., a family-owned medical technology company since 2014 and as its Chair since 2016. Ms. Engibous served on the board of directors of the National Kidney Foundation serving Minnesota, the Dakotas and Iowa from 2006 to 2010. She holds a Bachelor of Science degree in Chemical Engineering from the University of Michigan.

Ms. Engibous is distinguished by her technical background in Chemical Engineering, coupled with strong operational experience in manufacturing, regulatory affairs, quality assurance and marketing. She brings to the Natus Board over 30 years of experience in the medical device industry, including knowledge of organizational and operational management, financial expertise, marketing, R&D, human resources and integration experience relevant to a public company in the healthcare industry.

William M. Moore
Director Since 1989
Age: 69
Mr. Moore currently is the Chief Executive Officer and President and Chairman of the board of directors of IRIDEX Corporation, a medical device company, and has served in that capacity, or as interim Chief Executive Officer and President, since August 2012. Mr. Moore has served as the Managing Partner of Alpine Partners LLC since May 2008 as well as from 2003 to 2004. From 2004 until May 2008 Mr. Moore was a special limited partner for medical technology at Blue Line Partners, a private equity firm. He also has served on the boards of directors of Criticare Systems, Inc. from 2006 until it was acquired by Opto Circuits (India) Limited in April 2008 and Urologix Inc. from 2008 until June 2010. Mr. Moore holds a Bachelor of Science degree in Business from the University of Utah. Mr. Moore brings to the Board more than 25 years of executive experience in the worldwide medical technology field, particularly in the areas of sales, marketing, and product development. Mr. Moore is one of our co-founders and resigned as CEO of the Company in 1992.

James B. Hawkins
Chief Executive Officer
Director Since 2004
Age: 62
James B. Hawkins has served as Chief Executive Officer, and as a member of the Board, since joining Natus in April 2004 and as President since June 2013. He previously served as President from April 2004 through January 2011. Since December 2015, he has served as a member of the board of directors of OSI Systems, Inc., and he has served as a member of the board of directors of El Dorado Resorts since September 2014. Mr. Hawkins previously served as a director at Iradimed Corporation from 2005 until June 2016, IRIDEX Corporation from October 2007 until December 2014 and Digirad Corporation from April 2012 to October 2014. Prior to joining Natus, Mr. Hawkins was President, Chief Executive Officer and a director of Invivo Corporation, a developer and manufacturer of multi-parameter vital sign monitoring equipment, and its predecessor, from August 1985 through January 2004. He earned his undergraduate degree in Business Commerce from Santa Clara University and holds a Masters of Business Administration degree from San Francisco State University. Mr. Hawkins’ brings to the Board highly relevant leadership experience in the medical technology industry as well as a unique perspective on our operations due to his position as our Chief Executive Officer.

Robert A. Gunst
Chairman of the Board
Director Since 2004
Age: 70
Robert A. Gunst is Chairman of the Board of Directors of Natus Medical. Currently a private investor, Mr. Gunst served from 1990 to 1999 as President and Chief Executive Officer of The Good Guys, Inc., one of the largest specialty retailers of higher-end entertainment electronics in the nation. During that time he grew the business from a few stores in the San Francisco area to a chain of stores in four western states with approximately $1 billion in revenue. Earlier in his career, he held executive positions at several large corporations, including Shaklee Corporation, La Petite Boulangerie, Inc. and PepsiCo Foods International (both subsidiaries of PepsiCo, Inc.), Victoria Station Incorporated and The First National Bank of Chicago.

Mr. Gunst has served on a variety of public and private boards, including serving as a Director of The Good Guys, Inc. from 1986 to 1999, Director of Phoenix Footwear Group, Inc. from 2006 to 2007, Director of PortalPlayer, Inc. from 2005 to 2007, Director of AmNet Mortgage, Inc. (formerly American Residential Investment Trust Inc.) from 2004 to 2005, Director of Garden Fresh Restaurant Corp. from 1996 to 2004 and Chairman of Garden Fresh Restaurant Corp. from 2003 to 2004. He served as a member of the Deans Advisory Council of the Graduate School of Management at the University of California, Davis from 1997 to 2008. Mr. Gunst holds an MBA in Finance from the University of Chicago’s Graduate School of Business and a Bachelor of Arts degree in Economics from Dartmouth College.

Mr. Gunst brings to the Natus Board nearly five decades of leadership, strategy, financial and operational experience, as well as experience in overseeing the operations of companies in various stages of development and is therefore uniquely qualified to serve as chairman of our Board.

Kenneth E. Ludlum
Director since 2002
Age 64
Mr. Ludlum currently serves as a board member, and has acted as a board member and as an advisor to and investor in a number of public and private medical and biotechnology companies. He served as Chief Financial Officer of CareDx, Inc., a medical diagnostic company, from March 2014 to April 2016. From April 2011 to October 2013, Mr. Ludlum served as Vice President and Chief Financial Officer, and Head of Operations for Endogastric Solutions, Inc., a medical device company. Prior to that, Mr. Ludlum also served as CFO for two other publicly-held companies, Perclose, Inc. from 1995 to 2000, and Alteon, Inc. from 1992 to 1994. He has also served on the board of directors and as Chair of the Audit Committee of several public and private medical or biotechnology companies. Mr. Ludlum holds a B.S. in Business Administration from Lehigh University and a M.B.A. from Columbia University Graduate School of Business. Mr. Ludlum brings to the Board over 30 years of business and financial experience working with healthcare and biotechnology companies. His service as chief financial officer at several public companies has provided him with extensive financial and accounting experience, and knowledge of accounting principles, financial reporting rules, and regulations. With his background in investment banking, he also brings a broad perspective to the Board.

Barbara R. Paul, M.D.
Director since 2016
Age 64
Dr. Paul serves as an advisor and board member to healthcare companies. In addition to her role on the board of Natus Medical, she serves on the board of Quorum Health Corporation, an owner and operator of general acute care hospitals and outpatient service providers. She served as Senior Vice President & Chief Medical Officer at Community Health Systems (CHS) from July 2007 to January 2015. Prior to CHS, Dr. Paul was Senior Vice President & Chief Medical Officer for Beverly Enterprises, Inc. (now Golden Living, Inc.). Dr. Paul is a board-certified internist and she practiced as a full-time primary care physician for twelve years. She also worked at the federal Medicare program (Centers for Medicare & Medicaid Services, CMS), where she was Director of the Department of Quality Measurement & Health Assessment. Dr. Paul has a bachelor of science from the University of Wisconsin - Madison and earned her medical degree from Stanford University School of Medicine. Dr. Paul brings the perspective of a physician to the Board and also brings insight into quality measures and reporting, as well as federal government regulation of hospital-practitioner relationships.

Our Executive Officers
The names of our current executive officers, their ages as of April 30, 2018 and their positions are shown below:

NameAgePosition(s)
James B. Hawkins62
President and Chief Executive Officer
Jonathan A. Kennedy47
Executive Vice President and Chief Financial Officer
D. Christopher Chung, M.D.

54
Vice President Medical Affairs, Quality & Regulatory

Carsten Buhl44
President & CEO, Otometrics SBU
Leslie McDonnell45
Vice President and General Manager, Newborn Care
Austin F. Noll, III

51
Vice President and General Manager, Neurology SBU

There is no family relationship between any of the directors or executive officers and any other director or executive officer of Natus.
James B. Hawkins has served as Chief Executive Officer, and as a member of the Board of Directors, since joining Natus in April 2004, and as President from April 2004 through January 2011 and from June 2013 to present. In addition, he currently serves on the Board of Directors for Eldorado Resorts, Inc. and OSI Systems.  Prior to joining Natus, Mr. Hawkins was President, Chief Executive Officer and a Director of Invivo Corporation, a developer and manufacturer of multi-parameter vital sign monitoring equipment, and its predecessor, from August 1985 through January 2004. Mr. Hawkins also served as Secretary of Invivo from July 1986 until January 2004. He earned his undergraduate degree in Business Commerce from Santa Clara University and holds a Masters of Business Administration degree from San Francisco State University.
Jonathan A. Kennedy joined Natus as Senior Vice President and Chief Financial Officer in April 2013 and was appointed Executive Vice President and Chief Financial Officer in September 2016. In addition, he currently serves on the Board of Directors for IRadimed Corporation. Before joining Natus, Mr. Kennedy was Senior Vice President and Chief Financial Officer of Intersil Corporation, a global semiconductor manufacturer, since 2009. Prior to that, he was Intersil’s Corporate Controller since 2005 and Director of Finance since 2004. Before joining Intersil, Mr. Kennedy held management roles in Finance and Information Technology with Alcon Inc. and Harris Corporation. He holds a Bachelor of Science degree in Business Administration and a Master of Science degree in Accounting from the University of Central Florida. Mr. Kennedy is also a Certified Public Accountant.
D. Christopher Chung, M.D., has served as our Vice President Medical Affairs, Quality and Regulatory since June 2003, and has served as our Vice President Medical Affairs since February 2003. Dr. Chung also served as our Medical Director from October 2000 to February 2003. From 2000 to 2007, Dr. Chung also served as a Pediatric Hospitalist at the California Pacific Medical Center in San Francisco. From 1997 to 2000, Dr. Chung trained as a pediatric resident at Boston Children’s Hospital and Harvard Medical School. From 1986 to 1993, Dr. Chung worked as an Engineer at Nellcor, a medical device company. Dr. Chung holds a Bachelor of Arts degree in Computer Mathematics from the University of Pennsylvania and a Doctor of Medicine degree from the Medical College of Pennsylvania-Hahnemann University School of Medicine. He is board certified in Pediatrics and is a Fellow of the American Academy of Pediatrics.
Carsten Buhl joined Natus in February 2018 and is acting as President for Natus' strategic business unit Otometrics. Mr. Buhl has more than 15 years experience in the medical device industry and has a proven track record within commercial execution and global leadership positions. Prior to joining natus, Mr. Buhl acted as Executive Vice President and Chief Commercial Officer at Ambu, a successful medtech company within the fields of anesthesia, patient monitoring and emergency care. Previously, Mr. Buhl held various management positions at GN Hearing, which is one of the world's largest providers of hearing instruments, most recently as Senior Vice President of Europe and Strategic Accounts. Mr. Buhl holds a Master of Law from Copenhagen University and an E*MBA from SIMI/CBS Copenhagen supplemented by graduate diplomas in Finance and Accounting from CBS Copenhagen.
Leslie McDonnell joined Natus in February 2018 as the Vice President and General Manger, Newborn Care. Ms. McDonnell is a healthcare business executive with 17 years of global experience in medical devices and supplies. Prior to joining Natus, Ms. McDonnell served as Global Business Vice-President for the Critical & Chronic Care Solutions of 3M Healthcare. Prior to joining 3M Healthcare, Ms. McDonnell held leadership positions at Medtronic over a 12 year period in corporate M&A, business development, new therapy and product development, and marketing and business management in the Neuromodulation and Cardiac Rhythm Disease Management business. Ms. McDonnell holds a Bachelor of Science in Business and Masters of Busines Administration as an International Business Fellow from the Carlson School of Management at the University of Minnesota. In 2009, Ms. Donnell was selected as a 40 Under Forty honoree for business and community leadership by the Minneapolis/St. Paul Business Journal.
Austin F. Noll, III joined Natus in August 2012 as the Vice President and General Manager, Neurology. Prior to joining Natus, Mr. Noll served as the President and CEO of Simpirica Spine, a California-based start-up company that developed and commercialized a novel device for spinal stabilization. Prior to joining Simpirica Spine, Mr. Noll served as the President and CEO

of NeoGuide Systems, a medical robotics company acquired by Intuitive Surgical. Prior to joining NeoGuide Systems, Mr. Noll held numerous management positions at Medtronic over a 13-year period, where he served as the Vice President and General Manager of the Powered Surgical Solutions and the Neurosurgery businesses. Before Medtronic, he held sales positions at C.R. Bard and Baxter Healthcare. He received a bachelor’s degree in business administration from Miami University and a master’s of business administration from the University of Michigan.
Section 16(a) Beneficial Ownership Reporting Compliance
Section 16(a) of the Securities Exchange Act of 1934, as amended, requires our directors, executive officers and holders of more than 10% of our common stock to file with the Securities and Exchange Commission reports regarding their ownership and changes in ownership of our securities. We believe that, during fiscal 2017, our directors, executive officers and 10% stockholders complied with all Section 16(a) filing requirements. In making this statement, we have relied upon examination of the copies of Forms 3, 4 and 5, and amendments thereto, provided to us, and the written representations of our directors, named executive officers and 10% stockholders.
Code of Conduct and Code of Ethics
We have a code of conduct and ethics that applies to all of our employees, including our principal executive officer, principal financial officer, and principal accounting officer or controller. This code of conduct and ethics is posted on our internet website. The internet address for our website is www.natus.com, and the code of conduct and ethics may be found in the “Governance” section of our “Investor” webpage.
We intend to satisfy the disclosure requirement under Item 10 of Form 8-K regarding certain amendments to, or waivers from, provisions of this code of conduct and ethics by posting such information on our website, at the address and location specified above, or as otherwise required by The NASDAQ Stock Market.reference.
Audit Committee and Financial Expert
Our Audit Committee oversees and monitors our financial reporting and disclosure processes, our financial statement audits, the integrity of our financial statements, the qualifications, independence and performance of our independent registered public accounting firm, and our internal accounting and financial controls. The Committee also pre-approves audit and non-audit services, reviews, approves and monitors our Code of Business Conduct and Ethics with respect to our Chief Executive Officer, Chief Financial Officer, and other senior financial officers, and establishes procedures for receiving and handling complaints regarding accounting, internal accounting controls, or auditing matters.

Expert
The members of the Audit Committee of our Board of Directors are Kenneth E. Ludlum, Robert A. Gunst,Thomas J. Sullivan, and William M. Moore.Alice D. Schroeder. Our Board of Directors has determined that Kenneth E. Ludlum is an audit committee financial expert as defined in Item 407(d) of Regulation S-K. All of the members of our audit committee are considered “independent” as the term is used in Item 7(d)(3)(iv) of Schedule 14A under the Exchange Act.

Code of Conduct and Ethics
We have a code of conduct and ethics that applies to all of our employees, including our principal executive officer, principal financial officer, and principal accounting officer or controller. This code of conduct and ethics is posted on our internet website. The internet address for our website is www.natus.com, and the code of conduct and ethics may be found in the “Governance” section of our “Investor” webpage.
We intend to satisfy the disclosure requirement under Item 10 of Form 8-K regarding certain amendments to, or waivers from, provisions of this code of conduct and ethics by posting such information on our website, at the address and location specified above, or as otherwise required by The Nasdaq Stock Market.
ITEM 11.    Executive Compensation
Executive Compensation and Related Information
Compensation Discussion & Analysis (CD&A)
General
Our executive compensation programWe will provide information that is designed to:
attract and retain individuals with the skills and performance neededresponsive to achieve our business objectives
reward and incentivize individuals fairly over time
align the short and long-term compensation of those individuals with the Company’s performance

Executive Summary
In 2017 we completed two significant acquisitions that we believe lay the groundwork for our future revenue growth and growth in profitability, the Otometrics acquisition completed in January 2017, and the acquisition of neurocritical care and neurosurgical product lines from Integra LifeSciences in October 2017. In addition, we continued our efforts to strengthen our

neurology and newborn care franchises. With our acquisitions, we achieved record revenue in 2017, exceeding the goal of $500 million in annual revenue that we have shared with investors in recent years.
Notwithstanding our revenue growth of 31.2% in 2017, our net income was below our target levels and below the net income achieved in 2016. This was primarily due to lower profitabilitythis Item 11 in our newborn care business unit driven by lower gross profit margins due to unfavorable revenue mix and increased investments in product engineering and required to meet regulatory standards.
Similar to the cash bonus plans we adopted in prior years, our executive officers were eligible to receive cash bonuses for 2017 based on the attainment of specific performance objectives, as further described below. The 2017 plan included a threshold requirement for all executive officers that consolidated earnings must exceed 85% of the plan target as a condition to the payment of any cash bonuses. While many of the other performance metrics were attained at a level that would result in the payment of cash bonuses, nocashbonuses were paid for 2017 because our earnings per share did not meet the threshold. We believe that the cash bonus plan operated effectively in 2017 to establish meaningful performance criteria, resulting in no bonus payments as our earnings target was not satisfied. This being the case, we recognize that the responsibilities of our executive officers were increased substantially with the addition of the Otometrics and neurocritical care/neurosurgical product lines in 2017, and that our executves expended significant additional efforts to integrate these new businesses.
At our annual meeting in 2017, approximately 91% of the stockholders who voted on our 2017 Say on Pay proposal voted in favor of the proposal. Considering this outcome, the Compensation Committee determined that it would continue to apply the same philosophy and guiding principles to the 2018 compensation for the Company’s named executive officers, and, as a result, did not change the structure of our executive compensation for 2018.
Our Business and Our Compensation Philosophy
We believe that opportunities exist for us to increase stockholder value by increasing our per-share earnings, and believe that the optimal manner of doing so is to increase the revenue base of the Company. We seek revenue growth through organic growth involving, primarily, the introduction of existing products into new markets and the internal development of new products, as well as via acquisitions of complementary products and businesses. Our business plans challenge our executives to seek growth through both of these means, and we expect over time to achieve a higher level of overall growth than could be achieved through either method alone. Further, we expect our business, including the businesses that we acquire, to be operated efficiently so that earnings can grow as we increase revenue. We also seek to achieve earnings growth by managing our business efficiently and implementing cost reduction efforts from time to time when we determine that we can do so without impairing our ability to operate effectively.
Pursuit of this business model is demanding on our executives. They must implement efforts to enhance sales opportunities of existing products, oversee effective and efficient new product development and enhancements, successfully identify and complete the acquisition of complementary products and businesses and integrate these operations with our existing businesses, as well as conduct our business2020 Proxy Statement or in an efficient manner.
In consideration of these factors, the primary objectives of our executive compensation are:
Retain Qualified Executive Talent. During the period from 2003amendment to 2017 we have substantially increased the size of our company. In this time period, we have completed 28 acquisitions of companies with principal offices in six different countries. We believe that maintaining continuity within our executive team has contributed significantly to our ability to achieve this growth. Our business is competitive and our corporate headquarters is in an area where there is significant competition for executive talent. In light of these factors, a key objective of our compensation is to allow us to retain qualified executives.
Attract Qualified Executives. We understand that we may find it in our interests to, or may be required to, add new individuals to our executive team from to time. For example, in February 2018 we added two new executive officers to head our newborn care and Otometrics operations. For us to be appropriately positioned to attract new talent as needed, we must be prepared to, and be perceived as an employer that is willing to, offer competitive compensation.
Link Compensation to Achievement of Our Business Objectives. We believe that a significant portion of the current period cash compensation that our executives are eligible to receive should be tied to attainment of goals that our Compensation Committee has determined are most capable of increasing stockholder value for the Company. Accordingly, our annual bonus plan has been tied to earnings and revenue goals and, for certain of our executives, the attainment key business objectives.
Provide Direct Incentives for the Enhancement of Stockholder Value Over the Long Term. The effectiveness of our management in operating our business has a strong influence on the value of our common stock over time. We believe that our executives should be positioned to share, with our stockholders, in the gains and losses from changes in the value of our common

stock over time and that this form of compensation will further motivate our executives to seek to increase long-term stockholder value.
Elements of Compensation
Our executive officers’ compensation currently has two primary elements of compensation: (i) cash compensation in the form of salary and annual incentive awards, and (ii) equity awards in the form of restricted stock awards. In addition, we provide our executive officers with benefits that are available generally to all salaried employees.
We believe that we would impair our ability to retain our executives or, as required, attract new executives if we did not offer a competitive salary. As such, our goal is to provide salaries that are sufficient to make us reasonably confident of our ability to retain our executive team without overpaying. We further believe that a substantial portion of the cash compensation that our executives are eligible to receive should be directly tied to corporate performance. We believe that our annual business plans represent reasonably challenging targets, as evidenced by our paying no cash bonuses for 2017 and paying cash bonuses in the range of 17% to 64% of target for 2016. Our long-term equity-based incentive awards are designed to provide a competitive compensation package and to motivate our executives to increase stockholder value.
In establishing compensation, we take into account the compensation that is payable by companies that we believe to be our competitors and by other companies with which we believe we generally compete for executives. To this end, our Compensation Committee works with an outside compensation consultant, Willis Towers Watson, to define the criteria used to identify appropriate market comparisons for establishing compensation levels and the mix of salary, incentive compensation, and equity compensation. When determining our peer companies, we focus on identifying companies with whom we compete directly for customers and employees, as well as other medical device companies in the United States. In addition, we select companies that are similar to our size, limiting the peer group to companies whose trailing twelve-month revenue is generally within a range of approximately 0.5x to 2.0x of our projected annual revenue.
Our Compensation Committee requested and received a formal report from, Willis Towers Watson, to assist it in its deliberations for 2017 cash and equity compensation. The peer companies used in that report were: ABIOMED, Inc.; Accuray; Analogic; AngioDynamics; CONMED Corporation; Globus Medical, Inc.; Haemonetics Corporation; ICU Medical; Insulet Corporation; Integra LifeSciences; Masimo Corporation; Merit Medical Systems, Inc.; NuVasive, Inc.; Nxstage Medical, Inc.; Omnicell; and The Spectranetics Corporation. For the purpose of establishing competitive compensation ranges for elements of compensation, Willis Towers Watson considered the most recently reported compensation information for the peer group companies as well as the applicable compensation survey information based on our size and industry. The peer group was revised from the previous year group with the assistance of Willis Towers Watson in establishing compensation with two companies removed, as one company was acquired (Cyberonics), and another was deemed too small (Abaxis). Three companies were added (Integra LifeSciences, Insulet and Haemonetics) to the peer group based on the criteria described above. In addition to the reports from Willis Towers Watson, in determining the compensation of each of our executive officers other than that the Chief Executive Officer, our Compensation Committee considers the recommendations of the Chief Executive Officer.
Willis Towers Watson has worked directly with the Compensation Committee (and not on behalf of management) to assist the Compensation Committee in satisfying its responsibilities and will undertake no projects for management except at the request of our Compensation Committee chair and in the capacity of our Compensation Committee’s agent. To date, Willis Towers Watson has not undertaken any projects for management or for the Company other than advising the Compensation Committee with respect to compensation matters and assisting the Company in the preparation of the pay ratio disclosure required for the first time in this Annual Report on Form 10-K for the year ended December 31, 2017. The Compensation Committee has concluded that none of Willis Towers Watson’s work to date has raised any conflicts of interest that will prevent Willis Towers Watson from being independent consultants to the Compensation Committee.
We view the cash and equity elements of compensation as distinct. We think that each of these main components must be perceived by our executives as largely competitive with the corresponding compensation element paid by our peer companies. While we view cash and equity elements of compensation as distinct, we do link these two components of compensation insofar as it is our goal to establish aggregate cash and equity compensation that is between the median and the 75th percentile of our peer group, assuming achievement of target level of performance, with the understanding that we may from time to time elect to provide compensation above this level in connection with the hiring of a new executive if we determine that it is necessary to provide compensation at this level to attract an executive with skills and experience we desire.
Because we seek to provide cash compensation that our executives regard as competitive with relevant market conditions, when setting salaries and aggregate cash compensation we are mindful of the corresponding amounts of cash consideration of our peer group. However, we may set an individual officer’s salary and target bonus above or below median levels of our peer group, as determined to be appropriate by the Compensation Committee. We believe that this approach is sufficient to achieve our retention goals. For the achievement of performance goals above plan, our executives can earn aggregate cash consideration that is

substantially above the median level of the peer group. We believe that this is appropriate because we adopt business plans that are a challenge for us to attain, and we believe that if our executives exceed the demanding targets in these plans they should be eligible to receive higher levels of compensation.
We view our compensation decisions as an exercise in paying competitive compensation, with desired performance goals, on an annual basis. Our cash compensation is not tied to performance beyond one year. Our equity awards vest over a period of time, and as such are impacted by the value of our common stock over the vesting period of the restricted stock. We do not take account of prior wealth accumulation by our executives from the receipt of cash on exercise or vesting of equity awards as we do not believe these prior period returns provide a significant motivation or retention benefit in the current period. Further, we do not set the compensation of our executives at any multiple or ratio to the compensation of other executives or employees. Our Compensation Committee has not adopted any formal or informal policies or guidelines for allocating compensation between long-term and immediate compensation, between cash and non-cash compensation, or among different forms of non-cash compensation, otherlater than as described in this Compensation Discussion and Analysis for the manner in which we make restricted stock awards to executives.
Our Compensation Committee’s current intent is to perform on a regular basis a strategic review of our executive officers’ overall compensation packages to determine whether they provide adequate incentives and motivation and whether they adequately compensate our executive officers relative to comparable officers in our peer group companies.
Base Salaries
Our Compensation Committee reviews the base salaries of our executives annually and may adjust an officer’s salary if it determines that such a change is merited on the basis of the officer’s personal performance and market conditions. As set forth in the “Summary Compensation” table below, the Compensation Committee approved 2017 salary increases for executive officers based on market conditions, individual performance of the executives, the Company’s growth and the Company’s increased complexity of operation.
Cash Incentive Plan
As noted above, one element of our cash compensation has been a performance-based incentive plan. In 2015, upon the recommendation of the Board and Compensation Committee, our stockholders approved a Cash Incentive Plan, or CIP, for the Company to preserve our ability to deduct “performance-based compensation” awards pursuant to Section 162(m) of the Internal Revenue Code of 1986. The 2017 CIP further described below, which is the performance-based cash incentive plan for 2017, was adopted pursuant to the CIP.

Maximum Bonus and Performance Goals

The 2017 CIP applied the same performance metrics, with the same weighting, as the 2016 CIP for our CEO and CFO. In both plans, the bonus opportunity for our CEO and CFO was based primarily on consolidated adjusted pre-tax earnings per share with a lesser weighting for consolidated revenue. For our CEO and CFO the target bonus for 2017 was weighted (i) at 80% for attainment of the consolidated pre-tax earnings per share contained in the Company’s 2017 business plan approved by the Board (“2017 Plan”) and (ii) at 20% for attainment of the consolidated revenue contained in the 2017 Plan.
For Mr. Noll, the Vice President and General Manager of our Neurology strategic business units (“SBUs”) and Mr. Traverso, who served through the first quarter of 2017 as the general manager of our Newborn care SBU, the target bonus under the 2017 CIP was based on the achievement of five metrics: (i) the consolidated pre-tax earnings per share contained in the 2017 Plan weighted at 15%, (ii) the consolidated revenue contained in the 2017 Plan weighted at 15% (iii) the pre-tax earnings per share of their respective strategic business units contained in the 2017 Plan weighted at 25%, (iv) the revenue of their SBUs contained in the 2017 Plan weighted at 25%, and (v) successful completion of discrete operational goals for their respective SBUs in 2017 weighted at 20%. These performance metrics were the same performance categories implemented in the 2016 CIP. Dr. Chung’s bonus was based on the achievement of the following three metrics: (i) the consolidated pre-tax earnings per share contained in the 2017 Plan weighted at 60%, (ii) the consolidated revenue contained in the 2017 Plan weighted at 20% and (iii) the successful completion of discrete operational goals weighted at 20%. These performance metrics were the same performance categories implemented in the 2016 CIP for Dr. Chung.
The target consolidated revenue for 2017 was $519,400,000.00. The target amount of consolidated non-GAAP EPS was $ 1.89. The 2017 CIP required as a threshold to the payment of cash bonuses to any executive officers that we achieve the non-GAAP EPS target at a minimum of the 85% level. Because it was clear that no bonus payments would be made for 2017 in light of our actual operating results, the actual adjustments to EPS were not calculated. Had it been necessary to determine adjusted EPS for 2017, the likely adjustments would have been to eliminate restructuring costs, costs of acquisitions, and remediation costs at the Company’s Seattle facility.

Target amounts for our named executive officers under the 2017 CIP were established as a percentage of the base salaries of the respective officers and were as follows:

Name:
($)
Minimum Bonus
($)
Target Bonus
($)
Maximum Bonus
James B. Hawkins, Chief Executive Officer  400,000  800,0001,600,00
Jonathan A. Kennedy, Senior Vice President Finance and Chief Financial Officer156,000  312,000624,000
Austin A. Noll, III, Vice President, General Manager, Neurology90,000  180,000360,000
Kenneth M. Traverso, Vice President, General Manager, Newborn Care (1)82,500165,000330,000
D. Christopher Chung, M.D., Vice President Medical Affairs, Quality and Regulatory Affairs60,000   120,000240,000

(1) Mr. Traverso served as the general manager of our Newborn Care SBU, and as an executive officer, through the first quarter of 2017, following which time he continued as an employee.
Equity-Based Compensation Element
Equity-based compensation provides employees with a common interest with our stockholders to increase the value of our common stock. Equity awards are granted to employees, including our executive officers, in the form of restricted stock and restricted stock units. Equity grants help retain key employees because they typically cannot be fully exercised or are subject to a right of repurchase for four years. In addition, the four-year vesting schedule also helps focus our employees on long-term performance.
From 2006 until December 2014, we sought to achieve the equity portion of aggregate compensation through stock option grants and restricted stock awards, with each comprising approximately half of the value of the annual equity award. From December 2014 forward, the annual equity award is comprised solely of restricted stock awards.
Equity-based compensation is granted to an executive officer when the executive first joins us. Additional equity-based compensation may be granted in connection with a significant change in responsibilities. Further, we typically make annual equity awards to our executive officers. In making these awards our Compensation Committee applied the compensation philosophy discussed above. In particular, the Compensation Committee used equity awards to help to provide total annual compensation that was consistent with its goals for total compensation, to incent our executives to increase the per share value of the Company over the course of the vesting period of these awards and to provide a mechanism for the retention of the executives over the course of the vesting of the awards. The Compensation Committee’s procedure for timing of equity awards provides assurances that grant timing is not being manipulated to result in a price that is favorable to employees. In 2015, the Compensation Committee revised its practice with regard to the granting of equity awards to employees and did so at the beginning of the year in connection with its establishment of cash compensation. Previously, equity awards were made promptly following the annual meeting of stockholders, typically in June of each year. The exercise price for all option grants is the closing price on the last completed day of trading prior to the meeting of the Compensation Committee at which the options are granted.
In 2018 we revised the form of award agreement for our equity-based awards to provide that unvested awards would vest upon retirement if the employee had attained the age of 65 and had been continuously employed for at least 10 years. Our Compensation Committee elected to make this change because it sought to have the ability to continue to motivate employees to remain in our employ following the attainment of age 65, even if the employee might not otherwise be committed to working through the full customary vesting term. This provision applies to all recipients of equity awards made after the adoption of this change, including Executive Officers.
Employment Agreements and Change in Control Arrangements
We entered into employment agreements with Kenneth M. Traverso in November 2002 and D. Christopher Chung, M.D. inFebruary 2003, both of which were amended in December 2008, and with James B. Hawkins in April 2004, which was amended in April 2008, December 2008, and April 2014. We entered into an employment agreement with Austin A. Noll, III on August 1, 2012 and Jonathan A. Kennedy on April, 11, 2013. In addition, with the exception of Mr. Hawkins and Mr. Kennedy, the other executives entered into Amended Employment Agreements with the Company in August, 2014. Other than Mr. Hawkins, the terms of these agreements are substantially the same. Upon termination of employment for cause, death, or disability, the executive

will only be eligible for severance benefits, if any, in accordance with the Company’s established policies for all employees as then in effect, which consist primarily of short-term disability and group life insurance benefits.
Should an officer’s, other than Mr. Hawkins’ employment with us terminate for other than cause, death or disability, the officer shall be entitled to:
Receive continuing payments of severance pay, less applicable withholding taxes, at a rate equal to the officer’s then current base salary rate for a period of twelve months commencing with the latest payroll date that is also within 70 days from the date of “separation from service” (with earlier commencement possible only if in compliance with Section 409A of the Internal Revenue Code and with payments that would have been made on earlier payroll dates, but for this provision, cumulated and paid on such payroll date);
The immediate vesting and exercisability of any unvested stock options and of restricted stock, or other equity awards, which in the case of stock options would be exercisable for a period of 30 days after such termination; and
Continued payment by the Company of COBRA benefits through the lesser of (i) six to eighteen months from the effective date of such termination, (ii) the date upon which the officer and the officer’s eligible dependents become covered under similar plans, or (iii) the date the officer no longer constitutes a “Qualified Beneficiary”, as such term is defined in Section 4980B(g) of the Internal Revenue Code of 1986, as amended.
These agreements provide for the same severance benefits as above if the officer terminates his employment for “good reason” within 12 months following a change-in-control transaction, in which case the executive also is eligible to receive a cash payment equal to the amount of the officer’s target bonus in effect at the time of the change-in-control event occurs or the actual bonus at the time of the officer’s termination. Employment termination is for “good reason” if it follows a material reduction in the officer’s duties or responsibilities, a reduction in base salary, a material reduction in employee benefits, relocation of more than 35 miles from the officer’s present location, or the failure of a successor entity to assume the employment agreement. A change in control for such employment agreements is a transaction by which someone acquires more than 50% of the Company’s outstanding voting power, a change in the Board within a two-year period such that fewer than a majority are incumbent directors, a merger or consolidation following which the stockholders of the Company own 40% or less of the combined voting power of the Company or the surviving entity, or the sale of all or substantially all of the assets of the Company.
Should Mr. Hawkins’ employment with us terminate for other than cause, death or disability, Mr. Hawkins shall be entitled to:
Receive a lump sum payment due and payable within thirty (30)120 days after the dateend of separation, less applicable withholding taxes, equal to two times his then current base salary;
The immediate vesting of any unvested stock options, restricted stock, or other equity awards, which in the case of stock options would be exercisable for a period of 30 days after such termination; and
Continued payment by the Company of COBRA benefits through the lesser of (i) 18 months from the effective date of such termination, or (ii) the date upon which he or his eligible dependents become covered under similar plans
The agreement provides that if within twelve months of a change in control transaction Mr. Hawkins terminates his employment for “good reason” or is terminated without cause, then Mr. Hawkins will receive (i) a lump sum payment due and payable within thirty (30) days after the date of separation, less applicable withholding taxes, equal to two times the sum of (A) the greater of his then current base salary rate and his base salary rate in effect immediately prior to the change in control transaction and (B) the greater of 100% of his target bonus then in effect and 100% of his target bonus as in effect immediately prior to the change in control transaction; (ii) continued provision of COBRA or similar benefits through the lesser of twenty-four months or the date upon which Mr. Hawkins becomes covered under similar plans; and (iii) the immediate vesting of unvested stock options, restricted stock and other equity awards. Employment termination is for “good reason” if it follows a material reduction in the officer’s duties or responsibilities, a material reduction in base salary, a material reduction in employee benefits, relocation of more than 35 miles from the officer’s present location, or the failure of a successor entity to assume the employment agreement. A change in control for purposes of this employment agreement is a transaction by which someone acquires more than 50% of the Company’s outstanding voting power, a merger or consolidation following which the stockholders of the Company own 40% or less of the combined voting power of the Company or the surviving entity, stockholder approval of a plan to liquidate the Company, or the sale of all or substantially all of the assets of the Company.
To be eligible for termination benefits, all executives must comply with certain non-compete and non-solicitation provisions and retention is conditioned on execution of a release of claims.

The base salaries for our named executive officers for 2017 were as follows: James B. Hawkins, $820,000; Jonathan A. Kennedy, $490,000; Austin A. Noll, III, $370,000; Kenneth M. Traverso, $340,000; and D. Christopher Chung, M.D., $310,000.
We believe that these agreements appropriately balance our needs to offer a competitive level of severance protection to our executives and to induce our executives to remain in our employ through the potentially disruptive conditions that may exist around the time of a change in control, while not unduly rewarding executives for a termination of their employment. We note that our change in control terms include so-called “double trigger” provisions, so that the executive is not entitled to the severance payment by the mere occurrence of the change in control. This feature, we believe, will be an incentive to the executive to remain in the employ of the Company if such continuation is required by our partner in a change in control transaction.
Our 2011 Stock Awards Plan provides for the grant of options to purchase our common stock to employees, directors and consultants. Under the predecessor plan, prior to June 14, 2006, options granted to employees had a contractual term of ten years; options granted since June 14, 2006 have a contractual term of six years. The 2011 plan and the predecessor plan provide that after certain “change in control” events, including, for example, our merger with or into another corporation or the sale of all or substantially all of our assets, outstanding options may be assumed or equivalent options may be substituted, by the successor corporation. The plans provide that the plan administrator may provide that if an optionee’s options are assumed or substituted and the optionee’s status as our employee or employee of the successor corporation is terminated within 12 months other than by a voluntary resignation or termination for cause, the option may become fully exercisable. Further, if the successor corporation does not assume an outstanding option or substitute for it an equivalent option, the option becomes fully vested and exercisable.
For further detailed financial information concerning the severance and change in control arrangements with our executive officers, please see the tabular information contained in the section entitled “Potential Payments Upon Termination or Change in Control.”
Other Benefits
Executive officers are eligible to participate in all of our employee benefit plans, such as medical, dental, vision, group life, disability, and accidental death and dismemberment insurance, and our 401(k) plan, in each case on the same basis as other employees, subject to applicable law. We also provide vacation and other paid holidays to all employees, including our executive officers, which we intend to be comparable to those provided at peer companies.
Accounting Treatment
We account for equity compensation paid to our employees under ASC Topic 718 which requires us to estimate and record an expense over the service period of the award. Our cash compensation is recorded as an expense at the time the obligation is accrued. We structure the cash compensation element of our incentive compensation so that it is taxable to our executives at the time it becomes available to them. We currently intend that all cash compensation paid will be tax deductible by us. However, with respect to equity compensation awards, while any gain recognized by employees from nonqualified options granted at fair market value should be deductible, to the extent that an option constitutes an incentive stock option, gain recognized by the optionee will not be deductible if there is no disqualifying disposition by the optionee. In addition, if we grant restricted stock or restricted stock unit awards that are not subject to performance vesting, they may not be fully deductible by us at the time the award is otherwise taxable to employees.
Tax Deductibility of Executive Compensation
Section 162(m) of the Tax Code generally disallows public companies a tax deduction for federal income tax purposes of remuneration in excess of $1 million paid to certain executive officers.  While our Compensation Committee may consider the deductibility of awards as one factor in determining executive compensation, our Compensation Committee also looks at other factors in making its decisions and retains the flexibility to award compensation that it determines to be consistent with the goals of our executive compensation program even if the awards are not deductible by us for tax purposes.

Recent changes to Section 162(m) in connection with the passage of the Tax Cuts and Jobs Act repealed exceptions to the deductibility limit that were previously available for “qualified performance-based compensation” (including stock option grants, performance-based cash bonuses and performance-based equity awards, such as performance-based restricted stock units) effective for taxable years after December 31, 2017.  As a result, any compensation paid to certain of our executive officers in excess of $1 million following December 31, 2017 will be non-deductible. However, compensation payable pursuant to certain binding arrangements in effect on November 2, 2017 may qualify for transition relief afforded by the Tax Cuts and Jobs Act and remain deductible. Because of uncertainties in the interpretation and implementation of the changes to Section 162(m) in the Tax Cuts and Jobs Act, including the scope of the transition relief, we can offer no assurance of such deductibility.
Compensation Risk

The Compensation Committee regularly reviews the Company’s compensation policies and practices, including the risks created by the Company’s compensation plans. The Compensation Committee concluded that the compensation plans reflected the appropriate compensation goals and philosophy and that any risks arising from the Company’s compensation policies and practices are not reasonably likely to have a material adverse effect on the Company.


SUMMARY COMPENSATION TABLE

The following table sets forth information concerning compensation of our Chief Executive Officer, Chief Financial Officer, and the other three most highly compensated executive officers (the “named executive officers”), all of whom were serving as executive officers of the Company as of December 31, 2017, except for Mr. Traverso, who served as an executive officer through the first quarter of 2017, following which time he continued as an employee1.
Name and Principal PositionYearSalary
Stock Awards 3
Option Awards 2
Non-Equity Incentive Plan Compensation ($) 3
All Other Compensation 4
Total

James B. Hawkins
Chief Executive Officer

2017
2016
2015

$820,000
750,000
700,000

$4,106,400
3,999,905
2,811,120

$--
--
--
$ 0
   985,502
1,080,301

$6,144
6,064
7,522

$4,932,544
5,741,471
4,598,943
Jonathan A. Kennedy
Senior Vice President Finance and Chief Financial Officer

2017
2016
2015

490,000
440,000
410,000
1,113,600
1,000,090
792,159
--
--
--
           0
375,195
410,514
5,578
5,560
4,250
1,609,178
1,820,845
1,616,923
Austin A. Noll, III
Vice President, General Manager, Neurology
2017
2016
2015
370,000
340,000
320,000
556,800
530,075
419,866

--
--
--
           0
139,859
197,060
6,020
1,242
   828
   932,820
1,011,176
   937,754
Kenneth M. Traverso
Vice President, General
Manager, Newborn Care
2017
2016
2015
340,000
330,000
310,000
501,120
500,045
225,000

--
--
--
          0
225,229
156,055
7,124
7,072
4,319
  848,244
1,062,346
   945,008
D. Christopher Chung, M.D.
Vice President Medical Affairs, Quality and Regulatory
2017
2016
2015

310,000
286,000
277,000
320,160
299,845
237,504
--
--
--
          0
146,637
152,083
6,020
5,992
6,114

636,180
742,474
673,906


(1) Each of the named executive officers has an Employment Agreement with us that provided for an initial base salary that is subject to subsequent review and to adjustments. These agreements provide that the executive’s employment with us is on an “at will” basis. These agreements also provide for certain payments and other benefits upon termination of employment in certain circumstances, as further described under “Employment Agreements and Change in Control Arrangements” in the “Compensation Discussion and Analysis” above, and in the “Potential Payments Upon Termination or Change in Control” section below.
(2) The amounts included in the “Stock Awards” and “Option Awards” columns represent the grant-date fair value of the awards on the date of grant, computed in accordance with ASC Topic 718, except that in the case of option awards, a forfeiture rate of zero percent has been used. The assumptions we use in calculating these amounts, other than the exclusion of the impact of estimated forfeitures, are discussed in Note 14-Share Based Compensation of the Notes to our consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017. See the “Grants of Plan Based Awards Table” for more information regarding the equity awards granted by the Company in 2017. Refer to the “Compensation Discussion and Analysis” above for a discussion of these awards.
(3) The amounts in this column reflect bonuses under our CIP for 2015 and 2016 that were paid in March 2016 and 2017. See the “Grants of Plan Based Awards Table” for more information regarding non-equity incentive plan compensation. Refer to the “Compensation Discussion and Analysis” above for a discussion of non-equity incentive plan compensation.
(4) The amounts included in the “All Other Compensation” column consist of matching contributions paid by the Company into our 401(k) plan on behalf of the named executive officers, the value of group life insurance benefits.

GRANTS OF PLAN BASED AWARDS - FISCAL 2017
This table discloses the actual numbers of stock options and restricted stock awards granted to our named executive officers in 2017 and the grant date fair value of these awards. It also captures the payouts under the Company’s 2017 Management EMIP.


NameGrant Date
Estimated Future Payouts Under
Non-Equity Incentive Plan Awards 1

Threshold Target Maximum
($)($)($)
All Other Stock Awards:
Number of Shares of Stock or Units 2
All Other Option Awards: Number of Securities Underlying OptionsExercise or Base Price of Option Awards ($/Share)
Grant Date Fair Value of Stock and Option Awards ($)3 
Mr. Hawkins01/02/2017400,000800,0001,600,000118,000






$4,106,400
Mr. Kennedy01/02/2017156,000312,000624,00032,000  1,113,600
Mr. Noll01/02/201790,000180,000360,00016,000  556,800
Dr. Chung01/02/201760,000120,000240,0009,200  320,160
Mr. Traverso01/02/201782,50065,000330,00014,400  501,120

(1) Each of the named executive officers had a range of payouts targeted for 2017 non‑equity incentive compensation under our 2017 CIP based on the Company’s performance as described in “Compensation Discussion and Analysis” above.
(2) Each of the named executive officers received a grant of restricted shares in 2017 that vest as follows: 50% in January 2019, 25% in January 2020, and 25% in January 2021.
(3) Represents the grant date fair market value of restricted stock awards granted to the named executive officers in 2016 computed in accordance with ASC Topic 718. The assumptions we use in calculating these amounts are discussed in Note 14-Share Based Compensation of the Notes to our consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017.
OUTSTANDING EQUITY AWARDS AT 2017 FISCAL YEAR-END
 
Option Awards 1
Stock Awards
Name
Number of Securities Underlying Unexercised Options (#)
Exercisable
Number of Securities Underlying Unexercised Options (#)
Unexercisable
Option Exercise Price ($)Option Expiration DateNumber of Shares or Units of Stock That Have Not Vested (#)
Market Value of Shares or Units of Stock That Have Not Vested ($) 3
Mr. Hawkins
160,000
150,000
107,708
--
--
2,292
10.69
14.34
22.50
06/07/20182
06/03/20192 
01/01/20202
            181,4556,931,581
Mr. Kennedy

31,345
16,767

--
833

13.24
22.50

04/08/20192
01/01/20202
48,990649,018
Mr. Noll
  
  9,375
14,250
19,583
 
--
--
417

11.92
14.34
22.50

06/07/20182
02/14/20192
01/01/20202
24,950953,090
Dr. Chung

15,358
16,000
13,708


--
 --
292


10.69
14.34
22.50


06/07/20182
06/07/20192
01/01/20202

14,495553,709
Mr. Traverso
         
36,000
30,000
19,583

--
--
417

10.69
14.34
22.50
   
06/07/20182
06/07/20192
01/01/20202
22,770869,814

(1) Initial grants of options to the named executive officers upon employment vest 1/8th after the completion of six months of service with the remainder vesting ratably over the next 42 months. Subsequent grants of options vest ratably over a 48 month period.
(2) Options expire 6 years from the date of grant.
(3) Represents the value of these awards based on the closing price of our stock on December 30, 2017 of $38.20.

OPTION EXERCISES AND STOCK VESTED - FISCAL 2017
The following table sets forth certain information regarding options and stock awards exercised and vested, respectively, during 2017 for the named executive officers.
 Option AwardsStock Awards
NameNumber of Shares Acquired on Exercise (#)Value Realized on Exercise ($)
Number of Shares Acquired on Vesting (#) 1
Value Realized on Vesting ($) 1
Mr. Hawkins----           148,705
        5,425,244
Mr. Kennedy----             53,990
        2,009,868
Mr. Noll----             24,700
           895,565
Mr. Chung12,642407,33314,795
537,519
Mr. Traverso32,000633,73822,870
830,397

(1)Represents the value of restricted stock awards that were granted on June 7, 2013, and January 1, 2014, and January 1, 2015, and January 4, 2016 that vested in 2017.

POTENTIAL PAYMENTS UPON TERMINATION OR CHANGE IN CONTROL
Under the employment agreements between the Company and the named executive officers, upon termination of employment for cause, death or disability, the executive will only be eligible for severance benefits, if any, in accordance with the Company's established policies for all employees as then in effect. The table that follows reflects the amount of compensation due to our named executive officers if their employment is terminated for other than cause, death or disability, or their employment is terminated or the executive terminates his employment for good cause, following a change in control, as more fully described under “Employment Agreements and Change in Control Arrangements” in the “Compensation Discussion and Analysis” above. The amounts shown below assume that such termination or change in control event was effective as of December 31, 2017.  For a discussion of the amount of compensation due to our named executive officers if their employment is terminated without cause other than in connection with a change of control, see “Employment Agreements and Change in Control Arrangements” in the “Compensation Discussion and Analysis” above.

NameCash Severance PaymentContinuation of Medical and Welfare Benefits
Acceleration of Equity Awards 1
Total Termination Benefits
   Mr. Hawkins$2,440,000$42,030$6,967,565$9,449,595
   Mr. Kennedy810,00038,5431,884,4962,773,039
   Mr. Noll550,00038,543959,6371,548,180
   Dr. Chung430,00038,543558,2931,026,836
   Mr. Traverso505,00038,543876,3611,419,904

(1)The amounts shown in the table represent the payments to which the officer is entitled for a termination following a change in control. For termination without cause other than in connection with a change of his control, his cash severance

payment and other benefits are detailed in the “Employment Agreements and Change in Control Arrangements” Section, above.

Pay Ratio Disclosure
Our ratio of the annual total compensation of our Chief Executive Officer to the median of the annual total compensation of all our employees (excluding our Chief Executive Officer) for 2017 is 90 to 1. We believe this ratio, which was calculated in a manner consistent with Item 402(u) of Regulation S-K, to be a reasonable estimate, based upon the assumptions and adjustments described below. As disclosed in the 2017 Summary Compensation Table, the annual total compensation for 2017 for our Chief Executive Officer was $4,932,544. The annual total compensation for 2017 for our median employee was $55,061. In identifying the median employee under Item 402(u), reporting companies are permitted to use reasonable estimates, assumptions and methodologies based on their own facts and circumstances. As a result, the disclosure regarding the compensation of our median employee may not be directly comparable to similar disclosure by other reporting companies.
Calculation Methodology
We identified the employee with compensation at the median of the compensation of all of our employees (the “median employee”) by considering our employee population as of December 20, 2017 (the “employee population determination date”). We considered all individuals, excluding our Chief Executive Officer, who were employed by us on a world-wide basis (including our consolidated subsidiaries) on the employee population determination date, whether employed on a full-time, part-time, seasonal or temporary basis, including employees on a partial year leave of absence (our “employee population”), subject to the application of the “de minimis” exemption as described below.
The de minimis exemption allows us to exclude up to 5% of our total employees who are non-U.S. employees. Our total number of employees, including U.S. and non-U.S. employees as of the employee population determination date was 2,176, and we used this number to calculate the maximum number of employees excludable under the de minimis exemption. Accordingly, in identifying the median employee, we used the de minimis exemption to exclude the following numbers of employees who are employed in the following countries: Australia (12), Brazil (1), China (36), Spain (9), Finland (2), Hong Kong (3), India (2), Jordan (2), Lebanon (1), Mexico (2), Malaysia (1), Netherlands (3), Norway (2), New Zealand (1), Portugal (1), Sweden (4), Singapore (4) and South Africa (1).
Multiple consistently applied calculation measures (“CACM”) were reviewed before selecting base salary as the CACM for purposes of identifying the median employee. The employee compensation data under review reflects 2017 figures.
For employees paid other than in U.S. dollars, we converted their compensation to U.S. dollars using foreign exchange rates in effect on the employee population determination date. We did not make any cost-of-living adjustments for employees outside of the United States. For employees hired between January 1, 2017 and the employee population determination date, we calculated their cash compensation described above as if they had been employed for the entire measurement period.
We believe our methodology represents a CACM that strikes a balance in terms of administrative burden while consistently treating all the primary compensation components for our worldwide employee population.
Using this methodology, we identified the median employee who was in the sales department and based in the United States.
We calculated the annual total compensation for the median employee using the same methodology we use to calculate the amount reported for our named executive officers in the “Total” column of the Summary Compensation Table.

DIRECTOR COMPENSATION
Directors who are employees receive no additional compensation for serving on the Board or its committees. The table below discloses the annual compensation provided during the year ended December 31, 2017 to directors who are not employees:


Name
Fees Earned or Paid in Cash
($) 1
Stock Awards
($) 2
Option Awards
($) 2, 3
Total
($)
Mr. Gunst166,000149,468--312,985
Ms. Engibous4
88,775               149,468--235,760
Mr. Ludlum5
101,000               149,468--247,985
Mr. Moore6
95,549             149,468--242,534
Ms. Paul7
77,218149,468--224,203

(1) For 2017, fees earned and paid in cash were based on the following retainer and payment schedule:
Board Retainer                    $60,000
Audit Committee Member Retainer            $15,000
Compensation Committee Member Retainer        $10,000
Nominating Committee Member Retainer        $5,000
Chairman of the Board                $75,000
Audit Chair Retainer                $20,000
Compensation Chair Retainer            $10,000
Nominating Chair Retainer            $7,500
Compliance Chair Retainer            $10,000
Compliance Committee Member Retainer        $10,000

(2) Represents the grant‑date fair market value of restricted stock awards granted to the directors in 2017 computed in accordance with ASC Topic 718. Assumptions we use in calculating these amounts, other than the exclusion of the impact of estimated forfeitures, are discussed in Note 12-Share Based Compensation of the Notes to our consolidated financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2017.
(3) At December 31, 2017, Ms. Engibous had 18,000 options and 4,400 unvested restricted shares outstanding, Mr. Gunst had 18,000 options and 4,400 unvested restricted shares outstanding, Mr. Ludlum had 13,000 options and 4,400 unvested restricted shares outstanding, Mr. Moore had 13,000 options and 4,400 unvested restricted shares outstanding, and Ms. Paul had 4,400 unvested restricted shares outstanding.
(4) Nominating and Governance Committee Chair.

(5) Audit Committee Chair.

(6) Compensation Committee Chair.

(7) Compliance Committee Chair.
Compensation Committee Interlocks and Insider Participation
Our Compensation Committee consists of Ms. Engibous, Mr. Ludlum and Mr. Gunst. Mr. Moore, who served on the Compensation Committee for a portion of 2017, served as our Chief Executive Officer 26 years ago, from April 1989 to May 1992.
Compensation Committee Report
The Compensation Committee of the Board of Natus has reviewed and discussed the Compensation Discussion and Analysis required by Item 402(b) of Regulation S-K with management and, based on such review and discussions, the Compensation Committee recommended to the Board that the Compensation Discussion and Analysis be included in this Annual Report on Form 10-k for the fiscal year ended December 31, 2017.
Respectfully submitted by:
THE COMPENSATION COMMITTEE
DORIS E. ENGIBOUS, Chair

ROBERT A. GUNST
KENNETH E. LUDLUM

covered by this Annual Report. That information is incorporated into this Item 11 by reference.
ITEM 12.     Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
Equity Compensation Plan Information
The following table sets forth information about the number of shares of common stock that can be issued under our 20112018 Stock Awards Plan as amended, and our 2011 Employee Stock Purchase Plan as of December 31, 2017.2019.
Plan Category 
Number of Securities
to be Issued upon
Exercise of
Outstanding
Options, Warrants,
Awards and Rights
 
Weighted-Average
Exercise Price of
Outstanding
Options, Warrants,
Awards and Rights
 
Number of Securities
Remaining Available for
Future Issuance under
Equity Compensation Plans
(excluding securities
reflected in the first column)
 
Number of Securities
to be Issued upon
Exercise of
Outstanding
Options, Warrants,
Awards and Rights
 
Weighted-Average
Exercise Price of
Outstanding
Options, Warrants,
Awards and Rights
 
Number of Securities
Remaining Available for
Future Issuance under
Equity Compensation Plans
(excluding securities
reflected in the first column)
Equity compensation plans approved by security holders 819,073
 $15.18
 779,298
 247,029
 $35.31
 2,764,603
Equity compensation plans not approved by security holders 
 
 
 
 
 
Total 819,073
 15.18
 779,298
 247,029
 35.31
 2,764,603

Security Ownership of Certain Beneficial Owners and Management
The following table sets forthWe will provide certain other information as of March 31, 2017, concerning:
Beneficial owners of morethat is responsive to this Item 12 in our 2020 Proxy Statement or in an amendment to this Annual Report not later than 5% of Natus common stock;
Beneficial ownership by current Natus directors and nominees, and120 days after the named executive officers set forth in the “Summary Compensation Table”; and
Beneficial ownership by all current Natus directors and executive officers as a group.
The information provided in the table is based on Natus’ records, information filed with the Securities and Exchange Commission and information provided to Natus, except where otherwise noted.
The number of shares beneficially owned by each entity, person, director or executive officer is determined under rulesend of the Securities and Exchange Commission, and thefiscal year covered by this Annual Report. That information is not necessarily indicative of beneficial ownership for any other purpose. Under such rules, beneficial ownership includes any shares as to which the individual has the sole or shared voting power or investment power and also any shares that the individual has the right to acquire within 60 days of the measurement date through the exercise of any stock option or other right. The address for those individuals for which an address is not otherwise provided is c/o Natus Medical Incorporated, 6701 Koll Center Parkway Suite 120, Pleasanton, CA, 94566. Unless otherwise indicated, each person has sole voting and investment power (or shares such powers with his or her spouse) with respect to the shares set forth in the following table. For each individual and group included in the table below, percentage ownership is calculatedincorporated into this Item 12 by dividing the number of shares beneficially owned by such person or group by the sum of the 33,273,137 shares of common stock outstanding on March 31, 2018, plus the number of shares of common stock that such person or group had the right to acquire on or within 60 days after March 31, 2018.
SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT



Name and Address of Beneficial Owner
Shares
Beneficially Owned
Right to acquire beneficial ownership under options exercisable within 60 days
Total
Beneficially Owned
Percent of Class
Principal Stockholders    

BlackRock, Inc.
55 East 52nd Street
New York, NY 10055 (1)
4,032,681--4,032,681 12.2%
Dimensional Fund Advisors LP
Building One
6300 Bee Cave Road
Austin, TX 78746 (2)
1,619,337--1,619,3374.9%
Janus Henderson Group plc (3)2,164,927--2,164,9276.5%
Silvercrest Asset Management Group LLC
1330 Avenue of the Americas, 38th Floor
New York, NY 10019 (4)
1,587,355--1,587,3554.8%
Vanguard Group, Inc.
100 Vanguard Blvd.
Malvern, PA 19355 (5)
2,245,064--2,245,0646.8%
Wellington Management Group LLP
280 Congress Street
Boston, MA 02210 (6)
1,924,157--1,924,1575.8%
Directors, Nominees and Named Executive Officers    
Mr. Noll (7)  81,901               43,625     125,526*
Dr. Chung (8)136,373               45,358     181,731*
Ms. Engibous (9)  21,750               13,000       34,750*
Mr. Gunst (10)  50,850               13,000       63,850*
Mr. Hawkins (11)639,257             420,000  1,059,2573.1%
Mr. Ludlum (12)  88,825                 8,000       97,825*
Mr. Moore (13)123,962                 8,000     131,962*
Mr. Kennedy (14)107,588               48,945     156,533*
Mr. Traverso (15)107,889               86,000     193,889*
Dr. Paul (16)    7,460--         7,460*
Officers and Directors as a group (17)1,366,865642,3031,927,2676.0%

* Represents holdings of less than one percent.

(1) Based on information reported on Schedule 13-G/A filed with the Securities and Exchange Commission on January 19, 2018 by BlackRock, Inc. (“BlackRock”). BlackRock is a parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G) of the Securities Exchange Act of 1934. BlackRock has sole voting power with respect to 3,962,335 of the shares and sole dispositive power with respect to 4,032,681 of the shares. The Schedule 13-G/A states that the following subsidiaries of Blackrock acquired the securities reported on the schedule: BlackRock (Netherlands) B.V.; BlackRock Advisors, LLC; BlackRock Asset Management Canada Limited; BlackRock Asset Management Ireland Limited; BlackRock Asset Management Schweiz AG; BlackRock Financial Management, Inc.; BlackRock Fund Advisors; BlackRock Institutional Trust Company, National Association.; BlackRock Investment Management (Australia) Limited; BlackRock Investment Management (UK) Ltd; and

BlackRock Investment Management, LLC. The Schedule 13-G/A indicates that BlackRock Fund Advisors beneficially owns 5% or greater of the outstanding shares of our common stock.

(2) Based on information reported on Schedule 13-G filed with the Securities and Exchange Commission on February 9, 2018 by Dimensional Fund Advisors LP (“Dimensional”). Dimensional is an investment advisor in accordance with Rule 13d-1(b)(1)(ii)(E) of the Securities Exchange Act of 1934. Dimensional reported that is has sole power to vote or to direct the vote of 1,528,550 and sole power to dispose or to direct the disposition of 1,619,337 shares. The shares as to which the Schedule 13-G are filed represent shared held by certain investment companies, trusts and accounts to which Dimensional furnishes investment advice and are not held by Dimensional itself.
(3) Based on information reported on Schedule 13-G filed with the Securities and Exchange Commission on February 12, 2018 by Janus Henderson Group plc. (“Janus”). Janus is a parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G) of the Securities Exchange Act of 1934. Janus reported that is has shared voting power as to 2,164,927 shares and has shared dispositive power as to 2,164,927. The Schedule 13-G states that the following subsidiaries of Janus acquired the securities reported on the schedules: Janus Capital Management LLC, Intech Investment Management LLC, Perkins Investment Management LLC, Geneva Capital Management LLC, Henderson Global Investors Limited, Janus Henderson Investors Australia Institutional Funds Management Limited, and Henderson Global Investors North America Inc. The shares as to which the Schedule 13-G are filed represent shares held by individual and/or institutional clients of Janus and its named subsidiaries.
(4) Based on information reported on Schedule 13-G filed with the Securities and Exchange Commission on February 14, 2018 by Silvercrest Asset Management Group LLC (“Silvercrest”). Silvercrest is an investment advisor in accordance with Rule 13d-1(b)(1)(ii)(E) of the Securities Exchange Act of 1934 and a parent holding company or control person in accordance with Rule 240.13d-(b)(1)(ii)(G). Silvercrest reported that it has shared voting power with respect to 1,587,355 shares and shared dispositive power with respect to 1,587,355 shares. The shares as to which the Schedule 13-G are filed represent shares held by investment advisory clients of Silvercrest Asset Management Group LLC.
(5) Based on information reported on Schedule 13-G/A filed with the Securities and Exchange Commission on February 9, 2018 by The Vanguard Group. Inc. (“Vanguard”). Vanguard is an investment advisor in accordance with Rule 13d-1(b)(1)(ii)(E) of the Securities Exchange Act of 1934. Vanguard reported that it has sole power to vote or direct the vote of 60,127 shares that it beneficially owns, has shared power to vote or direct the vote of 4,500 shares, has sole power to dispose or to direct the disposition of 2,183,137 shares and has shared power to dispose or to direct the disposition of 61,927 shares. Vanguard further reported that (a) Vanguard Fiduciary Trust Company, a wholly-owned subsidiary of Vanguard, is the beneficial owner of 57,427 shares, or 0.17%, of our common stock as a result of its serving as investment manager of collective trust accounts and (b) Vanguard Investments Australia, Ltd., a wholly-owned subsidiary of The Vanguard Group, Inc., is the beneficial owner of 7,200 shares, or 0.02%, of our common stock as a result of its serving as investment manager of Australian investment offerings.
(6) Based on information reported on Schedule 13-Gfiled with the Securities and Exchange Commission on February8, 2018 by Wellington Group Holdings LLP (“Wellington”). Wellington is an investment advisor in accordance with Rule 13d-1(b)(1)(ii)(E) of the Securities Exchange Act of 1934 and a parent holding company or control person in accordance with Rule 240.13d-(b)(1)(ii)(G). Wellington reported that is has shared voting power with respect to 1,632,404 shares and shared dispositive power with respect to 1,924,157 of the shares. The Schedule 13-G states that the following holding companies of Wellington acquired the securities reported on the schedule: Wellington Group Holdings LLP, Wellington Investment Advisors LLP, Wellington Management Global Holdings, Ltd (“Wellington Holding Companies”). The shares as to which the Schedule 13-G are filed are held by the Wellington Holding Companies and owned of record by clients of Wellington Management Company LLP, Wellington Management Canada LLC, Wellington Management Singapore Pte Ltd., Wellington Management Hong Kong Ltd., Wellington International Ltd., Wellington Management Japane Pte Ltd., and Wellington Management Australia Pty Ltd.
(7) Includes 24,950 shares subject to a right of repurchase that expire as to 14,037 shares in 2019, 6,913 shares in 2020, and 4,000 shares in 2021 and 43,625 shares that Mr. Noll has the right to acquire within 60 days after March 31, 2018.
(8) Includes 14,495 shares subject to a right of repurchase that expire as to 8,247 shares in 2019, 3,948 shares in 2020, and 2,300 shares in 2021 and 45,358 shares that Dr. Chung has the right to acquire within 60 days after March 31, 2018.
(9) Includes 4,100 shares subject to a right of repurchase by the Company that expires in 2018 and 13,000 shares that Ms. Engibous has the right to acquire within 60 days after March 31, 2018.
(10) Includes 4,100 shares subject to a right of repurchase by the Company that expires in 2018 and 13,000 shares that Mr. Gunst has the right to acquire within 60 days after March 31, 2018.
(11) Includes 181,455 shares subject to a right of repurchase by the Company that expires with respectas to 100,477 shares in 2019, 51,478 shares in 2020, and 29,500 shares in 2021 and 420,000 shares that Mr. Mr. Hawkins has the right to acquire within 60 days after March 31, 2018.

(12) Includes 4,100 shares subject to a right of repurchase by the Company that expires in 2018 and 13,000 shares that Mr. Ludlum has the right to acquire within 60 days after March 31, 2018.
(13) Includes 4,100 shares subject to a right of repurchase by the Company that expires in 2018 and 8,000 shares that Mr. Moore has the right to acquire within 60 days after March 31, 2018.
(14) Includes 48,990 shares subject to a right of repurchase by the Company that expires as to 27,495 shares in 2019, 13,495 shares in 2020, and 8,000 shares in 2021 and 48,945 shares that Mr. Kennedy has the right to acquire within 60 days after March 31, 2018.

(15) Includes 22,770 shares subject to a right of repurchase by the Company that expires as to 12,822 shares in 2019, 6,348 shares in 2020, and 3,600 shares in 2021 and 86,000 shares that Mr. Traverso has the right to acquire within 60 days after March 31, 2018.

(16) Includes 4,100 shares subject to a right of repurchase by the Company that expires in 2018.

(17) Includes all shares referenced in notes 1 through 16 above.

reference.
ITEM 13. Certain Relationships and Related Transactions, and Director Independence
Certain Relationships and Policies on Related Party Transactions
The Company has adopted and maintains a Code of Business Conduct and Ethics (the “Code”)We will provide information that appliesis responsive to all membersthis Item 13 in our 2020 Proxy Statement or in an amendment to this Annual Report not later than 120 days after the end of the Company’s Board, all executive officers of the Company, and to all other persons who are employees of the Company. This Code covers matters that the Company believes are supportive of high standards of legal and ethical business conduct, including those relating to fair dealing with those with whom the Company does business, the avoidance of conflicts of interest, confidentiality, the protection of corporate assets, special obligations applicable to those involved in our financial reporting, the Company’s obligation to make full, fair, accurate and timely disclosure in its filings with the Securities and Exchange Commission and in other public communications, compliance with laws, insider trading, and the reporting of violations of the Code. The Code can be found at the Company’s website, www.natus.com, under “Investors/Governance/Governance Documents.” We intend to disclose any future amendments to certain provisions of the Code, or waivers of these provisions, on our website and/or in public filings.
The Code does not distinguish between potential conflict of interest transactions with executive officers or directors and those with other employees. It notes that allfiscal year covered persons must avoid situations where their interests conflict, or would appear to conflict, with those of the Company. The Code notes that itby this Annual Report. That information is not possible to list all types of conflict situations, but provides examples of several types of scenarios that would involve a conflict of interest, including:
Use of Company property
Dealings with customers and suppliers
Interests in or relationships with other companies
Dealings with relatives
Reporting obligations
Loans
The Code requires that covered persons report to the Company’s Chief Executive Officer ownership interest or other relationship that might affect their ability to exercise impartial, ethical judgments. The Code does not expressly set forth the standards that would be applied in reviewing or approving transactions in which directors or executive officers of the Company have a material interest. In general, any such transactions that are so identified would be submitted for approval to the Audit Committee of the Board, which is authorizedincorporated into this Item 13 by the Charter of the Audit Committee to review related party transactions. The Company expects that in reviewing, and potentially approving, any such transactions, that the Audit Committee would be provided with all material facts relative to the proposed transaction, the nature and extent of the director’s or executive officer’s interest in the transaction, and the terms upon which the products, services or other subject matter of the transaction could be provided by alternative sources. The Company further expects that any such transaction would be approved only if the Audit Committee determined that it was in the interest of the Company to proceed with it. The Company expects that pre-approval would be sought for any such transaction whenever practicable, and if pre-approval is not obtained, any such transaction would be submitted for ratification as soon as practicable.
Board Independence
The Board has determined that, except for James B. Hawkins, our Chief Executive Officer, each of our current directors has no material relationship with Natus (either directly or as a partner, shareholder or officer of another organization that has a

material relationship with Natus) and is independent within the meaning of the Nasdaq Stock Market (“Nasdaq”) director independence standards. Furthermore, the Board has determined that each of the members of each of the committees of the Board has no material relationship with Natus (either directly or as a partner, stockholder or officer of an organization that has a material relationship with Natus) and is “independent” within the meaning of the Nasdaq director independence standards, including in the case of the members of the Audit Committee, the heightened “independence” standard required for such committee members set forth in the applicable SEC rules.

reference.
ITEM 14.     Principal Accounting Fees and Services
The Audit CommitteeWe will provide information that is responsive to this Item 14 in our 2020 Proxy Statement or in an amendment to this Annual Report not later than 120 days after the end of the Board has appointed KPMG LLP, an independent registered public accounting firm, to audit Natus’ consolidated financial statements for thefiscal year ending December 31, 2018. We intend to seek stockholder ratification of the appointment of KPMG LLP as our independent registered public accounting firm for the year ending December 31, 2018 at the 2018 annual meeting of stockholders.
Fees Paid to KPMG LLP for 2016 and 2017, respectively
 20162017
Audit Fees (1)$  1,891,679
$  3,058,102
Audit-Related Fees (2)
       70,345
Tax Fees (3)        35,473
        35,024
All Other Fees (4)          1,780
          1,780
     Total$  1,928,933
$  3,165,251

(1) Audit fees associated with the annual audit of our consolidated financial statements and statutory audits. 
(2) Audit-related fees are fees associated with assurance and related services that are reasonably related to the performance of the audit or review of the Company’s financial statements. This category includes primarily fees for assistance in financial due diligence, and attestation services related to mergers and acquisitions.  
(3) Tax fees are fees associated primarily with tax advice and planning services.
(4) Includes fees for online research tools. 

Policy on Audit Committee Pre-Approval of Audit and Permissible Non-Audit Services of Independent Auditors
Our Audit Committee pre-approves all audit and permissible non-audit services providedcovered by our independent auditors. These services may include audit services, audit-related services, tax services and other services. Pre-approvalthis Annual Report. That information is generally detailed as to the particular service or category of services and is generally subject to a specific budget. Our independent auditors and management are required to periodically report to the Audit Committee regarding the extent of services providedincorporated into this Item 14 by our independent auditors in accordance with this pre-approval, and the fees for the services performed to date. Our Audit Committee may also pre-approve particular services on a case-by-case basis.

reference.
PART IV
ITEM 15.    Exhibits, Financial Statement Schedules
(a)(2) Financial Statement Schedule
SCHEDULE II: VALUATION AND QUALIFYING ACCOUNTS
For the years ended December 31, 2017, 20162019, 2018 and 20152017
(In thousands)

 Balance at
Beginning
of Period
 Additions
Charged to
Expense
 Deductions Balance
at End
of Period
Year ended December 31, 2019       
Allowance for doubtful accounts$6,960
 $1,584
 $(1,160) $7,384
Valuation allowance637
 
 (31) 606
Warranty reserve9,391
 3,949
 (6,936) 6,404
Year ended December 31, 2018       
Allowance for doubtful accounts$8,978
 $6,423
 $(8,441) $6,960
Valuation allowance5,862
 
 (5,225) 637
Warranty reserve10,995
 4,487
 (6,091) 9,391
Year ended December 31, 2017       
Allowance for doubtful accounts$4,182
 $10,017
 $(5,221) $8,978
Valuation allowance3,706
 2,156
 
 5,862
Warranty reserve10,670
 5,370
 (5,045) 10,995

 Balance at
Beginning
of Period
 Additions
Charged to
Expense
 Deductions Balance
at End
of Period
Year ended December 31, 2017       
Allowance for doubtful accounts$4,182
 $10,017
 $(5,221) $8,978
Valuation allowance3,706
 2,156
 
 5,862
Year ended December 31, 2016       
Allowance for doubtful accounts$4,686
 $1,123
 $(1,627) $4,182
Valuation allowance3,972
 
 (266) 3,706
Year ended December 31, 2015       
Allowance for doubtful accounts$4,324
 $1,496
 $(1,134) $4,686
Valuation allowance3,151
 821
 
 3,972
(a)(3) Exhibits
The Exhibits listed in the Index to Exhibits, which appears immediately following the signature page and is incorporated herein by reference, are filed as part of this 10-K.

    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
3.1 Natus Medical Incorporated Amended and Restated Certificate of Incorporation S-1 3.1.1
 333-44138 8/18/2000
3.2 Certificate of Amendment of the Amended and Restated Certificate of Incorporation 8-K 3.1
 000-33001 9/13/2012
3.3 Natus Medical Incorporated Certificate of Designation of Rights, Preferences and Privileges of Series A Participating Preferred Stock 8-A 3.1.2
 000-33001 9/6/2002
3.4 Bylaws of Natus Medical Incorporated 8-K 3.1
 000-33001 6/18/2008
3.5 Amended and Restated Bylaws of Natus Medical Incorporated 10-Q 3.1
 000-33001 5/9/2012
10.1 Form of Indemnification Agreement between Natus Medical Incorporated and each of its directors and officers S-1 10.1
 333-44138 8/18/2000
10.2* Natus Medical Incorporated Amended and Restated 2000 Stock Awards Plan 8-K 10.1
 000-33001 1/4/2006
10.2.1* Form of Option Agreement under the Amended and Restated 2000 Stock Awards Plan S-1 10.3.1
 333-44138 8/18/2000
10.2.2* Form of Restricted Stock Purchase Agreement under the Amended and Restated 2000 Stock Awards Plan 10-Q 10.2
 000-33001 8/9/2006
10.2.3* Form of Restricted Stock Unit Agreement under the Amended and Restated 2000 Stock Awards Plan 10-K 10.2.3
 000-33001 3/14/2008
10.3* Natus Medical Incorporated 2000 Director Option Plan 10-Q 10.02
 000-33001 5/9/2008
10.3.1* Form of Option Agreement under the 2000 Director Option Plan S-1 10.4.1
 333-44138 8/18/2000
10.4* Natus Medical Incorporated 2000 Supplemental Stock Option Plan S-1 10.15
 333-44138 2/9/2001
10.4.1* Form of Option Agreement for 2000 Supplemental Stock Option Plan S-1 10.15.1
 333-44138 2/9/2001
10.5* Natus Medical Incorporated 2000 Employee Stock Purchase Plan and form of subscription agreement thereunder 8-K 10.2
 000-33001 1/4/2006
10.6* [Amended] 2011 Stock Awards Plan 14-A 
 000-33001 4/20/2011
10.6.1* Form of Stock Option Award Agreement under the [Amended] 2011 Stock Plan 10-Q 10.1
 000-33001 11/7/2011
10.6.2* Form of Restricted Stock Award Purchase Agreement 10-Q 10.2
 000-33001 11/7/2011
10.6.3* Form of Restricted Stock Unit Agreement 10-Q 10.3
 000-33001 11/7/2011
10.7* 2011 Employee Stock Purchase Plan 14-A 
 000-33001 4/20/2011
10.7.1* 2011 Employee Stock Purchase Plan Subscription Agreement 14-A 
 000-33001 4/20/2011
10.8* Form of Employment Agreement between Natus Medical Incorporated and each of its executive officers other than its Chief Executive Officer and Chief Financial Officer 10-K 10.10
 000-33001 3/10/2009




    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
10.8.1* Form of Amendment to Employment Agreement between Natus Medical Incorporated and each of its executive officers other than its Chief Executive Officer and Chief Financial Officer 10-K   000-33001 3/16/2015
10.9* Amended employment agreement between Natus Medical Incorporated and its Chief Executive Officer, James B. Hawkins dated April 19, 2013 8-K 99.1
 000-33001 4/22/2013
10.10* Form of Employment Agreement between Natus Medical Incorporated and Jonathan A. Kennedy dated April 8, 2013 10-Q 10.1
 000-33001 8/8/2013
10.11 Credit Agreement between Natus Medical Incorporated and CitiBank, NA dated October 9, 2015 8-K 10.1
 000-33001 10/9/2015
10.12 Agreement For the Acquisition of Medical Devices between Medix ICSA and the Ministry of Health of the Republic of Venezuela dated October 15, 2015 10-Q   000-33001 2/29/2016
10.13 Amendment to Agreement For the Acquisition of Medical Devices between Medix ICSA and the Ministry of Health of the Republic of Venezuela dated October 15, 2015 10-Q 10.2
 000-33001 11/3/2016
10.14 Credit Agreement, dated September 23, 2016, between the Company, JP Morgan Chase Bank, N.A. and Citibank, N.A. 10-Q 10.1
 000-33001 11/3/2016
10.15 Master Purchase Agreement, dated September 25, 2016, between GN Hearing A/S, GN Nord A/S and the Company 10-Q 10.3
 000-33001 11/3/2016
16.1 Letter Regarding Change in Certifying Accountant 8-K 16.1
 000-33001 3/28/2014
21.1 Significant Subsidiaries of the Registrant        
23.1 Consent of Independent Registered Public Accounting Firm        
24.1 Power of Attorney        
31.5 Certification of Principal Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002        
31.6 Certification of Principal Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002        
32.3 Certification of Principal Executive Officer and Principal Financial Officer pursuant to 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002        
101.INS XBRL Instance Document        
101.SCH XBRL Taxonomy Extension Schema Document        
101.CAL XBRL Taxonomy Extension Label Calculation Linkbase Document        
    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
3.1 Natus Medical Incorporated Restated Certificate of Incorporation, as filed with the Delaware Secretary of State as of July 25, 2001 S-1 3.1.1
 333-44138 8/18/2000
3.2 Certificate of Amendment of the Amended and Restated Certificate of Incorporation, as filed with the Delaware Secretary of State as of September 12, 2012 8-K 3.1
 000-33001 9/13/2012
3.3 Certificate of Amendment of the Amended and Restated Certificate of Incorporation, as filed with the Delaware Secretary of State as of June 5, 2019 8-K 3.1
 000-33001 6/7/2019
3.4 Second Amended and Restated Bylaws of Natus Medical Incorporated 8-K 3.1
 000-33001 12/16/2019
4.1 Specimen stock certificate for shares of common stock, par value $0.001 per share S-1/A 4.1
 333-44138 2/9/2001
4.2 Natus Medical Incorporated Certificate of Designation of Rights, Preferences and Privileges of Series A Participating Preferred Stock 8-A 3.1.2
 000-33001 9/6/2002
4.3 Description of Common Stock        
10.1 Form of Indemnification Agreement between Natus Medical Incorporated and each of its directors and officers S-1 10.1
 333-44138 8/18/2000
10.1.1* 2018 Equity Incentive Plan 8-K 10.1
 000-33001 12/18/2018
10.1.2* Form of Stock Option Awards Agreement under the 2018 Equity Incentive Plan 8-K 10.1.1
 000-33001 12/18/2018
10.1.3* Form of Restricted Stock Award Agreement under the 2018 Equity Incentive Plan 8-K 10.1.2
 000-33001 12/18/2018
10.1.4 Form of Restricted Stock Unit Agreement under the 2018 Equity Incentive Plan 8-K 10.1.3
 000-33001 12/18/2018
10.1.5* Form of Performance Stock Unit Agreement under the 2018 Equity Incentive Plan 8-K 10.1.4
 000-33001 12/18/2018
10.2* Natus Medical Incorporated Amended and Restated 2000 Stock Awards Plan 8-K 10.1
 000-33001 1/4/2006
10.2.1* Form of Option Agreement under the Amended and Restated 2000 Stock Awards Plan S-1 10.3.1
 333-44138 8/18/2000
10.2.2* Form of Restricted Stock Purchase Agreement under the Amended and Restated 2000 Stock Awards Plan 10-Q 10.2
 000-33001 8/9/2006
10.2.3* Form of Restricted Stock Unit Agreement under the Amended and Restated 2000 Stock Awards Plan 10-K 10.2.3
 000-33001 3/14/2008
10.3* Natus Medical Incorporated 2000 Director Option Plan 10-Q 10.02
 000-33001 5/9/2008
10.3.1* Form of Option Agreement under the 2000 Director Option Plan S-1 10.4.1
 333-44138 8/18/2000
10.4* Natus Medical Incorporated 2000 Supplemental Stock Option Plan S-1 10.15
 333-44138 2/9/2001
10.4.1* Form of Option Agreement for 2000 Supplemental Stock Option Plan S-1 10.15.1
 333-44138 2/9/2001
10.5* Natus Medical Incorporated 2000 Employee Stock Purchase Plan and form of subscription agreement thereunder 8-K 10.2
 000-33001 1/4/2006
10.6* [Amended] 2011 Stock Awards Plan 14-A 
 000-33001 4/20/2011


    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
10.6.1* Form of Stock Option Award Agreement under the [Amended] 2011 Stock Plan 10-Q 10.1
 000-33001 11/7/2011
10.6.2* Form of Restricted Stock Award Purchase Agreement 10-Q 10.2
 000-33001 11/7/2011
10.6.3* Form of Restricted Stock Unit Agreement 10-Q 10.3
 000-33001 11/7/2011
10.7* 2011 Employee Stock Purchase Plan 14-A 
 000-33001 4/20/2011
10.7.1* 2011 Employee Stock Purchase Plan Subscription Agreement 14-A 
 000-33001 4/20/2011
10.8* Form of Employment Agreement between Natus Medical Incorporated and each of its executive officers other than its Chief Executive Officer and Chief Financial Officer 10-K 10.10
 000-33001 3/10/2009
10.8.1* Form of Amendment to Employment Agreement between Natus Medical Incorporated and each of its executive officers other than its Chief Executive Officer and Chief Financial Officer 10-K   000-33001 3/16/2015
10.9* Amended employment agreement between Natus Medical Incorporated and its Chief Executive Officer, James B. Hawkins dated April 19, 2013 8-K 99.1
 000-33001 4/22/2013
10.10* Terms of Resignation between Natus Medical Incorporated and James B. Hawkins dated July 11, 2018 10-Q 10.16
 000-33001 8/8/2018
10.11 Credit Agreement between Natus Medical Incorporated and CitiBank, NA dated October 9, 2015 8-K 10.1
 000-33001 10/9/2015
10.12 Agreement For the Acquisition of Medical Devices between Medix ICSA and the Ministry of Health of the Republic of Venezuela dated October 15, 2015 10-Q   000-33001 2/29/2016
10.13 Amendment to Agreement For the Acquisition of Medical Devices between Medix ICSA and the Ministry of Health of the Republic of Venezuela dated October 15, 2015 10-Q 10.2
 000-33001 11/3/2016
10.14 Credit Agreement, dated September 23, 2016, between the Company, JP Morgan Chase Bank, N.A. and Citibank, N.A. 10-Q 10.1
 000-33001 11/3/2016
10.15 Master Purchase Agreement, dated September 25, 2016, between GN Hearing A/S, GN Nord A/S and the Company 10-Q 10.3
 000-33001 11/3/2016
10.16* Forms of Employment Agreement between Natus Medical Incorporated and Jonathan A. Kennedy dated August 24, 2018 8-K 99.1
 000-33001 8/29/2018
10.17* Form of Employment Agreement between Natus Medical Incorporated and Drew Davies dated October 1, 2018 10-Q 10.18
 000-33001 11/8/2018
21.1 Significant Subsidiaries of the Registrant        
23.1 Consent of Independent Registered Public Accounting Firm        
24.1 Power of Attorney (included on signature page)        
31.1 Certification of Principal Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002        

    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
101.DEF31.2 XBRL Taxonomy Extension Definition DocumentCertification of Principal Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002        
101.LAB32.1 XBRL Taxonomy Extension Label Linkbase DocumentCertification of Principal Executive Officer and Principal Financial Officer pursuant to 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002        
101.PRE101 The following financial information from Natus Medical Incorporated Annual Report on Form 10-K for the fiscal year ended December 31, 2019, formatted in XBRL Taxonomy Extension Presentation Linkbase Document(eXtensible Business Reporting Language): (i) Consolidated Balance Sheets as of December 31, 2019 and December 31, 2018, (ii) Consolidated Statements of Operations for the years ended December 31, 2019, 2018 and 2017, (iii) Consolidated Statements of Comprehensive Income for the years ended December 31, 2019, 2018 and 2017 (iv) Consolidated Statements of Cash Flows for the years ended December 31, 2019, 2018 and 2017, (v) Consolidated Statements of Stockholders’ Equity for the years ended December 31, 2019, 2018 and 2017, and (vi) the Notes to Consolidated Financial Statements.
104The cover page of the Annual Report on Form 10-K formatted in Inline XBRL (included in Exhibit 101).        
 *    Indicates a management contract or compensatory plan or arrangement

SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this Annual Report on Form 10-K to be signed on its behalf by the undersigned thereunto duly authorized.
   
NATUS MEDICAL INCORPORATED
  
By /s/    JONATHAN A. KENNEDY        
  
Jonathan A. Kennedy
President and Chief Executive Officer
By/s/    B. DREW DAVIES        
B. Drew Davies
Executive Vice President and Chief Financial Officer
Dated: July 20, 2018March 2, 2020

POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that each person whose signature appears below hereby constitutes and appoints Jonathan A. Kennedy and B. Drew Davies and each of them acting individually, as his or her attorney-in-fact, each with full power of substitution, for him or her in any and all capacities, to sign any and all amendments to this Report on Form 10-K, and to file the same, with all exhibits thereto and other documents in connection therewith, with the Securities and Exchange Commission.
Pursuant to the requirements of the Securities Exchange Act of 1934, this Annual Report on Form 10-K has been signed by the following persons on behalf of the registrant and in the capacity and dates indicated:
SignatureTitleDate
/S/    JONATHAN A. KENNEDY
President and Chief Executive Officer (Principal Executive Officer)March 2, 2020
(Jonathan A. Kennedy)
/S/    B. DREW DAVIES
Executive Vice President & Chief Financial Officer (Principal Financial and Accounting Officer)March 2, 2020
(B. Drew Davies)
/S/    BARBARA R. PAUL
Chairperson of the Board of DirectorsMarch 2, 2020
(Barbara R. Paul)
/S/    LISA W. HEINE
DirectorMarch 2, 2020
(Lisa W. Heine)
/S/    JOSHUA H. LEVINE
DirectorMarch 2, 2020
(Joshua H. Levine)
/S/    KENNETH E. LUDLUM
DirectorMarch 2, 2020
(Kenneth E. Ludlum)
/S/    ALICE D. SCHROEDER
DirectorMarch 2, 2020
(Alice D. Schroeder)
/S/    THOMAS J. SULLIVAN
DirectorMarch 2, 2020
(Thomas J. Sullivan)

NATUS MEDICAL INCORPORATED
INDEX TO CONSOLIDATED FINANCIAL STATEMENTS
 

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Stockholders and Board of Directors
Natus Medical Incorporated:
Opinion on the Consolidated Financial Statements
We have audited the accompanying consolidated balance sheets of Natus Medical Incorporated and subsidiaries (the Company) as of December 31, 20172019 and 2016,2018, the related consolidated statements of operations, and comprehensive income (loss), stockholders’ equity, and cash flows for each of the years in the three-year period ended December 31, 2017,2019, and the related notes and financial statement schedule II: Valuation and Qualifying Accounts (collectively, the consolidated financial statements). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 20172019 and 2016,2018, and the results of its operations and its cash flows for each of the years in the three-year period ended December 31, 2017,2019, in conformity with U.S. generally accepted accounting principles.
We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company'sCompany’s internal control over financial reporting as of December 31, 2017,2019, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission, and our report dated March 1, 20182, 2020 expressedan adverse opinion on the effectiveness of the Company'sCompany’s internal control over financial reporting.
Change in Accounting Principle
As discussed in Note 1 to the consolidated financial statements, the Company has changed its method of accounting for leases due to the adoption of Financial Accounting Standards Board Accounting Standards Codification Topic 842, Leases, on a modified retrospective basis as of January 1, 2019.
Basis for Opinion
These consolidated financial statements are the responsibility of the Company'sCompany’s management. Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the consolidated financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements. We believe that our audits provide a reasonable basis for our opinion.
Critical Audit Matter
The critical audit matter communicated below is a matter arising from the current period audit of the consolidated financial statements that was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that are material to the consolidated financial statements and (2) involved our especially challenging, subjective, or complex judgments. The communication of a critical audit matter does not alter in any way our opinion on the consolidated financial statements, taken as a whole, and we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the accounts or disclosures to which it relates.
Evaluation of net realizable value adjustments for inventory excess and obsolescence
As discussed in Notes 1 and 4 to the consolidated financial statements, the Company has inventory with a carrying value of $89.6 million at December 31, 2019, of which $71.4 million is classified as current and $18.2 million is classified as noncurrent. Within noncurrent inventory are service components for products the Company no longer sells and inventory purchased for lifetime buys, which are required by regulation given the nature of the Company’s products. The Company reduces the carrying value of inventory for any differences between its cost and estimated net realizable value. Net realizable value is estimated by evaluating ending inventories for excess quantities, obsolescence, and other factors that potentially impact the Company’s ability to consume inventory for its intended use. In making its estimate of net realizable value, the Company’s evaluation includes an analysis of historical sales by product, projections of future demand by product, and an analysis of obsolescence by product.

We identified the evaluation of net realizable value adjustments for inventory excess and obsolescence as a critical audit matter given the high degree of auditor judgement required. The degree of auditor judgment required was considered high given the inherent uncertainty in projecting future demand and complexity involved in assessing whether the Company’s analysis of historical sales by product, projections of future demand, and assessment of obsolescence effectively captured the subset of inventory requiring net realizable value adjustments.
The primary procedures we performed to address this critical audit matter included the following. We tested certain internal controls over the Company’s process to identify inventory subject to risk of excess and obsolescence and reduce this inventory to an estimate of net realizable value. In evaluating potential excess inventory, we compared on hand inventory to the Company’s estimate of future inventory consumption. We evaluated the estimate of future inventory consumption through an analysis of historical inventory usage by product and information obtained from the Company’s manufacturing planning department. We obtained internal and external product inspection reports to identify inventory subject to remediation and evaluated the Company’s assessment of obsolescence. We also compared the Company’s estimate of net realizable value adjustments for identified excess and obsolete to the prior period estimate and to actual inventory scrapping history.

(signed) KPMG LLP
We have served as the Company's auditor since 2014.


San Francisco, California
March 1, 20182, 2020



NATUS MEDICAL INCORPORATED
CONSOLIDATED BALANCE SHEETS
(In thousands, except share amounts)
December 31,December 31,
2017 20162019 2018
ASSETS      
Current assets:      
Cash and cash equivalents$88,950
 $213,551
$63,297
 $56,373
Short-term investments
 34,019
Accounts receivable, net of allowance for doubtful accounts of $8,978 and $4,182126,809
 86,638
Accounts receivable, net of allowance for doubtful accounts of $7,384 and $6,960115,889
 127,041
Inventories71,529
 49,587
71,368
 79,736
Prepaid expenses and other current assets18,340
 22,004
19,195
 22,625
Total current assets305,628
 405,799
269,749
 285,775
Property and equipment, net22,071
 17,333
24,702
 22,913
Operating lease right-of-use assets15,046
 
Intangible assets, net172,582
 77,165
114,799
 139,453
Goodwill172,998
 113,112
146,367
 147,644
Deferred income tax10,709
 14,915
30,355
 22,639
Other assets25,931
 20,688
21,509
 19,716
Total assets$709,919
 $649,012
$622,527
 $638,140
LIABILITIES AND STOCKHOLDERS’ EQUITY      
Current liabilities:      
Accounts payable$25,242
 $18,700
$27,253
 $28,805
Current portion of long-term debt35,000
 35,000
Current portion of operating lease liabilities5,871
 
Accrued liabilities51,738
 37,895
54,451
 52,568
Deferred revenue15,157
 23,346
20,246
 17,073
Total current liabilities92,137
 79,941
142,821
 133,446
Long-term liabilities:      
Other liabilities21,995
 8,013
17,616
 19,845
Long-term debt154,283
 140,000
19,665
 69,474
Operating lease liabilities12,051
 
Deferred income tax19,407
 3,684
14,251
 16,931
Total liabilities287,822
 231,638
206,404
 239,696
Commitments and contingencies (Note 20)
 
Commitments and contingencies (Note 21)

 

Stockholders’ equity:      
Common stock, $0.001 par value; 120,000,000 shares authorized; shares issued and outstanding 33,134,101 in 2017 and 32,920,246 in 2016316,577
 312,986
Preferred stock, $0.001 par value; 10,000,000 shares authorized; no shares issued and outstanding in 2017 and in 2016
 
Common stock, $0.001 par value; 120,000,000 shares authorized; shares issued and outstanding 34,148,700 in 2019 and 33,804,379 in 2018344,476
 334,215
Preferred stock, $0.001 par value; 10,000,000 shares authorized; no shares issued and outstanding in 2019 and in 2018
 
Retained earnings129,115
 149,408
87,922
 102,261
Accumulated other comprehensive loss(23,595) (45,020)(16,275) (38,032)
Total stockholders’ equity422,097
 417,374
416,123
 398,444
Total liabilities and stockholders’ equity$709,919
 $649,012
$622,527
 $638,140
The accompanying notes are an integral part of these Consolidated Financial Statements.

NATUS MEDICAL INCORPORATED
CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME
(In thousands, except per share amounts)
 Years Ended December 31,
 2019 2018 2017
Revenue$495,175
 $530,891
 $500,970
Cost of revenue196,551
 217,952
 213,376
Intangibles amortization6,916
 8,924
 6,380
Gross profit291,708
 304,015
 281,214
Operating expenses:     
Marketing and selling129,109
 136,680
 126,166
Research and development58,733
 61,482
 51,822
General and administrative59,649
 70,599
 74,424
Intangibles amortization15,144
 22,585
 19,171
Restructuring44,739
 37,231
 914
Total operating expenses307,374
 328,577
 272,497
Income (loss) from operations(15,666) (24,562) 8,717
Other expense, net(5,591) (7,698) (3,567)
Income (loss) before provision (benefit) for income tax(21,257) (32,260) 5,150
Provision (benefit) for income tax(5,586) (9,325) 25,443
Net loss$(15,671) $(22,935) $(20,293)
Net loss per share:     
Basic$(0.47) $(0.69) $(0.62)
Diluted$(0.47) $(0.69) $(0.62)
Weighted average shares used in the calculation of net loss per share:     
Basic33,696
 33,111
 32,564
Diluted33,696
 33,111
 32,564
 Years Ended December 31,
 2017 2016 2015
Revenue$500,970
 $381,892
 $375,865
Cost of revenue213,376
 144,632
 145,492
Intangibles amortization6,380
 2,327
 2,836
Gross profit281,214
 234,933
 227,537
Operating expenses:     
Marketing and selling126,166
 84,834
 87,675
Research and development51,822
 33,443
 30,434
General and administrative74,424
 50,877
 46,363
Intangibles amortization19,171
 8,983
 7,447
Restructuring914
 1,536
 2,145
Total operating expenses272,497
 179,673
 174,064
Income from operations8,717
 55,260
 53,473
Other income (expense), net(3,567) (357) (1,064)
Income before provision for income tax5,150
 54,903
 52,409
Provision for income tax25,443
 12,309
 14,485
Net income (loss)$(20,293) $42,594
 $37,924
Net income (loss) per share:     
Basic$(0.62) $1.31
 $1.17
Diluted$(0.62) $1.29
 $1.14
Weighted average shares used in the calculation of net income (loss) per share:     
Basic32,564
 32,460
 32,348
Diluted32,564
 33,056
 33,241
Other Comprehensive income:     
Unrealized losses on available-for-sale investments$(45) $(168) $
Foreign currency translation adjustment21,470
 (5,003) (8,378)
Total other comprehensive income21,425
 (5,171) (8,378)
Comprehensive income$1,132
 $37,423
 $29,546

The accompanying notes are an integral part of these Consolidated Financial Statements.

NATUS MEDICAL INCORPORATED
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(In thousands, except per share amounts)

 Years Ended December 31,
 2019 2018 2017
Net loss(15,671) (22,935) (20,293)
Other comprehensive income (loss):     
Unrealized losses on available-for-sale investments$
 $
 $(45)
Foreign currency translation adjustment(1,576) (14,360) 21,470
Interest rate swap designated as a cash flow hedge(180) (77) 
Reclassification of stranded tax effects upon adoption of ASU 2018-02(1,332) 
 
Reclassification of deferred foreign currency related adjustments related to the sale of Medix (See FN 23)
24,845
 
 
Total other comprehensive income (loss)21,757
 (14,437) 21,425
Comprehensive income (loss)$6,086
 $(37,372) $1,132
The accompanying notes are an integral part of these Consolidated Financial Statements.



NATUS MEDICAL INCORPORATED
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
(In thousands, except share amounts)
Common Stock Retained
Earnings
 Accumulated
Other
Comprehensive
Loss
 Stockholders’
Equity
Common Stock Retained
Earnings
 Accumulated
Other
Comprehensive
Loss
 Stockholders’
Equity
Shares Amount Shares Amount 
Balances, December 31, 201432,649,158
 $315,296
 $68,890
 $(31,471) $352,715
Tax benefit of options exercises
 7,104
 
 
 7,104
Vesting of restricted stock units21,619
 
 
 
 
Net issuance of restricted stock awards199,620
 
 
 
 
Employee stock purchase plan35,467
 1,251
 
 
 1,251
Stock-based compensation expense
 6,953
 
 
 6,953
Repurchase of company stock(281,915) (11,526) 
 
 (11,526)
Taxes paid related to net share settlement of equity awards(102,112) (4,341) 
 
 (4,341)
Exercise of stock options631,663
 9,008
 
 
 9,008
Other comprehensive income
 
 
 (8,378) (8,378)
Net income
 
 37,924
 
 37,924
Balances, December 31, 201533,153,500
 $323,745
 $106,814
 $(39,849) $390,710
Vesting of restricted stock units20,937
 
 
 
 
Net issuance of restricted stock awards191,492
 
 
 
 
Employee stock purchase plan45,515
 1,360
 
 
 1,360
Stock-based compensation expense
 9,008
 
 
 9,008
Repurchase of company stock(545,109) (19,289) 
 
 (19,289)
Taxes paid related to net share settlement of equity awards(97,231) (4,107) 
 
 (4,107)
Exercise of stock options151,142
 2,269
 
 
 2,269
Other comprehensive income
 
 
 (5,171) (5,171)
Net income
 
 42,594
 
 42,594
Balances, December 31, 201632,920,246
 $312,986
 $149,408
 $(45,020) $417,374
32,920,246
 $312,986
 $149,408
 $(45,020) $417,374
Vesting of restricted stock units35,929
 
 
 
 
35,929
 
 
 
 
Net issuance of restricted stock awards249,366
 
 
 
 
249,366
 
 
 
 
Employee stock purchase plan48,470
 1,581
 
 
 1,581
48,470
 1,581
 
 
 1,581
Stock-based compensation expense
 9,445
 
 
 9,445

 9,445
 
 
 9,445
Repurchase of company stock(60,800) (2,268) 
 
 (2,268)(60,800) (2,268) 
 
 (2,268)
Taxes paid related to net share settlement of equity awards
(193,212) (7,052) 
 
 (7,052)(193,212) (7,052) 
 
 (7,052)
Exercise of stock options134,102
 1,885
 
 
 1,885
134,102
 1,885
 
 
 1,885
Other comprehensive income
 
 
 21,425
 21,425

 
 
 21,425
 21,425
Net loss
 
 (20,293) 
 (20,293)
 
 (20,293) 
 (20,293)
Balances, December 31, 201733,134,101
 $316,577
 $129,115
 $(23,595) $422,097
33,134,101
 $316,577
 $129,115
 $(23,595) $422,097
Cumulative-effect adjustment for ASU 2016-16
 
 (3,919) 
 (3,919)
Vesting of restricted stock units266
 
 
 
 
Net issuance of restricted stock awards272,941
 
 
 
 
Employee stock purchase plan63,649
 1,700
 
 
 1,700
Stock-based compensation expense
 17,003
 
 
 17,003
Repurchase of company stock(173,545) (5,630) 
 
 (5,630)
Taxes paid related to net share settlement of equity awards(160,700) (5,183) 
 
 (5,183)
Exercise of stock options667,667
 9,748
 
 
 9,748
Other comprehensive loss
 
 
 (14,437) (14,437)
Net loss
 
 (22,935) 
 (22,935)
Balances, December 31, 201833,804,379
 $334,215
 $102,261
 $(38,032) $398,444
Reclassification of stranded tax effects for ASU 2018-02    1,332
 (1,332) 
Vesting of restricted stock units42,130
 
 
 
 
Net issuance of restricted stock awards175,833
 
 
 
 
Employee stock purchase plan53,839
 1,354
 
 
 1,354
Stock-based compensation expense
 8,315
 
 
 8,315
Taxes paid related to net share settlement of equity awards
(51,784) (1,689) 
 
 (1,689)
Exercise of stock options124,303
 2,281
 
 
 2,281
Other comprehensive income
 
 
 23,089
 23,089
Net loss
 
 (15,671) 
 (15,671)
Balances, December 31, 201934,148,700
 $344,476
 $87,922
 $(16,275) $416,123
The accompanying notes are an integral part of these Consolidated Financial Statements.

NATUS MEDICAL INCORPORATED
CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
Year Ended December 31,Year Ended December 31,
2017 2016 20152019 2018 2017
Operating activities:          
Net income (loss)$(20,293) $42,594
 $37,924
Adjustments to reconcile net income to net cash provided by operating activities:     
Net loss$(15,671) $(22,935) $(20,293)
Adjustments to reconcile net loss to net cash provided by operating activities:     
Provision for losses on accounts receivable10,017
 1,123
 1,496
1,584
 6,909
 10,017
Excess tax benefit on the exercise of stock options
 
 (7,104)
Depreciation and amortization30,098
 16,879
 15,987
30,722
 33,863
 30,098
Gain on disposal of property and equipment(21) (29) (5)
(Gain) loss on disposal of property and equipment449
 746
 (21)
Impairment of intangible assets1,674
 
 

 8,192
 1,674
Impairment charge for sale of entity24,571
 
 
Goodwill impairment charge
 14,846
 
Warranty reserve5,370
 2,934
 10,729
2,886
 2,168
 5,370
Stock-based compensation9,445
 9,008
 6,953
8,352
 17,051
 9,445
Deferred taxes(5,364) (13,714) 4,032
Changes in operating assets and liabilities, net of assets and liabilities acquired in acquisitions:          
Accounts receivable(30,473) 19,723
 (15,272)9,817
 (5,199) (30,473)
Inventories7,581
 (7,668) (12,232)7,185
 (7,443) 7,581
Other assets5,492
 (11,387) 858
(2,486) (5,118) 5,492
Accounts payable(1,385) (4,965) 3,270
(1,367) 4,105
 (1,385)
Accrued liabilities5,421
 (6,967) (6,177)(4,010) (2,527) 5,421
Deferred revenue(7,232) 13,879
 (1,118)3,392
 2,076
 (7,232)
Deferred taxes4,032
 (2,437) 1,543
Net cash provided by operating activities19,726
 72,687
 36,852
60,060
 33,020
 19,726
Investing activities:          
Acquisition of businesses, net of cash acquired(190,888) (15,849) (14,284)
 151
 (190,888)
Acquisition of property and equipment(4,066) (3,186) (4,068)(5,326) (7,875) (4,066)
Acquisition of intangible assets
 (210) (1,126)(13) (665) 
Purchases of short-term investments
 (34,019) 
Sales of short-term investments34,019
 
 

 
 34,019
Net cash used in investing activities(160,935) (53,264) (19,478)(5,339) (8,389) (160,935)
Financing activities:          
Proceeds from stock option exercises and ESPP3,466
 3,630
 10,258
3,635
 11,448
 3,466
Excess tax benefit on the exercise of stock options
 
 7,104
Principal payments of financing lease liability(478) 
 
Repurchase of company stock(2,268) (19,289) (11,525)
 (5,630) (2,268)
Taxes paid related to net share settlement of equity awards(7,052) (4,107) (4,341)(1,689) (5,183) (7,052)
Proceeds from short-term borrowings
 16,000
 
Proceeds from long-term borrowings60,000
 140,000
 

 
 60,000
Deferred debt issuance costs(354) (533) 

 
 (354)
Contingent consideration earn-out(2,966) (1,284) (664)
 (147) (2,966)
Payments on borrowings(45,000) (16,000) 
(50,000) (50,000) (45,000)
Net cash provided by financing activities5,826
 118,417
 832
Net cash provided by (used in) financing activities(48,532) (49,512) 5,826
Exchange rate effect on cash and cash equivalents10,782
 (6,758) (2,295)735
 (7,696) 10,782
Net increase (decrease) in cash and cash equivalents(124,601) 131,082
 15,911
6,924
 (32,577) (124,601)
Cash and cash equivalents, beginning of year213,551
 82,469
 66,558
56,373
 88,950
 213,551
Cash and cash equivalents, end of year$88,950
 $213,551
 $82,469
$63,297
 $56,373
 $88,950
Supplemental disclosure of cash flow information:   ��      
Cash paid for interest$4,464
 $41
 $
$4,580
 $6,169
 $4,464
Cash paid for income taxes$5,740
 $16,344
 $10,164
$6,445
 $9,247
 $5,740
Non-cash investing activities:          
Property and equipment included in accounts payable$148
 $134
 $289
$69
 $167
 $148
Inventory transferred to property and equipment$1,006
 $1,303
 $1,056
$300
 $1,211
 $1,006
The accompanying notes are an integral part of these Consolidated Financial Statements.

NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
Years Ended December 31, 2017, 20162019, 2018 and 20152017
1—ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES
Organization
Natus Medical Incorporated (“Natus”we”, the “Company”“our”, “us”) was incorporated in California in May 1987 and reincorporated in Delaware in August 2000. Natus isWe are a leading provider of newborn care, neurology,medical device solutions focused on the diagnosis and hearingtreatment of central nervous and balance assessment healthcare products and services usedsensory system disorders for the screening, diagnosis, detection, treatment, monitoring and trackingpatients of common medical ailments in newborn care, hearing impairment, neurological dysfunction, epilepsy, sleep disorders, neuromuscular diseases and balance and mobility disorders.all ages. Product offerings include computerized neurodiagnostic systems for audiology, neurology, polysomnography, and neonatology, as well as newborn care products such as hearing screening systems, phototherapy devices for the treatment of newborn jaundice, head-cooling products for the treatment of brain injury in newborns, incubators to control the newborn’s environment, software systems for managing and tracking disorders and diseases for public health laboratories, computer-based audiological, otoneurologic and vestibular instrumentation and sound rooms for hearing and balance care professionals.
Basis of Presentation and Principles of Consolidation
The accompanying Consolidated Financial Statements include theincludes our accounts and accounts of the Company and itsour wholly-owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation. Certain reclassifications to the prior periods have been made to conform to the current period presentation.
Use of Estimates
The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America (U.S. GAAP) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities in the Consolidated Financial Statements and the reported amount of revenue and expenses during the reporting period. Such estimates include allowances for potentially uncollectible accounts receivable, valuation of inventory, intangible assets, goodwill, share-based compensation, deferred income taxes, reserves for warranty obligations, and the provision for income taxes. Actual results could differ from those estimates.
Revenue recognition
Revenue net of discounts, is recognized from saleswhen obligations under the terms of medicala contract with a customer are satisfied; generally this occurs with the transfer of control of devices, supplies, or services. Revenue is measured as the amount of consideration we expect to receive in exchange for transferring goods or providing services.
For the majority of devices and supplies, including saleswe transfer control and recognize revenue when products ship from the warehouse to distributors, when the following conditions have been met: a purchase order has been received, title has transferred, the selling price is fixed or determinable,customer. We generally do not provide rights of return on devices and collection of the resulting receivable is reasonably assured. Terms of sale for most domestic sales are FOB origin, reflecting that title and risk of loss are assumed by the purchaser at the shipping point; however, terms of sale for some neurology, sleep-diagnostic, and head cooling systems are FOB destination, reflecting that title and risk of loss are assumed by the purchaser upon delivery. Terms of sales to international distributors are generally EXW, reflecting that goods are shipped “ex works,” in which title and risk of loss are assumed by the distributor at the shipping point. For products shipped under FOB origin or EXW terms, delivery is generally considered to have occurred when the product is shipped.supplies. Freight charges billed to customers are included in revenue and freight-related expenses are charged to cost of revenue.
Depending on the terms of the arrangement, we may also defer the recognition of a portion of the consideration received because we have to satisfy a future obligation (e.g. installation). Judgment is required to determine the standalone selling price for each distinct performance obligation. Our estimate of SSP is a point estimate.  The Company generally doesestimate is calculated annually for each performance obligation that is not provide rightssold separately. In instances where SSP is not directly observable, such as when we do not sell the product or service separately, the SSP is determined using information that may include market conditions and other observable inputs.
We sell separately-priced service contracts that extend maintenance coverages for both medical devices and data management systems beyond the base agreements to customers. The separately priced service contracts range from 12 months to 60 months. We receive payment at the inception of return on products.the contract and recognize revenue ratably over the service period.
For products containing embedded software, the Company haswe have determined that the hardware and software components function together to deliver the products’products' essential functionality and therefore, the revenue from the sale of these products does not fall within the scope of the software revenue recognition rules. The Company's revenueare considered a combined performance obligation. Revenue recognition policies for sales of these products are substantially the same as for other tangible products.
Revenue from sales of certain products that remain within the scope of the software revenue recognition rules under ASC Subtopic 985-605 is not significant.
Revenue from extended service and maintenance agreements, for both medical devices and data management systems, is recognized ratably over the service period. Revenue from installation or training services is deferred until such time service is provided. Hearing screening and ambulatory EEG monitoring revenue is recorded when the procedure is performed at the estimated net realizable value based on contractual agreements with payers and historical collections.
Certain revenue transactions include multiple element arrangements. The Company allocates revenue in these arrangements to each unit of accounting using the relative selling price method. The selling prices used during the allocation process are based on vendor specific objective evidence (“VSOE”) if available, third party evidence (“TPE”) if VSOE is not available, or estimated selling price (“ESP”) if neither VSOE or TPE is available.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Group purchasing organization (“GPOs”) negotiate volume purchase prices for member hospitals, group practices, and other clinics. The Company's agreements with GPOs typically contain preferential terms for the GPO and its members, including provisions for some, if not all, of the following:
Payment of marketing fees by Natus to the GPO, usually based on purchasing experience of group members; and
Non-recourse cancellation provisions.
Natus does not sell products to GPOs. Hospitals, group practices, and other clinics that are members of a GPO purchase products directly from the Company under the terms negotiated by the GPO. Negotiated pricing and discounts are recognized as a reduction of the selling price of products at the time of the sale. Revenue from sales to members of GPOs is otherwise consistent with general revenue recognition policies as previously described.
Inventory Valuation
Inventories are carried at the lower of cost or market,net realizable value, with cost being determined using the first-in, first-out method. The carrying value of the Company's inventoriesour inventory is reduced for any difference between cost and estimated marketnet realizable value of the inventory. We determine net realizable value by evaluating ending inventories for excess quantities, obsolescence, and other factors that is determinedcould impact our ability to be obsolete or unmarketable, based upon assumptions aboutconsume inventory for its intended use. Our evaluation includes an analysis of historical sales by product, projections of future demand by product, and market conditions.an analysis of obsolescence by product. Adjustments to the value of inventory establish a new cost basis and are considered permanent even if circumstances later suggest that increased carrying amounts are recoverable. If demand is higher than expected, Natuswe may sell inventory that had previously been impaired.written down.
Carrying value
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Table of intangibleContents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

Intangible assets and goodwill
The Company amortizesWe amortize intangible assets with finite lives over the estimate of their useful lives; anylives. Any future changes that would limit thetheir useful lives or any determination that these assets are carried at amounts greater than thetheir estimated fair value could result in additional charges.acceleration of amortization over a revised useful life.
We review intangible assets with finite lives for impairment on an annual basis or whenever events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. Recoverability of the finite-lived intangible assets is assessed based on the estimated undiscounted future cash flows expected to result from the use and eventual disposition of the asset. If the undiscounted future cash flows are less than the carrying amount, the finite-lived intangible assets are considered to be impaired. The amount of the impairment loss, if any, is measured as the difference between the carrying amount of the asset and its fair value. We estimate the fair value of finite-lived intangible assets by using an income approach or, when available and appropriate, using a market approach.
Goodwill
Goodwill is not amortized but is subject to an annual impairment analysis, which is performed as of October 1st; this assessment is also performed whenever there is a change in circumstances that indicates the carrying value of goodwill may be impaired.
Goodwill is tested for impairment at the reporting unit level. In 2018 and 2017 2016we had four reporting units for purposes of goodwill impairment testing. In early 2019 we announced the implementation of a new organizational structure which consolidated our three strategic business units, Neuro, Newborn Care and 2015, the Company performedHearing & Balance into “One Natus”. As a result of these organizational changes we have concluded we have one operating segment and one reporting unit for purposes of goodwill impairment testing in 2019.
In accordance with accounting standards we perform a qualitative assessment to test goodwill for impairment.impairment prior to the performing the first step of the goodwill impairment process. Qualitative factors considered in this assessment include industry and market considerations, overall financial performance and other relevant events and factors affecting eachthe reporting unit. Based on
Prior to the qualitative assessment,adoption of ASU 2017-04, Intangibles - Goodwill and Other (Topic 350) in 2019, which simplified the Company determined thatgoodwill impairment test, if the fair value was more likely than not to be greater than its carrying amount, and no further analysis was needed.
If the fair valueof a reporting unit was less than its carrying amount, the Companywe would perform a two-step impairment test on goodwill. The first step of the goodwill impairment test, used to identify potential impairment, compares the fair value of a reporting unit to its carrying value, including goodwill. The Company usesWe use a projected discounted cash flow model to determine the fair value of a reporting unit. If the fair value of the reporting unit exceeds its carrying amount, goodwill of the reporting unit is considered not impaired, and the second step of the impairment test is not required. The second step, if required, compares the implied fair value of the reporting unit goodwill with the carrying amount of that goodwill. The fair value of a reporting unit is allocated to all of the assets and liabilities of that unit (including any unrecognized intangible assets) as if the reporting unit had been acquired in a business combination and the fair value of the reporting unit was the price paid to acquire the reporting unit. If the carrying amount of the reporting unit’s goodwill exceeds its implied fair value, an impairment charge is recognized in an amount equal to that excess.
Based on the qualitative assessment in 2019 and 2017, we determined the fair value of goodwill was more likely than not greater than its carrying amount, and no further analysis was needed.
Due to organizational changes announced in late 2018 our evaluation of our GND reporting unit, which was part of our Neuro business unit, was determined to be impaired. Prior to calculating the assignmentgoodwill impairment loss, we analyzed the recoverability of definite lives to trade namesGND long-lived assets (other than goodwill). As a result, we recorded a goodwill impairment charge of $14.8 million within restructuring expense on our income statement. There was no remaining goodwill in the second quarter of 2015 (See Note 6 - Intangible Assets), the Company tested indefinite lived intangibles for impairment by comparing the carrying value of those assets to be fair valueGND reporting unit as of December 31, 2018.
In 2019 we elected to early adopt ASU 2017-04, Intangibles - Goodwill and Other (Topic 350). The adoption of this standard eliminates the assessment date. Thesecond step of the two-step impairment test described above and allows a Company usedto expense the relief from royalty method to determinedifference between carrying amount in excess of the fair value of the assets. This analysis is dependent uponreporting unit as a numberreduction in goodwill. The adoption of quantitative and qualitative factors including estimates of forecasted revenue, royalty rate, and taxes. The discount rate applied also hasASU 2017-04 did not have an impact on our consolidated financial statements as we concluded based on the estimates ofqualitative assessment performed in 2019 that the fair value of the reporting unit was more likely than not to be greater than its carrying amount, and no further analysis was needed.
Leases
We determine if an arrangement is a lease at inception of the lease. Right-of-use (“ROU”) assets represent the right to use an underlying asset for the lease term, and lease liabilities represent an obligation to make lease payments arising from the

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

lease. Operating lease ROU assets and liabilities are recognized at commencement date based on the present value of lease payments over the lease term. As most of our leases do not provide an implicit borrowing rate, generally we use an incremental borrowing rate based on the estimated rate of interest for collateralized borrowing over a similar term of the lease payments at the lease commencement date. We use the implicit rate when readily determinable. The operating lease ROU asset also includes any lease payments made and excludes lease incentives. Our lease terms may include options to exclude or terminate the lease when it is reasonably certain that they will exercise that option. Lease expense for lease payments are recognized on a straight-line basis over the lease term.
Operating leases are included in operating lease ROU assets, accrued liabilities, and operating lease liabilities in our consolidated balance sheet. Finance leases are included in property and equipment, accrued liabilities, and other liabilities in the consolidated balance sheet.
We have lease agreements with lease and non-lease components, which are generally accounted for based on the type of asset. For real estate and telecom leases, we account for these components separately. For equipment leases, such as use ofoffice equipment and vehicles, we account for the lease and non-lease components as a higher rate will result in a lower estimate of fair value.single lease component.
Long lived assets
The CompanyWe continually monitorsmonitor events and changes in circumstances that could indicate that carrying amounts of itsour long-lived assets, including property and equipment and intangible assets, may not be recoverable. When such events or changes in circumstances occur, the Companywe will assess the recoverability by determining whether the carrying value of such assetsan asset group will be recovered through undiscounted expected future cash flows. If the future undiscounted cash flows are less than the carrying amount of these assets, the Companyasset group, we will recognize an impairment loss based on the excess of the carrying amount over the fair value of the assets.

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Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Liability for product warranties
The Company providesWe provide a warranty for products that is generally one year in length. In some cases, regulations may require the Companyus to provide repair or remediation beyond the typical warranty period. If any products contain defects, the Companywe may be required to incur additional repair and remediation costs. Service, for domestic customers is provided by Company-owned service centers that perform all service, repair and calibration services. Service for international customers isservices are provided by a combination of Company-ownedour owned facilities and vendors on a contract basis.
We accrue estimated product warranty costs at the time of sale based on historical experience. A warranty reserve is included in accrued liabilities for the expected future costs of servicing products. Additions to the reserve are based on management’s best estimate of probable liability. The Company considersWe consider a combination of factors including material and labor costs, regulatory requirements, and other judgments in determining the amount of the reserve. The reserve is reduced as costs are incurred to honor existing warranty and regulatory obligations.
Share-based compensation
The Company recognizesWe recognize share-based compensation expense associated with employee stock options under the single-option straight line method over the requisite service period, which is generally a four-year vesting period and ten-year contractual term pursuant to ASC Topic 718, Compensation-Stock Compensation. See Note 1416 of the Consolidated Financial Statements.
For employee stock options, the value of each option is estimated on the date of grant using the Black-Scholes option pricing model, which was developed for use in estimating the value of freely traded options. Similar to other option pricing models, the Black-Scholes method requires the input of highly subjective assumptions, including stock price volatility. Changes in the subjective input assumptions can materially affect the estimated fair value of the employee stock options.
The Company recognizesWe recognize share-based compensation associated with Restricted Stock Awards (“RSA”) and Restricted Stock Units (“RSU”). RSAs and RSUs vest ratably over a three-year period for employees. RSAs and RSUs for executives vest over a four-year period; 50% on the second anniversary of the awarded date and 25% on each of the third and fourthannual anniversaries. RSAs and RSUs for non employeesnon-employees (Board of Directors) vest over a one-year period; 100% on the first anniversary. The value is estimated based on the market value of Natus common stock on the date of issuance pursuant to ASC Topic 718, Compensation-Stock Compensation.
We grant market stock unit (“MSU”) awards to certain employees. We estimate the fair value of MSUs at the date of grant using a Monte Carlo simulation model and amortize those fair values over the requisite service period, which is generally three years. The Company issuesMonte Carlo simulation model that we use to estimate the fair value of market-based MSUs at the date of grant incorporates into the valuation the possibility that the market condition may not be satisfied. Provided that the requisite service is rendered, the total fair value of the market-based MSUs, which is determined at the date of grant, must be recognized as compensation expense even if the market condition is not achieved. However, the number of shares that ultimately vest can vary significantly with the performance of the specified market criteria.
We issue new shares of common stock upon the exercise of stock options and the vesting of RSAs, RSUs, and RSUs.MSUs.

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Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

Forfeitures of employee stock options and awards are estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from initial estimates. Share-based compensation expense is recorded net of estimated forfeitures, such that expense is recorded only for those share-based awards that are expected to vest.
Cash Equivalents and Short-term Investments
All highly liquid investments purchased with an original maturity of three months or less are classified as cash equivalents. Investments with maturities greater than one year are classified as current because management considers all investments to be available for current operations. Cash equivalents and investments are stated at amounts that approximate fair value based on quoted market prices.
The Company's investments have been classified and accounted for as available-for-sale. Such investments are recorded at fair value and unrealized holding gains and losses are reported as a separate component of comprehensive income until realized. Realized gains and losses on sales of investments, if any, are determined on the specific identification method and are reclassified from accumulated other comprehensive loss to results of operations as other income (expense).
Allowance for Doubtful Accounts
The Company estimatesWe estimate the allowance for potentially uncollectible accounts receivable based on historical collection experience within the markets in which the Company operateswe operate and other customer-specific information, such as bankruptcy filings or customer liquidity problems. When all internal efforts have been exhausted to collect the receivable, it is written off and relieved from the reserve.
Assets and Liabilities Held for Sale
We consider assets and liabilities to be held for sale when all of the following criteria are met:
Management approves and commits to a formal plan to sell the asset or disposal group;
The assets or disposal group is available for immediate sale in its present condition;
An active program to locate a buyer and other actions required to complete the sale have been initiated;
The sale of the asset or disposal group is expected to be completed within one year;
The asset or disposal group is being actively marketed for sale at the price that is reasonable in relation to the current fair value; and
It is unlikely that significant changes will be made to the plan.
Assets held for sale are not depreciated. Upon designation of the asset or disposal group as held for sale, we record the asset or disposal group at the lower of its carrying value or its estimated fair value, less estimated costs of sale. We consider deferrals accumulated in other comprehensive income, including cumulative currency translation adjustments, in the total carrying value of the disposal group in accordance with GAAP. Any loss resulting from this measurement is recognized on our income statement as a restructuring operating expense in the period in which the held for sale criteria are met and gains, if any are not recognized until the date of sale. We assess the fair value of assets held for sale less any costs to sell each reporting period it remains classified as held for sale and report any reduction in fair value as an adjustment to the carrying value of the assets held for sale.
Fair Value of Financial Instruments
Financial instruments include cash and cash equivalents, investments, accounts receivable, and accounts payable. Cash is reported at its fair value on the balance sheet dates. The recorded carrying amounts of investments, accounts receivable and accounts payable approximate thetheir fair values due to the short-term maturities.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Property and Equipment
Property and equipment are stated at cost less accumulated depreciation. Depreciation expense is computed using the straight-line method over estimated useful lives of the respective assets, which are three to tenfive years for office furniture and equipment, three to five years or the length of the license for computer software and hardware, three to five years for demonstration and loaned equipment, and 30 to 40 years for buildings. Leasehold improvements are amortized over the shorter of the lease term or the estimated useful life. Land is not depreciated. Costs associated with acquiring and installing software to be used for internal purposes are capitalized and amortized on a straight-line basis over three years.
Research & Development Costs
Costs incurred in research and development are charged to operations as incurred.
Income Taxes
The Company accountsWe account for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, deferred tax assets and liabilities are determined based on the differences between the financial statements carrying value of assets and liabilities and the tax basis of those assets and liabilities, using enacted tax rates in effect for the year in which the differences are expected to reverse. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date.
The Company records
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Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

We record net deferred tax assets to the extent it is more likely than not that the assets will be realized. In making such determination, the Company considerswe consider all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies and recent financial operations. To the extent that previously reserved deferred tax assets are estimated to be realizable, the Company adjustswe adjust the valuation allowance which reduces the provision for income taxes.
The Company recognizesWe recognize the tax benefit of uncertain tax positions in the financial statements as defined in ASC Topic 740, Income Tax. When the tax position is deemed more likely than not of being sustained, the Company recognizeswe recognize the largest amount of tax benefit that is greater than 50 percent likely of being ultimately realized upon settlement, as defined in ASC 740-10-05.
On December 22, 2017, the SEC staff issued Staff Accounting Bulletin No. 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740, Income Taxes. In accordance with SAB 118, a company must reflect the income tax effects of those aspects of the Tax Act for which the accounting under ASC 740 is complete. To the extent that a company’s accounting for certain income tax effects of the Tax Act is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements.
Foreign Currency
The functional currency of the Company'sour subsidiaries outside of North America is generally the local currency of the country where the subsidiary is located. Accordingly, foreign currency translation adjustments relating to the translation of foreign subsidiary financial statements are included as a component of accumulated other comprehensive loss. The CompanyWe have recorded $21.5$(1.6) million, $(5.0)$(14.4) million, and $(8.4)$21.5 million of foreign currency translation gains (losses) for the years ended December 31, 2017, 20162019, 2018 and 2015,2017, respectively.
Gains and losses from transactions denominated in currencies other than the functional currencies are included in other income and expense. In 2017, 2016,2019, 2018, and 2015,2017, net foreign currency transaction gains (losses) were $1.0$(0.8) million, $(0.4)$(0.8) million, and $(1.4)$1.0 million, respectively. Foreign currency gains and losses result primarily from fluctuations in the exchange rate between the U.S. Dollar,dollar, Canadian Dollar,dollar, Euro, Argentine Peso, British Pound,pound, and Danish Kroner.kroner.
Effective July 1, 2018, Argentina's economy is considered to be highly inflationary under U.S. GAAP since it has experienced a rate of general inflation in excess of 100% over the latest three-year period, based upon the cumulative inflation rates published by Center for Audit Quality (CAQ) SEC Regulations Committee and its International Practices Task Force (IPTF). As a result, beginning July 1, 2018, the U.S. dollar is the functional currency for our subsidiary in Argentina, Medix I.C.S.A. (“Medix”). Accordingly, all gains and losses resulting from the translation of our Argentinian operations are required to be recorded directly in the statement of operations. Through June 30, 2018, prior to being designated as highly inflationary, currency translation adjustments of Medix's balance sheet are reflected in shareholders' equity as part of Accumulated Other Comprehensive Income; however subsequent to July 1, 2018, such adjustments are reflected in earnings. Currency adjustments recorded in earnings for Medix subsequent to July 1, 2018 represented a gain of $0.9 million.
We divested our wholly owned subsidiary, Medix, on April 2, 2019 via a stock sale. Included in the year ended December 31, 2019 is the impact of the sale of Medix, which was completed as of June 30, 2019, and the deferred foreign currency related translation adjustments previously in accumulated other comprehensive income have been released from the balance sheet along with the held for sale accrual (See Note 23 - Sale of a Certain Subsidiary).
Comprehensive Income
The Company reportsWe report by major components and as a single total the change in net assets during the period from non-owner sources as defined in ASC Topic 220, Comprehensive Income. The consolidated statement of comprehensive income (loss) has been included withseparately stated from the consolidated statements of operations. Accumulated other comprehensive incomeloss consists of translation gains and losses on foreign subsidiary financial statements, interest rate swap designated as well as unrealized gainsa cash flow hedge, reclassifications from the adoption of ASU 2018-02, and reclassification of previously recorded deferred foreign currency related translation adjustment losses on investments.upon the divestiture of Medix.
Basic and Diluted Net Income per Share
Natus computesWe compute net income per share as defined in ASC Topic 260, Earnings per Share. Basic net income per share is based upon the weighted average number of common shares outstanding during the period. Diluted net income per share is based upon the weighted average number of common shares outstanding and dilutive common stock equivalents outstanding during the period.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Common stock equivalents are options granted, shares of restricted stock, and shares of restrictedmarket stock issued under the stock awards plans and are calculated under the treasury stock method. Common equivalent shares from unexercised stock options and restricted stock are excluded from the computation when there is a loss as the effect is anti-dilutive, or if the exercise price of such options is greater than the average market price of the stock for the period.
RecentRecently Adopted Accounting Pronouncements
In July 2015, the FASB issued ASU 2015-11, Inventory (Topic 330). This standard requires an entity to measure inventory at the lower of cost and net realizable value. Net realizable value is estimated selling prices in the ordinary course of business, less reasonable predictable costs of completion, disposal, and transportation. ASU 2015-11 is effective for fiscal years beginning after December 15, 2016, including interim periods within those fiscal years. The Company adopted ASU 2015-11in January 2017 and no impact was recorded by the Company.
In January 2017, the FASB issued ASU 2017-01, Business Combinations (Topic 805). This update is to clarify the definition of a business with the objective of adding guidance to assist entities with evaluating whether transactions should be accounted for as acquisition (or disposals) of assets or businesses. The definition of a business affects many areas of accounting including acquisitions, disposals, goodwill, and consolidation. ASU 2017-01 is effective for annual periods beginning after December 15, 2017, including interim periods within those periods, and must be applied prospectively. The Company will apply this guidance to business combinations that occur on or after the effective date.
Recent Issued Accounting Pronouncements
In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update No. 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”), which supersedes nearly all existing revenue recognition guidance. The standard's core principle is that an entity should recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. The standard creates a five-step model to achieve its core principle: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction's price to the separate performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. In addition, entities must disclose sufficient information to enable users of financial statements to understand the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. Qualitative and quantitative disclosures are required about: (i) the entity's contracts with customers; (ii) the significant judgments, and changes in judgments, made in applying the guidance to those contracts; and (iii) any assets recognized from the costs to obtain or fulfill a contract with a customer. In August 2015, the FASB issued ASU 2015-14, Revenue from Contracts with Customers (Topic 616) - Deferral of the Effective Date, which deferred the effective date of ASU 2014-09 to interim and annual periods beginning January 1, 2018. The standard allows entities to apply the standard retrospectively to each prior period presented (“full retrospective adoption”) or retrospectively with the cumulative effect of initially applying the standard recognized at the date of initial application (“modified retrospective adoption”). The Company adopted the modified retrospective approach of this guidance on January 1, 2018 and has determined that its adoption will not have a material effect on its financial position or results of operations.
In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842). This standard requires a lessee to recognize the lease assets and lease liabilities arising from operating leases to be presented in the statement of financial position. Qualitative along with specific quantitative disclosures are required by lessees and lessors to meet the objective of enabling users of financial statements to

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

assess the amount, timing, and uncertainty of cash flows arising from leases. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018 including interim periods within those fiscal years. In July 2018, FASB issued ASU 2018-10, Codification Improvements to Topic 842, Leases, which affects narrow aspects of the guidance issued in the amendments in Update 2016-02. In July 2018, the FASB also issued ASU 2018-11, Targeted Improvements. The Company is currently evaluatingamendments in ASU 2018-11 provide additional clarification and implementation guidance on certain aspects of the impact that will result from adoptingpreviously issued ASU 2016-02 and have the same effective and transition requirements as ASU 2016-02.
The new standard provides a number of optional practical expedients in transition. We have elected the package of practical expedients, which permits an entity to not reassess prior conclusions about lease identification, lease classification and initial direct costs under the new standard. We have not elected the use-of-hindsight practical expedient or the practical expedient pertaining to land easements; the latter of which is not applicable to us. We made an accounting policy election to keep leases with an initial term of 12 months or less off of the balance sheet. We will recognize those lease payments in the Consolidated Statements of Operations on a straight-line basis over the lease term.
The new standard became effective for us on January 1, 2019. We adopted the new standard using the modified retrospective transition method with the effective date as the date of initial application. Upon adoption, we recognized additional new lease assets of approximately $19.5 million and additional lease liabilities of approximately $22.3 million as of January 1, 2019. The standard did not materially affect consolidated net earnings. By electing the effective date as the date of initial application, financial performance has not been adjusted and the disclosures required under the new standard have not been provided for periods prior to January 1, 2019. See Significant Accounting Policies and Note 8 for additional discussion and disclosure.
The adoption of the new standard did not impact our liquidity or debt-covenant compliance under its current agreements.
In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other (Topic 350). This update modifies the concept of impairment from the condition that exists when the carrying amount of goodwill exceeds its implied fair value to the condition that exists when the carrying amount of a reporting unit exceeds its fair value. An entity no longer will determine goodwill impairment by calculating the implied fair value of goodwill by assigning the fair value of a reporting unit to all of its assets and liabilities as if that reporting unit had been acquired in a business combination. Because these amendments eliminate a stepStep 2 from the goodwill impairment test, they should reduce the cost and complexity of evaluating goodwill for impairment. ASU 2017-04 is effective for our annual orand any interim goodwill impairment tests in fiscal years beginningperformed on or after December 15, 2019.January 1, 2020. We elected to early adopt. The Company will adoptadoption of ASU 2017-04 to goodwill impairment testingdid not have an impact on the effective date.our consolidated financial statements.
In May 2017,February 2018, the FASB issued ASU 2017-09, Compensation2018-02, Income Statement - Stock CompensationReporting Comprehensive Income (Topic 718): Scope of Modification Accounting.220). This update provides guidance about which changespermits a company to reclassify its disproportionate income tax effects of the terms or conditionsTax Cuts and Jobs Act of a share-based payment award require an entity2017 (the “Tax Act”) on items within accumulated other comprehensive income (“AOCI”) to apply modification accounting in Topic 718. This guidance isretained earnings (termed “stranded tax effects”). Only the stranded tax effects resulting from the 2017 Act are eligible for reclassification. The ASU was effective for annual periods beginning after December

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Tableus on January 1, 2019. Upon adoption, we reclassified its stranded tax effects resulting from the 2017 Act of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016$1.3 million, resulting in a decrease to AOCI and 2015

15, 2017, including interim periods within that year, and must be applied prospectivelyan increase to an award modified on or after the adoption date. The Company will adopt this guidance and will apply to all future share-based modifications.retained earnings as of January 1, 2019.
2—BUSINESS COMBINATIONS
The assets acquired and liabilities assumed at the date of acquisition are recorded in the Consolidated Financial Statements at the respective fair values as of the acquisition date. The excess of the purchase price over the fair value of the acquired net assets is recorded as goodwill.
The determination of estimated fair value of acquired assets and liabilities requires management to make significant estimates and assumptions. The Company determinesWe determine the fair value by applying established valuation techniques, based on information that management believes to be relevant to this determination. The CompanyWe also utilizesutilize independent third parties to assist in the valuation of goodwill and intangible assets.
The results of operations from acquisitions are included in the Consolidated Financial Statements from the date of the acquisition.
Integra
On October 6, 2017, the Companywe acquired certain neurosurgery business assets from Integra LifeSciences (“Integra” or “Neurosurgery”) for $46.4$46.2 million in cash. As part of the acquisition, the Companywe acquired a global product line, including the manufacturing facility it leases from a third party and the U.S. rights related to four other product lines. The total purchase price has been preliminarily allocated to $12.5$13.7 million of tangible assets, $19.5$25.7 million of intangible assets with an associated weighted average life of 9 years being

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

amortized on the straight line method, and $15.5$8.1 million of goodwill, offset by $1.1$1.3 million of net liabilities. Purchase price allocation is considered preliminary at this time although no material adjustments are anticipated. Pro formBesides pro forma revenue, pro forma financial information for the Integra acquisition is not presented as thecertain Integra expense data necessary to present pro forma net income and pro forma earnings per share is not available. However, proPro forma revenue assuming the acquisition occurred on January 1, 20162017 would be $539.1 million and $432.4 million for the yearsyear ended December 31, 2017 and 2016, respectively.2017.
Otometrics
On January 3, 2017, the Companywe acquired the Otometrics business from GN Store Nord A/S for a cash purchase price of $149.2 million, which includes a $4.2 million net working capital adjustment. Otometrics is a manufacturer of hearing diagnostics and balance assessment equipment, disposables and software. Otometrics provides computer-based audiological, otoneurologic and vestibular instrumentation and sound rooms to hearing and balance care professionals worldwide. Otometrics has a complete product and brand portfolio known for its sophisticated design technology in the hearing and balance assessment markets.
The following table summarizes the purchase price allocation of the fair value of the assets acquired and liabilities assumed at the date of acquisition, (in thousands):
Cash and cash equivalents$5,604
Accounts receivable26,851
Inventories22,182
Property and equipment2,256
Intangible assets90,913
Goodwill39,355
Other assets1,748
Accounts payable(7,655)
Accrued liabilities(16,069)
Deferred revenue(745)
Deferred income tax(15,193)
Total purchase price$149,247
The goodwill recorded represents the future economic benefits arising from the other assets acquired that could not be individually identified and separately recognized. The goodwill recorded as part of the acquisition of Otometrics is not amortized and includes the following:
The expected synergies and other benefits that the Company believes will result from combining the operations of Otometrics with the operations of Natus;

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Any intangible assets that did not qualify for separate recognition, as well as future, yet unidentified projects and products; and
The value of the going-concern element of Otometrics's existing businesses (the higher rate of return on the assembled collection of net assets versus if Natus has acquired all of the net assets separately).
Management worked with an independent valuation firm to determine fair values of the identifiable intangible assets. The CompanyWe used a combination of income approaches including relief from royalty and multi-period excess earnings methods. The valuation models were based on estimates of future operating projections of the acquired business and rights to sell products as well as judgments on the discount rates used and other variables. The CompanyWe determined the forecasts based on a number of factors, included theirincluding our best estimate of near-term net sales expectations and long-term projections, which included a review of internal and independent market analyses.
Otometrics's
3—REVENUE
Contract assets for the periods presented primarily represent the difference between revenue recognized based on the relative selling price of $114.2 millionthe related performance obligations and loss from operations of $1.0 million are includedthe contractual billing terms in the condensed consolidated statement of operationsarrangements. Deferred revenue for the periods presented was primarily related to extended service contracts, installation, and training, for which the service fees are billed up-front. The associated deferred revenue is generally recognized ratably over the extended service period from January 3, 2017 (acquisition date) to December 31, 2017.or when installation and training are complete.

The unaudited pro forma financial results presented below forfollowing table summarized the twelve months ended December 31, 2017changes in the contract assets and December 31, 2016, include the effects of pro forma adjustments as if the acquisition occurred on January 1, 2016. The pro forma results were prepared using the acquisition method of accounting and combine the historical results of Natus and Otometrics for the twelve months ended December 31, 2017 and December 31, 2016, including the effects of the business combination, primarily amortization expense related to the fair value of identifiable intangible assets acquired, interest expense associated with the financing obtained by Natus in connection with the acquisition, and the elimination of acquisition-related costs incurred.
The pro forma financial information is presented for informational purposes only and is not necessarily indicative of the results of operations that would have been achieved if the acquisition had taken place at the beginning of the earliest period presented, nor is it intended to be a projection of future results.
Unaudited Pro forma Financial Information
(in thousands)
 Year Ended  December 31,
 2017 2016
Revenue$500,970
 $491,994
Net income (loss)$(15,965) $17,385
    
Earnings (loss) per share:   
Basic$(0.49) $0.54
Diluted$(0.49) $0.53
Weighted average shares used in the calculation of earnings per share:   
Basic32,564
 32,460
Diluted32,564
 33,056
The pro forma resultscontract liability balances for the year ended December 31, 2017 were adjusted to exclude $4.3 million of nonrecurring expense related to the fair value adjustment of acquisition-date inventory.2019 (in thousands):
The pro forma results for the year ended
Unbilled AR, December 31, 2018$3,012
Additions354
Transferred to Trade Receivable(699)
Unbilled AR, December 31, 2019$2,667
Deferred Revenue, December 31, 2018$21,410
Additions19,465
Revenue Recognized(16,067)
Deferred Revenue, December 31, 2019$24,808

At December 31, 20162019, the contract assets of $2.7 million were adjusted to include $3.0included in accounts receivable in the consolidated balance sheet. At December 31, 2019, the short-term portion of the contract liability of $20.2 million and the long-term portion of amortization of intangible assets, and $4.6 million were included in deferred revenue and other long-term liabilities respectively, in the consolidated balance sheet. As of interest expense.
RetCam
On July 6, 2016, the Company acquired the portfolioDecember 31, 2019, we expect to recognize revenue associated with deferred revenue of RetCam Imaging Systems (“RetCam”) from Clarity Medical Systems, Inc. for $10.6approximately $20.2 million in cash. RetCam is an imaging system used to diagnose2020, $2.2 million in 2021, $1.2 million in 2022, $0.7 million in 2023, and monitor a range$0.5 million thereafter.

4—INVENTORIES
Inventories consist of ophthalmic maladies in premature infants. The purchase agreement also included a holdback of $2.0 million which was paid on February 16, 2017. Subsequent to the acquisition, an additional $1.1 million was paid by the Company to Clarity Medical Systems as a(in thousands):


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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017

result of a working capital adjustment. Results of operations for RetCam are included in the consolidated financial statements from the date of acquisition. The total purchase price was allocated $7.2 million to tangible assets, $4.9 million to intangible assets with an assigned weighted average life of 5 years being amortized on the straight line method, and $1.7 million to goodwill, offset by $2.0 million to net liabilities. Pro forma financial information for the RetCam acquisition is not presented as it is not considered material.
NeuroQuest
On March 2, 2016, the Company acquired NeuroQuest, LLC (“NeuroQuest”) through an asset purchase. NeuroQuest complements the Global Neuro-Diagnostics (“GND”) and Monarch Medical Diagnostics, LLC (“Monarch”) acquisitions which offer patients a convenient way to complete routine-electroencephalography and extended video electronencephalography (“VEEG”) testing. The cash consideration for NeuroQuest was $4.6 million. The purchase agreement included a consideration holdback of $0.5 million which was paid on April 30, 2017. The total purchase price was allocated to $0.5 million of tangible assets, $1.3 million of intangible assets with an assigned weighted average life of 5 years being amortized on the straight line method, and $3.5 million of goodwill, offset by $0.1 million of net liabilities. Pro forma financial information for the NeuroQuest acquisition is not presented as it is not considered material.
Monarch
The Company acquired Monarch Medical Diagnostics, LLC (“Monarch”) through an asset purchase on November 13, 2015. Monarch's service compliments the Global Neuro-Diagnostics acquisition which offers patients a more convenient way to complete routine diagnostic electroencephalography and video electromyography testing which can be performed at the home, hospital or physician's office. The service also provides comprehensive reporting and support to the physician. The cash consideration for Monarch was $2.7 million. The purchase agreement also included contingent consideration which was paid on January 11, 2016 of $1.0 million. The total purchase price was allocated to $112,000 of tangible assets, $1.2 million of intangible assets with an assigned weighted average life of 5 years being amortized on the straight line method, and $2.4 million of goodwill. Pro forma financial information for the Monarch acquisition is not presented as it is not considered material.
Global Neuro-Diagnostics
The Company acquired GND through an equity purchase on January 23, 2015. GND's service offers patients a more convenient way to complete routine EEG and EMG testing which can be performed at the home, hospital or physician's office. The service also provides comprehensive reporting and support to the physician. The cash consideration for GND was $11.4 million, which consists primarily of $1.5 million of tangible assets, $4.8 million of intangible assets with an assigned weighted average life of 5 years being amortized on the straight line method, and $8.9 million of goodwill, offset by $0.5 million of net liabilities. The purchase agreement also included an earn-out condition which was originally estimated to be $3.2 million. The earn-out condition was subsequently not achieved. Pro forma financial information for the GND acquisition is not presented as it is not considered material.
NicView
On January 2, 2015, the Company purchased the assets of NicView. NicView provides streaming video for families with babies in the neonatal intensive care unit. The cash consideration for NicView was $1.1 million, of which $0.3 million was allocated to tangible assets and $2.7 million to goodwill, offset by $0.6 million allocated to net liabilities. The asset purchase agreement included an earn-out condition contingent upon orders received in and installed by February 28, 2016. The Company settled this earnout for $1.3 million in March 2016. Pro forma financial information for the NicView acquisition is not presented as it is not considered material.
3—CASH, CASH EQUIVALENTS, AND SHORT-TERM INVESTMENTS
The Company has invested its excess cash in highly liquid marketable securities such as corporate debt instruments, U.S. government agency securities and asset-backed securities. Investments with maturities greater than one year are classified as current because management considers all investments to be available for current operations.

The Company's investments are designed to provide liquidity, preserve capital and maximize total return on invested assets with a focus on high credit-quality securities.

The Company's investments have been classified and accounted for as available-for-sale. Such investments are recorded at fair value, and unrealized holding gains and losses are reported as a separate component of accumulated other comprehensive income (loss) in stockholders' equity until realized. Realized gains and losses on sales of investments, if any, are


F-14
 December 31,
 2019 2018
Raw materials and subassemblies$37,259
 $31,459
Work in process1,780
 2,424
Finished goods50,521
 63,932
Total Inventories89,560
 97,815
Less: Non-current Inventories(18,192) (18,079)
Inventories$71,368
 $79,736

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

determined on the specific identification method and are reclassified from accumulated other comprehensive income (loss) to results of operations as other income (expense).

The Company, to date, has not determined that any of the unrealized losses on its investments are considered to be other-than-temporary. The Company reviews its investment portfolio to determine if any security is other-than-temporarily impaired, which would require the Company to record an impairment charge in the period any such determination is made. In making this judgment, the Company evaluates, among other things: the duration and extent to which the fair value of a security is less than its cost; the financial condition of the issuer and any changes thereto; and the Company's intent and ability to hold its investment for a period of time sufficient to allow for any anticipated recovery in market value, or whether the Company will more likely than not be required to sell the security before recovery of its aggregated cost basis.    

Cash, cash equivalents and short-term investments consisted of the following (in thousands):

 December 31, 2017 December 31, 2016
Cash and cash equivalents:   
Cash88,950
 213,551
Short-term investments:   
U.S. investment grade bonds
 24,477
Developed investment grade bonds
 9,542
Total short-term investments
 34,019
Total cash, cash equivalents and short-term investments88,950
 247,570

Short-term investments by investment type are as follows (in thousands):
 December 31, 2017 December 31, 2016
 Aggregated Cost Basis Gross Unrealized Gains Gross Unrealized Losses Aggregated Fair Value Aggregated Cost Basis Gross Unrealized Gains Gross Unrealized Losses Aggregated Fair Value
U.S. investment grade bonds
 
 
 
 24,531
 
 (54) 24,477
Developed investment grade bonds
 
 
 
 9,567
 
 (25) 9,542
Total short-term investments$
 $
 $
 $
 $34,098
 $
 $(79) $34,019

Short-term investments by contractual maturity are as follows (in thousands):

 December 31, 2017 December 31, 2016
 Investments Investments
Due in one year or less$
 $21,655
Due after one year through five years
 12,364
Total short-term investment$
 $34,019

See Note 21 to these Consolidated Financial Statements for additional discussion regarding the fair value of the Company's short-term investments.


4—INVENTORIES
Inventories consist of (in thousands):

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

 December 31,
 2017 2016
Raw materials and subassemblies$44,699
 $28,245
Work in process3,788
 1,507
Finished goods43,488
 34,908
Total Inventories91,975
 64,660
Less: Non-current Inventories(20,446) (15,073)
Inventories$71,529
 $49,587
At December 31, 2017 and 2016, the Company has classified $20.4 million and $15.1 million, respectively, of inventories as non-current. ThisNon-current inventory consists of service components used to repair products held by customers pursuant to warranty obligations and extended service contracts, including service components for products that the Companywe no longer sells,sell, inventory purchased for lifetime buys, inventory built as a last-time build, and inventory that is turning at a slow rate. The Company believesWe believe that these inventories will be utilized for thetheir intended purpose.


5—PROPERTY AND EQUIPMENT
Property and equipment consist of (in thousands):
 December 31,
 2019 2018
Land$1,719
 $1,828
Buildings6,943
 7,036
Leasehold improvements8,664
 4,649
Finance lease right-of-use assets2,377
 
Office furniture and equipment22,819
 23,487
Computer software and hardware12,610
 12,803
Demonstration and loaned equipment11,621
 12,843
 66,753
 62,646
Accumulated depreciation(42,051) (39,733)
Total$24,702
 $22,913
 December 31,
 2017 2016
Land$2,815
 $2,856
Buildings5,096
 5,219
Leasehold improvements3,295
 2,386
Office furniture and equipment25,612
 18,398
Computer software and hardware9,760
 9,100
Demonstration and loaned equipment11,932
 11,393
 58,510
 49,352
Accumulated depreciation(36,439) (32,019)
Total$22,071
 $17,333

Depreciation expense of property and equipment was $4.1$6.6 million, $3.7$6.0 million, and $4.2$4.1 million in the years ending December 31, 2017, 20162019, 2018 and 2015,2017, respectively.


6—INTANGIBLE ASSETS
The following table summarizes the components of gross and net intangible asset balances (in thousands):
 December 31, 2019 December 31, 2018
 Gross
Carrying
Amount
 Accumulated
Impairment
 Accumulated
Amortization
 Net Book
Value
 Gross
Carrying
Amount
 Accumulated
Impairment
 Accumulated
Amortization
 Net Book
Value
Technology$108,400
 (6,035) $(55,408) $46,957
 $111,198
 (6,768) $(50,046) $54,384
Customer related90,351
 (50) (40,527) 49,774
 99,440
 (1,961) (38,574) 58,905
Trade names45,874
 (3,237) (25,355) 17,282
 47,217
 (4,397) (19,250) 23,570
Internally developed software13,281
 
 (12,606) 675
 16,264
 
 (14,164) 2,100
Patents2,692
 (133) (2,559) 
 2,718
 (133) (2,524) 61
Service Agreements1,190
 
 (1,079) 111
 1,190
 
 (757) 433
Total Definite-lived intangible assets261,788
 (9,455) (137,534) 114,799
 278,027
 (13,259) (125,315) 139,453

 December 31, 2017 December 31, 2016
 Gross
Carrying
Amount
 Accumulated
Impairment
 Accumulated
Amortization
 Net Book
Value
 Gross
Carrying
Amount
 Accumulated
Impairment
 Accumulated
Amortization
 Net Book
Value
Technology$101,045
 (1,058) $(42,048) $57,939
 $62,563
 
 $(34,683) $27,880
Customer related108,074
 (50) (28,972) 79,052
 38,087
 
 (17,610) 20,477
Trade names49,313
 (3,916) (13,273) 32,124
 32,106
 (3,290) (7,135) 21,681
Internally developed software15,610
 
 (12,293) 3,317
 16,978
 
 (10,220) 6,758
Patents2,778
 (133) (2,495) 150
 2,620
 
 (2,251) 369
Total Definite-lived intangible assets276,820
 (5,157) (99,081) 172,582
 152,354
 (3,290) (71,899) 77,165
Finite lived intangible assets are amortized over their weighted average lives, which are 13 years for patents, 14 years for technology, 10 years for customer-related intangibles, 10 years for trade names, and 6 years for internally developed software.


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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017


Finite lived intangible assets are amortized over their weighted average lives, which are 14 years for technology, 13 years for patents, 10 years for customer-related intangibles, 7 years for trade names, 6 years for internally developed software, 2 years for service agreements, and 11 years weighted average in total.
Internally developed software consists of $14.8$11.1 million relating to costs incurred for development of internal use computer software and $2.2 million for development of software to be sold.
During the fourth quarter of 2018 we recorded an impairment charge related to intangible assets of $8.2 million. These impairments relate to end of life decisions for the core technology utilized in our Bio-logic products and our GND and Neurocom product lines. We acquired Bio-logic core technology as part of the acquisition of Bio-logic Systems Corp in 2006 and have maintained the technology since its acquisition. In 2018 we partnered with one of our contract manufacturers to develop and manufacture the next generation technology to be used in its Bio-logic products. The decision to develop this new technology resulted in an impairment of the originally acquired core technology of $5.6 million, which was recorded within intangibles amortization expense on our income statement.
On January 15, 2019, we announced the implementation of a new organizational structure, "One Natus." As a result of this new organizational structure, we announced we exited two of our non-core businesses, GND and Neurocom. The decision to exit these non-core businesses resulted in the impairment of intangible assets of $2.6 million as of December 31, 2018. These impairments were the result of deterioration of expected future cash flows as compared to the carrying value of the assets. Impairments were determined by performing an undiscounted cash flow analysis on intangibles assets. The impairment charge for GND and Neurocom is recorded on our income statement within restructuring expense.
Amortization expense related to intangible assets with finite lives, including impairment charges described above, was as follows (in thousands):
 Years Ended December 31,
 2019 2018 2017
Technology$6,906
 $14,100
 $7,705
Customer related8,662
 12,244
 10,945
Trade names6,111
 6,736
 6,479
Internally developed software1,438
 2,123
 2,117
Patents60
 84
 244
Service Agreements322
 757
 
Total amortization$23,499
 $36,044
 $27,490

 Years Ended December 31,
 2017 2016 2015
Technology$7,705
 $3,407
 $3,916
Customer related10,945
 3,452
 2,938
Trade names6,479
 4,115
 3,159
Internally developed software2,117
 2,069
 1,620
Patents244
 112
 112
Total amortization$27,490
 $13,155
 $11,745
The amortization expense amounts shown above include internally developed software not held for sale of $1.3 million, $1.9 million, and $1.9 million for the years ended 2019, 2018, and 2017, respectively. The amortization expense for internally developed software not held for sale is recorded within our income statement as a general and administrative operating expense.
Expected annual amortization expense related to amortizable intangible assets is as follows (in thousands): 
2020$21,616
202120,724
202217,329
202316,375
202414,483
Thereafter24,272
Total expected amortization expense$114,799
2018$27,014
201925,836
202023,634
202122,210
202218,564
Thereafter55,324
Total expected amortization expense$172,582

        
7—GOODWILL
The carrying amount of goodwill and the changes in those balances are as follows (in thousands):
As of December 31, 2015$107,466
Acquisitions/Purchase Accounting Adjustments6,705
Foreign currency translation(1,059)
As of December 31, 2016$113,112
Acquisitions/Purchase Accounting Adjustments54,746
Foreign currency translation5,140
As of December 31, 2017$172,998

8—ACCRUED LIABILITIES
Accrued liabilities consist of (in thousands):


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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017

As of December 31, 2017$172,998
Purchase Accounting Adjustments(7,324)
Impairment charge(14,846)
Foreign currency translation(3,184)
As of December 31, 2018$147,644
Foreign currency translation(1,277)
As of December 31, 2019$146,367


8—LEASES
We have operating and finance leases for offices, warehouses, and certain equipment. The leases have remaining lease terms of one to eight years, some of which include options to extend the leases for up to ten years. Our leases do not have any residual value guarantees or any restrictions or covenants imposed by leases.

Components of lease cost were as follows (in thousands):
 Year Ended 
 December 31,
 2019
Operating lease cost$6,823
Finance lease cost: 
Amortization of right-of-use assets (principal payments)466
Interest on lease liabilities58
Short-term lease cost51
Variable lease cost2,836
Sublease income(179)
Total lease cost$10,055
Supplemental cash flow information related to leases was as follows (in thousands):
 Year Ended 
 December 31,
 2019
Cash paid for amounts included in the measurement of lease liabilities: 
Operating cash flows from operating leases$13,612
Operating cash flows from finance leases42
Financing cash flows from finance leases478
Right-of-use assets obtained in exchange for lease obligations: 
Operating leases2,697
Finance leases300


Supplemental balance sheet information related to leases was as follows (in thousands):

 December 31, 2019
Operating Leases 
Operating lease right-of-use assets$15,046
  
Current portion of operating lease liabilities
$5,871
Operating lease liabilities12,051
Total operating lease liabilities$17,922
  
Finance Leases 
Property and equipment, gross$2,377
Accumulated amortization(1,418)
Property and equipment, net$959
  
Accrued liabilities$390
Other liabilities599
Total finance lease liabilities$989
  
Weighted Average Remaining Lease Term 
Operating leases3.75 years
Finance leases2.92 years
Weighted Average Discount Rate 
Operating leases5.3%
Finance leases5.1%

 December 31,
 2017 2016
Compensation and related benefits$22,816
 $16,064
Accrued federal, state, and local taxes8,155
 4,160
Warranty reserve10,995
 10,670
Accrued amounts due to customers2,424
 1,625
Accrued professional fees2,280
 1,191
Accrued selling expenses1,704
 292
Contingent consideration147
 3,043
Accrued travel338
 
Deferred rent161
 132
Other2,718
 718
Total$51,738
 $37,895


As of December 31, 2019, future minimum lease payments included in the measurement of lease liabilities on the consolidated balance sheet, for the following five fiscal years and thereafter, were as follows (in thousands):
Year ending December 31,Operating Leases Finance Leases
2020$6,788
 $401
20215,302
 346
20223,657
 176
20232,498
 97
20241,277
 5
Thereafter842
 
Total lease payments20,364
 1,025
Less imputed interest(2,442) (36)
Total$17,922
 $989




9—ACCRUED LIABILITIES
Accrued liabilities consist of (in thousands):

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

 December 31,
 2019 2018
Compensation and related benefits$26,991
 $24,891
Warranty reserve6,404
 9,391
Accrued federal, state, and local taxes

11,156
 8,285
Accrued amounts due to customers3,008
 5,507
Accrued professional fees2,083
 1,820
Accrued selling expenses507
 246
Self-funded insurance expense950
 
Accrued travel224
 201
Deferred rent
 205
Other3,128
 2,022
Total$54,451
 $52,568


10—LONG-TERM OTHER LIABILITIES
Long-term other liabilities consist of (in thousands):
 December 31,
 2019 2018
Long-term taxes payable$12,330
 $15,425
Non-current deferred revenue4,563
 4,338
Finance lease liabilities599
 
Other124
 82
Total$17,616
 $19,845

 December 31,
 2017 2016
Contingent tax obligations$17,934
 $6,125
Non-current deferred revenue4,039
 1,885
Other22
 3
Total$21,995
 $8,013


10—11—DEBT AND CREDIT ARRANGEMENTS
The Company hasWe have a Credit Agreement with JP Morgan, Chase Bank ("JP Morgan")Citibank and Citibank, NA (“Citibank”).Wells Fargo. The Credit Agreement provides for an aggregate $150 million of secured revolving credit facility. In the third quarter of 2017, the Companywe exercised the right to increase the amount available under the facility by $75.0 million, bringing the aggregate revolving credit facility to $225.0 million. The Credit Agreement contains covenants relating to maintenance of books and records, financial reporting and notification, compliance with laws, maintenance of properties and insurance, and limitations on guaranties, investments, issuance of debt, lease obligations and capital expenditures, and is secured by virtually all of the Company'sour assets. The Credit Agreement provides for events of default, including failure to pay any principal or interest when due, failure to perform or observe covenants, bankruptcy or insolvency events and the occurrence of a material adverse effect. The Company hasWe have no other significant credit facilities.
In addition to the customary restrictive covenants listed above, the Credit Agreement also contains financial covenants that require the Companyus to maintain a certain leverage ratio and fixed charge coverage ratio, each as defined in the Credit Agreement:
Leverage Ratio, as defined, to be no higher than 2.75 to 1.00.
Interest Coverage Ratio, as defined, to be at least 1.75 to 1.00 at all times.
As of December 31, 2017, the Company was2019, we were in compliance with the Leverage Ratio at 2.44 to 1.00 and the Interest Coverage Ratio at 10.16 to 1.00.covenants as defined in the Credit Agreement.
As of December 31, 2017, the Company had $1552019, we have $55 million outstanding under the Credit Agreement.
Pursuant to the terms of the Credit Agreement, the outstanding principal balance will bear interest at either (a) a fluctuating rate per annum equal to the Applicable Rate, as defined in the Credit Agreement, depending on the leverage ratio plus the higher of (i) the federal funds rate plus one-half of one percent per annum; (ii) the prime rate in effect on such a day; and (iii) the LIBOR rate plus one percent, or (b) a fluctuating rate per annum of LIBOR Rate plus the Applicable Rate, which ranges between 1.75% to 2.75%. The effective interest rate during the twelve months ended December 31, 20172019 was 3.34%4.54%.


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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017


The Credit Agreement matures on September 23, 2021, at which time all principal amounts outstanding under the Credit Agreement will be due and payable.


Long-term debt consists of (in thousands):
 December 31,
 2019 2018
Revolving credit facility$55,000
 $105,000
Debt issuance costs(335) (526)
Less: current portion of long-term debt35,000
 35,000
Total long-term debt$19,665
 $69,474
 December 31,
 2017 2016
Revolving credit facility$155,000
 $140,000
Debt issuance costs(717) 
Less: current portion of long-term debt
 
Total long-term debt$154,283
 $140,000

Maturities of long-term debt as of December 31, 20172019 are as follows (in thousands):
 December 31,
 2019 2018
2019$
 $
2020
 
202155,000
 105,000
Thereafter
 
Total$55,000
 $105,000
 December 31,
 2017 2016
2018$
 $
2019
 
2020
 
Thereafter154,283
 140,000
Total$154,283
 $140,000

As of December 31, 2017,2019, the carrying value of the total debt approximated fair market value.
11—12—FINANCIAL INSTRUMENTS AND DERIVATIVES
We use interest rate swap derivative instruments to manage earnings and cash flow exposure resulting from changes in interest rates. These interest rate swaps apply a fixed interest rate on a portion of our expected LIBOR-indexed floating-rate borrowings. We held the following interest rate swaps as of December 31, 2019 (in thousands):


Hedged ItemCurrent Notional AmountDesignation DateEffective DateTermination DateFixed Interest RateFloating RateEstimated Fair Value
1-month USD LIBOR loan$40,000
May 31, 2018June 1, 2018September 23, 20212.611%1-month USD LIBOR$313
Total interest rate derivatives designated as cash flow hedge$40,000
     $313


We designated these derivative instruments as cash flow hedges. We assess the effectiveness of these derivative instruments and record the changes in the fair value of a derivative instrument designated as a cash flow hedge as unrealized gains or losses in accumulated other comprehensive income, net of tax. Once the hedged item affects earnings, the effective portion of any gain or loss will be reclassified to earnings. If the hedged cash flow does not occur, or if it becomes probable that it will not occur, we will reclassify the amount of any gain or loss on the related cash flow hedge to interest expense at that time.

As of December 31, 2019, we expect that approximately $143 thousand of losses associated with the cash flow hedge, net of tax, could be reclassified from AOCI into earnings within the next twelve months.

13—RESERVE FOR PRODUCT WARRANTIES
The Company providesWe provide a warranty for products that is generally one year in length and in some cases, regulations may require them to provide repair or remediation beyond the typical warranty period. If any of the products contain defects, the Companywe may be required to

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

incur additional repair and remediation costs. Service, for domestic customers is provided by Company-owned service centers that perform all service, repair and calibration services. Service for international customers isservices are provided by a combination of Company-ownedour owned facilities and vendors on a contract basis.
A warranty reserve is included in accrued liabilities for the expected future costs of servicing products. Additions to the reserve are based on management's best estimate of probable liability. The Company considersWe consider a combination of factors including material and labor costs, regulatory requirements, and other judgments in determining the amount of reserve. The reserve is reduced as costs are incurred to honor existing warranty and regulatory obligations.
As of December 31, 2017, the Company has2019, we have accrued $5.4$6.4 million to bring certain NeoBLUE® phototherapy products into U.S. regulatory compliance. The Company's estimate of the costs associated with bringing the NeoBLUE® phototherapy products into compliance is primarily based upon the number of units outstanding that may require the repair, costs associated with shipping and repairing thefor product and the assumption that the FDA will approve the Company's plan for compliance.
The details of activity in the warranty reserve are as follows (in thousands):
 
Balance at
Beginning
of Period
 
Assumed
Through
Acquisitions
 
Additions
Charged to
Expense
 Reductions 
Balance
at End
of Period
December 31, 2017$10,670
 $1,159
 $5,370
 $(6,204) $10,995
December 31, 2016$10,386
 $222
 $2,711
 $(2,649) $10,670
December 31, 2015$2,753
 $
 $10,729
 $(3,096) $10,386
related warranties. The estimates the Company useswe use in projecting future product warranty costs may prove to be incorrect. Any future determination that product warranty reserves are understated could result in increases to cost of sales and reductions in operating profits and results of operations.



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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

12—14—STOCKHOLDERS’ EQUITY
Common StockThe Company hasWe have 120,000,000 shares of common stock authorized at a par value or $0.001 per share.
Preferred StockThe Company hasWe have 10,000,000 shares of preferred stock authorized at a par value of $0.001 per share. In accordance with the terms of the amended and restated certificate of incorporation, the Board of Directors is authorized to provide for the issuance of one or more series of preferred stock, including increases or decreases to the series. The Board of Directors has the authority to set the rights, preferences, and terms of such shares. As of December 31, 2017,2019, no shares of preferred stock were issued and outstanding.


13—15—EARNINGS PER SHARE
The components of basic and diluted EPS are as follows (in thousands, except per share amounts):
 December 31,
 2019 2018 2017
Net loss$(15,671) $(22,935) $(20,293)
Weighted average common shares33,696
 33,111
 32,564
Dilutive effect of stock based awards
 
 
Diluted Shares33,696
 33,111
 32,564
Basic loss per share$(0.47) $(0.69) $(0.62)
Diluted loss per share$(0.47) $(0.69) $(0.62)
Shares excluded from calculation of diluted EPS104
 343
 565

 December 31,
 2017 2016 2015
Net income (loss)$(20,293) $42,594
 $37,924
Weighted average common shares32,564
 32,460
 32,348
Dilutive effect of stock based awards
 596
 893
Diluted Shares32,564
 33,056
 33,241
Basic earnings per share$(0.62) $1.31
 $1.17
Diluted earnings per share$(0.62) $1.29
 $1.14
Shares excluded from calculation of diluted EPS565
 2
 


14—16—SHARE-BASED COMPENSATION
Share-Based Compensation ExpenseThe Company accountsWe account for share-based compensation in accordance with ASC Topic 718, Compensation—Stock Compensation. Share-based compensation was recognized as follows in the consolidated statement of income (in thousands):
 December 31,
 2019 2018 2017
Cost of revenue$264
 $218
 $232
Marketing and selling800
 801
 540
Research and development1,024
 1,039
 1,332
General and administrative6,227
 14,945
 7,341
Total expense$8,315
 $17,003
 $9,445

 December 31,
 2017 2016 2015
Cost of revenue$232
 $219
 $156
Marketing and selling540
 821
 808
Research and development1,332
 1,515
 1,264
General and administrative7,341
 6,453
 4,725
Total expense9,445
 9,008
 6,953
Stock Awards Plans—Natus' 20112018 Stock Awards Plan (the “Plan”) provides for the granting of the following:
Incentive stock options to employees;

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

Non-statutory stock options to employees, directors and consultants;
Restricted stock awards and restricted stock units;
Market stock units;
Stock bonuses; and
Stock appreciation rights.
As of December 31, 2017,2019, there were 779,2982,764,603 shares available for future awards under the plan.
Under the Plan, stock options may be issued at not less than the fair market value of the common stock on the date of grant, as determined by the Board of Directors. Options issued under the Plan become exercisable as determined by the Board of Directors and expire no more than six years after the date of grant. Most options vest ratably over four years.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Stock Option Activity—Stock option activity under the stock awards plans for the year ended December 31, 20172019 is summarized as follows:
 
Number of
Shares
 
Weighted
Average
Exercise Price
Outstanding, December 31, 2018 (127,453 shares exercisable at a weighted average exercise price of $18.22 per share)201,542
 $24.48
Granted
 $
Exercised(124,303) $18.35
Forfeited
 $
Expired(3,150) $13.35
Outstanding, December 31, 2019 (18,531 shares exercisable at a weighted average exercise price of $35.25 per share)74,089
 $35.25
 
Number of
Shares
 
Weighted
Average
Exercise Price
Outstanding, December 31, 2016 (816,691 shares exercisable at a weighted average exercise price of $14.54 per share)933,096
 $15.02
Granted
 $
Exercised(134,102) $14.06
Forfeited(1,317) $13.83
Expired(2,592) $16.31
Outstanding, December 31, 2017 (790,573 shares exercisable at a weighted average exercise price of $15.14 per share)795,085
 $15.18

As of December 31, 2017,2019, unrecognized compensation related to the unvested portion of stock options was approximately $1.0 thousand,$0.5 million, which is expected to be recognized at the beginningover a weighted average period of 2018.2.7 years. The intrinsic value of options exercised, representing the difference between the closing stock price of common stock on the date of the exercise and the exercise price, in the years ended December 31, 2019, 2018 and 2017 2016 and 2015 was $3.1$1.4 million, $3.4$13.6 million, and $17.7$3.1 million, respectively.
As of December 31, 2017,2019, there were: (i) 795,08570,990 options vested and expected to vest with a weighted average exercise price of $15.18,$35.25, an intrinsic value of $18.3$0.0 million, and a weighted average remaining contractual term of 1.24.5 years; and (ii) 790,57318,531 options exercisable with a weighted average exercise price of $15.14,$35.25, an intrinsic value of $18.2$0.0 million, and a weighted average remaining contractual term of 1.24.5 years.
Black-Scholes Inputs—The fair value of option grants was estimated using the Black-Scholes option pricing model with the following weighted average assumptions:
 December 31,
 2018
Weighted-average fair value of options granted$11.03
Expected life in years4.0
Risk-free interest rate2.7%
Expected volatility35%
Dividend yieldNaN

We did not grant any stock options during the years ended December 31, 2019 and December 31, 2017.
The expected life of options is based primarily on historical share option exercise experience of the employees for options granted by the Company.granted. All options are treated as a single group in the determination of expected life, as the Company doeswe do not currently expect substantially different exercise or post-vesting termination behavior among the employee population. The risk-free interest rate is based on the U.S. Treasury yield for a term consistent with the expected life of the awards in effect at the time of grant. Expected volatility is based primarily on historical volatility data of the Company'sour common stock. The Company hasWe have no history or expectation of paying dividends on common stock.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

Share-based compensation expense associated with options is based on awards ultimately expected to vest. At the time of an option grant, the Company estimateswe estimate the expected future rate of forfeitures based on historical experience. These estimates are revised, if necessary, in subsequent periods if actual forfeiture rates differ from those estimates. If the actual forfeiture rate is lower than estimated the Companywe will record additional expense and if the actual forfeiture is higher than estimated the Companywe will record a recovery of prior expense.
Restricted Stock Awards Activity—The following table summarizes the activity for restricted stock awards during the year ended December 31, 2017: 2019:
 Shares 
Weighted
Average
Grant
Date Fair
Value
Unvested at December 31, 2018293,588
 $37.04
Granted197,333
 $31.53
Vested(129,659) $36.46
Forfeited(21,500) $35.76
Unvested at December 31, 2019339,762
 $34.14
 Shares 
Weighted
Average
Grant
Date Fair
Value
Unvested at December 31, 2016506,389
 $34.82
Granted265,449
 $34.94
Vested(391,947) $32.41
Forfeited(16,083) $35.87
Unvested at December 31, 2017363,808
 $37.46

As of December 31, 2017,2019, unrecognized compensation related to the unvested portion of stock awards was $10.8$6.4 million, which is expected to be recognized over a weighted average period of 2.3 years. The fair market value of outstanding restricted stock awards at December 31, 20172019 was $13.9$11.2 million. For the restricted stock awards unitsgranted during the years ended December 31, 2019, 2018, 2017, the weighted average grant date fair values were $31.53, $37.22, and $34.94, respectively. The total grant date fair value of restricted stock awards vested during fiscal year 2019, 2018, and 2017 was $4.7 million, $12.9 million, and $12.7 million, respectively. For the restricted stock awards that vested during the years ended December 31, 2017, 2016,2019, 2018, and 2015,2017, the total intrinsic value was $14.3$4.0 million, $9.0$11.2 million, and $10.3$14.3 million, respectively.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

Restricted Stock Units Activity—The following table summarizes restricted stock units activity for the year ended December 31, 2017: 2019:
Shares 
Weighted
Average
Grant
Date Fair
Value
Shares 
Weighted
Average
Grant
Date Fair
Value
Outstanding at December 31, 201629,903
 $34.39
Outstanding at December 31, 2018112,805
 $36.80
Awarded55,176
 $35.16
118,740
 $38.62
Released(35,929) $33.65
(42,130) $34.11
Forfeited(25,006) $34.47
(16,319) $37.60
Outstanding at December 31, 201724,144
 $37.17
Outstanding at December 31, 2019173,096
 $38.62
*Includes the MSUs granted at the valuation date, which may be subject to additional awards or forfeitures depending on the outcome of the performance measures at the end of the performance period.
As of December 31, 2017,2019, unrecognized compensation related to the unvested portion of stock units was $0.9$3.7 million, which is expected to be recognized over a weighted average period of 1.82.0 years. The aggregate intrinsic value of outstanding restricted stock units at December 31, 2019 was $5.7 million. For the restricted stock units granted during the years December 31, 2019, 2018, 2017, the weighted average grant date fair values were $38.62, $36.77, and $35.16, respectively. The total grant date fair value of restricted stock units vested during fiscal year 2019, 2018, and 2017 was $0.9 million.$1.4 million, $10.0 thousand, and $1.2 million, respectively. For the restricted stock units that vested during the years ended December 31, 2017, 2016,2019, 2018, and 2015,2017, the total intrinsic value was $1.3 million, $0.9 million,$8.7 thousand, and $0.9$1.3 million, respectively.
Employee Stock Purchase Plan—Under Natus' 2011 Employee Stock Purchase Plan (the “ESPP”), U.S. employees can elect to have salary withholdings of up to 15% of eligible compensation to a maximum of $10,625 per offering period, to purchase shares of common stock on April 30 and October 31 of each year. The purchase price for shares acquired under the ESPP is 85% of the fair market value on the last day of the offering period. As of December 31, 2017,2019, there were 117,270499,431 shares reserved for future issuance under the ESPP.

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

Because the ESPP does not have a “look back” feature, the compensation expense associated with the Plan is not measured by the use of the Black-Scholes pricing model, but rather by measuring the difference between the fair market value of common stock on the last day of the offering period and the purchase price for the offering period, which is 85% of the fair market value. Compensation expense associated with the ESPP for the years ended December 31, 2017, 20162019, 2018 and 2015,2017, respectively, was $0.2 million, $0.3 million, $0.2 million, and $0.2$0.3 million.


15—RESTRUCTURING RESERVE
The Company has historically incurred an ongoing level of restructuring-type activities to maintain a competitive cost structure, including manufacturing and workforce optimization resulting from acquisitions.
The balance of the restructuring reserve is included in accrued liabilities on the accompanying consolidated balance sheets. Employee termination benefits are included as a part of restructuring expenses.
Activity in the restructuring reserves for these plans for the years ended December 31, 2017, 2016 and 2015 is as follows (in thousands): 

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

 
Personnel
Related
 
Facility
Related
 Total
Balance as of December 31, 2014$368
 
 $368
Additions1,905
 156
 2,061
Reversals(124) 
 (124)
Payments(473) (156) (629)
Balance as of December 31, 20151,676
 
 1,676
Additions1,093
 725
 1,818
Reversals(436) 
 (436)
Payments(1,990) (573) (2,563)
Balance as of December 31, 2016343
 152
 495
Additions431
 
 431
Reversals(182) 
 (182)
Payments(631) (93) (724)
Balance as of December 31, 2017$(39) 59
 $20
16—17—OTHER INCOME (EXPENSE), NET
Other income (expense), net consists of (in thousands):
 Years Ended December 31,
 2019 2018 2017
Interest income$250
 $334
 $425
Interest expense(4,941) (6,794) (5,081)
Foreign currency gain (loss)(765) (800) 1,013
Other(135) (438) 76
Total other expense, net$(5,591) $(7,698) $(3,567)

 Years Ended December 31,
 2017 2016 2015
Interest income$425
 $315
 $27
Interest expense(5,081) (430) (352)
Foreign currency gain (loss)1,013
 (359) (1,415)
Other76
 117
 676
Total other income (expense), net$(3,567) $(357) $(1,064)


17—18—INCOME TAXES
Income (loss) before provision for income tax is as follows (in thousands):
 Years Ended December 31,
 2019 2018 2017
U.S.$(22,851) $(54,370) $(18,059)
Foreign1,594
 22,110
 23,209
Income (loss) before provision for income tax$(21,257) $(32,260) $5,150

 Years Ended December 31,
 2017 2016 2015
U.S.$(18,059) $68
 $20,507
Foreign23,209
 54,835
 31,902
Income before provision for income tax$5,150
 $54,903
 $52,409


The components of income tax expense (benefit) for the years ended December 31, 2017, 20162019, 2018 and 20152017 (in thousands):

F-23
 Years Ended December 31,
 2019 2018 2017
Current     
U.S. Federal$(948) $(1,872) $10,110
U.S. State and local561
 (59) 1,079
Non-U.S.8,386
 5,732
 12,764
Total current tax expense7,999
 3,801
 23,953
Deferred     
U.S. Federal(7,491) (8,248) 6,345
U.S. State and local(816) (1,751) (1,333)
Non-U.S.(5,278) (3,127) (3,522)
Total deferred tax expense (benefit)(13,585) (13,126) 1,490
Total income tax expense (benefit)$(5,586) $(9,325) $25,443

Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

 Years Ended December 31,
 2017 2016 2015
Current     
U.S. Federal$10,110
 $(1,388) $13,497
U.S. State and local1,079
 692
 1,984
Non-U.S.12,764
 15,069
 2,239
Total current tax expense23,953
 14,373
 17,720
Deferred     
U.S. Federal6,345
 (1,534) (3,410)
U.S. State and local(1,333) (378) (385)
Non-U.S.(3,522) (152) 560
Total deferred tax benefit1,490
 (2,064) (3,235)
Total income tax expense$25,443
 $12,309
 $14,485
Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of deferred tax assets and liabilities as of December 31, 20172019 and 20162018 are as follows (in thousands):

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NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017
 December 31,
 2017 2016
Deferred tax assets:   
Net operating loss carryforwards$3,958
 $6,557
Credit carryforwards4,466
 2,512
Accruals deductible in different periods11,969
 16,157
Employee benefits1,085
 2,389
Total deferred tax assets21,478
 27,615
Valuation allowance(5,862) (3,706)
Total net deferred tax assets$15,616
 $23,909
Deferred tax liabilities: 
Basis difference in fixed and intangible assets(23,934) (12,678)
Foreign earnings to be repatriated(380) 
Total deferred tax liabilities(24,314) (12,678)
Total net deferred tax assets$(8,698) $11,231

 December 31,
 2019 2018
Deferred tax assets:   
Net operating loss carryforwards$3,035
 $3,192
Credit carryforwards2,415
 2,882
Accruals deductible in different periods23,672
 15,197
Employee benefits1,554
 1,262
Operating leases4,643
 
Total deferred tax assets35,319
 22,533
Valuation allowance(606) (637)
Total net deferred tax assets$34,713
 $21,896
Deferred tax liabilities: 
Basis difference in fixed and intangible assets(13,850) (15,687)
Operating leases(3,959) 
Foreign earnings to be repatriated(800) (500)
Total deferred tax liabilities(18,609) (16,187)
Total net deferred tax assets$16,104
 $5,709

The income tax expense (benefit) in the accompanying statements of income differs from the provision calculated by applying the U.S. federal statutory income tax rate of 21%, 21%, and 35% in 2019, 2018, and 2017, 2016, and 2015respectively to income before taxes due to the following:

F-24
 Years Ended December 31,
 2019 2018 2017
Federal statutory tax expense$(4,464) $(6,775) $1,802
State tax expense(300) (1,160) (318)
Foreign taxes at rates less than U.S. rates(2,205) (1,071) (3,101)
Deferred charges on sales of U.S. intellectual property
 
 980
Equity compensation824
 519
 606
Tax credits(1,428) (2,021) (1,498)
Uncertain tax position2,910
 1,311
 2,048
Lapse of statute(3,961) (1,214) (1,521)
Change of valuation allowance on foreign tax credit
 
 314
Earnout adjustment
 
 (190)
Repatriation tax net of foreign tax credits172
 
 16,564
Net deferred tax asset re-measurement


 
 3,883
Tax audits
 658
 726
Withholding taxes1,107
 1,185
 2,880
Global intangible low-taxed income net of foreign tax credits1,601
 2,326
 
Return to provision560
 (1,417) 711
AMT on acquisition
 
 621
SAB 118 adjustments
 (2,676) 
Other(402) 1,010
 936
Total expense (benefit)$(5,586) $(9,325) $25,443

Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 2016 and 2015

 Years Ended December 31,
 2017 2016 2015
Federal statutory tax expense$1,802
 $19,216
 $18,343
State tax expense(318) 188
 1,249
Foreign taxes at rates less than U.S. rates(3,101) (6,838) (1,760)
Deferred charges on sales of U.S. intellectual property980
 980
 (5,878)
Equity compensation606
 (530) 204
Tax credits(1,498) (911) (935)
Uncertain tax position2,048
 485
 3,897
Lapse of statute(1,521) (495) (784)
Change of valuation allowance on foreign tax credit314
 
 
Earnout adjustment(190) (1,184) 
Repatriation tax net of foreign tax credits16,564
 
 
Net deferred tax asset re-measurement

3,883
 
 
Tax audits726
 543
 
Withholding taxes2,880
 
 
Return to provision711
 
 
AMT on acquisition621
 
 
Other936
 855
 149
Total expense$25,443
 $12,309
 $14,485
On December 22, 2017, the Tax Cuts and Jobs Act of 2017 (the “Act”) was signed into law making significant changes to the Internal Revenue Code. Changes include, but are not limited to, a corporate tax rate decrease from 35% to 21% effective for tax years beginning after December 31, 2017, the transition of U.S. international taxation from a worldwide tax system to a modified territorial system, and a one-time transition tax on the mandatory deemed repatriation of cumulative foreign earnings as of December 31, 2017. On December 22, 2017, Staff Accounting Bulletin No. 118 (“SAB 118”) was issued to address the application of US GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Act. The Company has calculated its best estimate of the impact of the Act in its year end income tax provision in accordance with its understanding of the Act and guidance available as of the date of this filing. As a result, the Company has recorded $20.5 million as an additional income tax expense in the fourth quarter of 2017, the period in which the legislation was enacted. The provisional amount related to the re-measurement of certain deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future was $3.9 million. The provisional amount related to the one-time transition tax on the mandatory deemed repatriation of foreign earnings, net of foreign tax credits was $16.6 million based on cumulative foreign earnings of $181.0 million.
In accordance with SAB 118, the Company has determined that the $16.6 million of current tax expense recorded in connection with the transition tax on the mandatory deemed repatriation of foreign earnings was a provisional amount and a reasonable estimate at December 31, 2017. Additional work is necessary to do a more detailed analysis of historical foreign earnings as well as potential correlative adjustments. Any subsequent adjustment to these amounts will be recorded to current tax expense in the quarter of 2018 when the analysis is complete.
As of December 31, 2017, the Company has not assessed the impact of the changes arising from the Act that are effective in tax year 2018 and onward and will be included in the 2018 as interpreted guidance is further released. The Company has also not yet made a policy election with respect to its treatment of potential global intangible low-taxed income (“GILTI”). Companies can either account for taxes on GILTI as incurred or recognize deferred taxes when basis differences exist that are expected to affect the amount of the GILTI inclusion upon reversal. The Company is still in the process of analyzing the provisions of the Act associated with GILTI and the expected impact of GILTI on the Company in the future.
At December 31, 2017, the Company2019, we had deferred tax assets attributable to U.S. state net operating loss carryforwards of $1.2$23.7 million, of which an immaterial amount will begin to expire in 2018.2020. At December 31, 2017, the Company2019, we had U.S. federal and state R&D credit carryforwards of $0.4$1.2 million whichand $0.6 million, respectively. These R&D credit carryforwards will begin to expire in 2021.2039 and 2021, respectively. At December 31, 2017, the Company2019, we had $4.2$0.1 million of U.S. foreign tax credit carryforwards that can be used to offset future U.S. tax liabilities related to foreign source taxable income. The foreign tax credits will start to expire in 2022.


F-25F-26

Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017


At December 31, 2017,2019, certain foreign subsidiaries had deferred tax assets attributable to net operating loss carryforwards as follows: $0.03 million in Germany, $1.4$1.0 million in France, $0.5$0.4 million in Denmark, $0.4 million in Canada, and $0.5$0.1 million in Denmark.Germany. These foreign net operating loss carryforwards, if not utilized to offset taxable income in future periods, will expire in various amounts beginning in 2028.
A valuation allowance is provided when it is more likely than not that some portion or all of the deferred tax assets will not be realized. Accordingly, valuation allowances of $5.9$0.6 million and $3.7$0.6 million were recorded at December 31, 20172019 and 2016,2018, respectively. The increasedecrease of $2.2 million$31.0 thousand in valuation allowance was primarily due to a valuation allowance recorded against our net operating loss carryforward in Canada due to utilization in the Company's current year generation of the Foreign Tax Credit in U.S.year.
The realizability of the deferred tax assets is primarily dependent on the Company'sour ability to generate sufficient taxable income in future periods. The Company's management weighedManagement weighs the aggregate effect of all positive evidence and negative evidence in determining the likelihood of realization of the deferred tax assets. The factors used by management to collect evidence included historical earnings of the applicable taxing jurisdiction, the cash refund opportunity to utilize the tax losses, and the future forecast of profitability in the jurisdiction. Weighing all the positive and negative evidence, the Company haswe have recorded a valuation allowance related primarily to net operating losses in certain foreign jurisdictions and U.S. foreign tax credits where it is more likely than not that the tax benefit of the net operating losses and tax credits will not be realized.
There are no changes to the position on the Company'sour permanent reinvestment of its earnings from foreign operations, with the exception of Excel-Tech and Natus Ireland.operations. As of December 31, 2017, the Company intends2019, we intend to distribute all of the earnings from Excel-Tech and Natus Ireland in excess of their operational needs. The Company hasWe have recorded a deferred tax liability of $0.4$0.8 million accordingly for 5% Canadian withholding tax on the expected Excel-Tech distribution to Natus Ireland. Natus Ireland has 0% withholding tax under domestic exemption and therefore, no liability has been recorded. The Company intendsWe intend on permanently reinvesting the earnings of its remaining foreign subsidiaries. The other remaining foreign subsidiaries have both the intent and ability to indefinitely reinvest its undistributed earnings.
Uncertain Tax Positions
A reconciliation of the beginning and ending amount of unrecognized tax benefits (excluding interest and penalties) is as follows (in thousands):
Balance at January 1, 2017$5,898
Increases for tax positions related to prior years747
Increases for tax positions related to the current year1,712
Lapse of statutes of limitations(1,393)
Foreign exchange difference53
Balance at January 1, 2018$7,017
Increases for tax positions related to prior years526
Increases for tax positions related to the current year699
Lapse of statutes of limitations(965)
Foreign exchange difference(50)
Balance at January 1, 2019$7,227
Decreases for tax positions related to prior years(48)
Increases for tax positions related to the current year495
Lapse of statutes of limitations(3,763)
Foreign exchange difference6
Balance at December 31, 2019$3,917
Balance at January 1, 2015$3,395
Increases for tax positions related to prior years281
Increases for tax positions related to the current year3,302
Lapse of statutes of limitations(664)
Balance at January 1, 2016$6,314
Increases for tax positions related to prior years174
Increases for tax positions related to the current year70
Lapse of statutes of limitations(475)
Foreign exchange difference(185)
Balance at January 1, 2017$5,898
Increases for tax positions related to prior years747
Increases for tax positions related to the current year1,712
Lapse of statutes of limitations(1,393)
Foreign exchange difference53
Balance at December 31, 2017$7,017

For the year ended December 31, 2017,2019, unrecognized tax benefits increaseddecreased by $1.1$3.3 million and $0.6$3.5 million of income tax expensebenefit in the income tax provision were recorded. The increasedecrease was primarily attributable to the increaselapse of the statute of limitations in uncertain tax positions and adjustments related to the current yearprior years in certain jurisdictions.
The unrecognized tax benefits for the tax years ended December 31, 2019, 2018 and 2017 2016 and 2015 were $7.0$3.9 million, $5.9$7.2 million and $6.3$7.0 million, respectively which include $4.0$3.6 million, $2.5$6.5 million and $2.4$4.0 million, respectively that would impact the effective tax rate if recognized.
The Company expectsWe expect a range from zero0 to $0.9$2.4 million of unrecognized tax benefit that will impact the effective tax rate in the next 12 months due to the lapse of statute of limitations provided that no taxing authority conducts a new examination.


F-26F-27

Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017


At December 31, 2019, 2018 and 2017, 2016 and 2015, the Companywe had cumulatively accrued $0.6$0.4 million, $0.6$0.5 million, and $0.4$0.6 million for estimated interest and penalties related to uncertain tax positions. The Company recordsWe record interest and penalties related to recognizedunrecognized tax positions as a component of income tax expense (benefit), which totaled approximately $(0.01) million, $0.2 million,$(80.0) thousand, $(80.0) thousand, and $0.1 million$(10.0) thousand for the years ended December 31, 2017, 2016,2019, 2018, and 2015,2017, respectively.
The Company isWe are currently unaware of any uncertain tax positions that could result in significant additional payments, accruals, or other material deviation in this estimate over the next 12 months.
The Company'sOur tax returns remain open to examination as follows: U.S. federal, 20142015 through 2017;2018; U.S. states, generally 20132014 through 2017;2018; and significant foreign jurisdictions, generally 20132014 through 2017.2018.


18—19—EMPLOYEE BENEFIT PLAN
The Company offersWe offer pre-tax and after-tax 401(k) savings plan options under which eligible U.S. employees may elect to have a portion of their salary deferred and contributed to the plan. Employer matching contributions are determined by management and are discretionary. Employer matching contributions were $2.5$3.6 million, $1.5$4.7 million, and $1.3$2.5 million respectively, in the years ended December 31, 2017, 2016,2019, 2018, and 2015.2017. For new hires, employer contributions vest ratably over the first two years of employment.


19—20—SEGMENT, CUSTOMER, AND GEOGRAPHIC INFORMATION
The Company operatesWe determine our reportable segments by first identifying our operating segments, and then by assessing whether any components of these segments constitute a business for which discrete financial information is available and where segment management regularly reviews the operating results of that component. Historically, our operating segments were based on its three strategic business units. In January 2019 we announced the transition of our operating structure from three strategic business units to a single, unified company with globally led operational teams in Sales and Marketing, Manufacturing, Research and Development, Quality, and General and Administrative functions.
Following the reorganization, we operate as one operating segment and 1 reportable segment, which provides medical device solutions focused on the diagnosis and treatment of central nervous and sensory system disorders for patients of all ages. Financial information is presented asreviewed on a consolidated basis for purposes of making operating decisions and assessing financial performance. Consolidated financial information is accompanied by disaggregated information about revenues by end market and geographic region. We do not assess the aggregationperformance of our end markets or geographic regions on measures of profit or loss, or asset-based metrics. We have disclosed the revenues for each end market and geographic region to provide the reader of the Neurology, Newborn Care, and Otometrics operating segments. Through the one reportable segment the Company is organized on the basis of the healthcare products and services provided which are used for the screening, detection, treatment, monitoring and tracking of common medical ailments in newborn care, hearing impairment, neurological dysfunction, epilepsy, and sleep disorders.financial statements transparency into our operations.
End-users customer base includes hospitals, clinics, laboratories, physicians, nurses, audiologists, and governmental agencies. Most of the Company's international sales are to distributors who resell products to end users or sub-distributors. The Company's foreign countries’following tables present revenue is determined based on the customer’s billing address.
Revenue and long-lived asset information by end market and geographic regionregion. Revenue is as followsbased on the destination of the shipments and long-lived assets are based on the physical location of the assets (in thousands):


F-27F-28

Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2017, 20162019, 2018 and 20152017


 Years Ended December 31,
 2019 2018 2017
Consolidated Revenue: 
United States$292,400
 $300,860
 $270,860
Foreign countries202,775
 230,031
 230,110
 $495,175
 $530,891
 $500,970
Revenue by End Market: 
Neuro 
Devices and Systems$220,306
 $200,762
 $171,315
Supplies66,059
 67,025
 59,955
Services871
 12,000
 11,886
Total Neuro Revenue$287,236
 $279,787
 $243,156
Newborn Care 
Devices and Systems$53,465
 $72,807
 $89,027
Supplies38,264
 40,669
 43,928
Services19,183
 20,396
 22,325
Total Newborn Care Revenue$110,912
 $133,872
 $155,280
Hearing & Balance 
Devices and Systems$92,050
 $110,597
 $75,466
Supplies4,977
 6,635
 27,068
Services
 
 
Total Hearing & Balance Revenue$97,027
 $117,232
 $102,534
Total Revenue$495,175
 $530,891
 $500,970
Long-lived asset information by geographic region is as follows (in thousands):
 Years Ended December 31,
 2017 2016 2015
Consolidated Revenue: 
United States$270,860
 $250,694
 $242,050
Foreign countries230,110
 131,198
 133,815
 $500,970
 $381,892
 $375,865
Revenue by End Market: 
Neuro 
Devices and Systems$171,315
 $168,200
 $168,776
Supplies59,955
 58,681
 60,205
Services11,886
 11,641
 8,320
Total Neurology Revenue$243,156
 $238,522
 $237,301
Newborn Care 
Devices and Systems$77,573
 $72,562
 $72,669
Supplies43,732
 47,674
 49,982
Services22,325
 23,134
 15,913
Total Newborn Care Revenue$143,630
 $143,370
 $138,564
Otometrics 
Devices and Systems$86,920
 $
 $
Supplies27,264
 
 
Services
 
 
Total Otometrics Revenue$114,184
 $
 $
Total Revenue$500,970
 $381,892
 $375,865
      
Property and equipment, net: 
United States$10,128
 $7,024
  
Canada5,068
 4,941
  
Argentina1,591
 2,121
  
Ireland3,178
 2,530
  
Denmark1,158
 17
  
Other foreign countries948
 700
  
 $22,071
 $17,333
  
 Years Ended December 31,
 2019 2018
Property and equipment, net:   
United States$11,868
 $10,019
Ireland5,732
 5,083
Canada4,140
 4,504
Denmark1,799
 1,371
Argentina
 999
Other foreign countries1,163
 937
 $24,702
 $22,913
During the years ended December 31, 2017, 20162019, 2018 and 2015,2017, no single customer or foreign country contributed to more than 10% of revenue.


20—21—COMMITMENTS AND CONTINGENCIES
Leases—The Company has entered into noncancelable operating leases for some of the facilities including related office equipment located in the U.S. and Europe through 2024. Minimum lease payments under noncancelable operating leases as of December 31, 2017 are as follows (in thousands):

 
Operating
Leases
Year Ending December 31, 
2018$7,038
20195,732
20204,609
20213,392
20222,457
Thereafter6,850
Total minimum lease payments$30,078
Rent expense, which is recorded on the straight-line method from commencement over the period of the lease, totaled $6.7 million, $5.3 million and $4.4 million in 2017, 2016, and 2015, respectively.
Purchase commitmentsThe Company hasWe have various purchase obligations for goods or services totaling $47.8$45.0 million at December 31, 2017,2019, which are expected to be paid within the next year.
Indemnifications—Under the bylaws, the Company has agreed to indemnify the officers and directors for certain events or occurrences arising as a result of the officer or director serving in such capacity. The Company has a director and officer liability insurance policy that limits the exposure under these indemnifications and enables them to recover a portion of any future loss arising out of them. In addition, the Company entered into indemnification agreements with other parties in the ordinary course of business. The Company has determined that these agreements fall within the scope of ASC 460, Guarantees. In some cases liability insurance is obtained to provide coverage that limits its exposure for these other indemnified matters. The Company has not incurred material costs to defend lawsuits or settle claims related to these indemnification agreements. The Company believes the estimated fair value of these indemnification agreements is minimal and have not recorded a liability for these agreements as of December 31, 2017.
Legal mattersThe CompanyWe currently are, and may from time to time become, a party to various legal proceedings or claims that arise in the ordinary course of business. The Company doesOur managements reviews these matters if and when they arise and believes that the resolution of any such matters currently known will not believe that any current legal or administrative proceedings are likely to have a material effect on business, financial condition, orour results of operations.operations or financial position.
In January 2017, a putative class action lawsuit (Badger v. Natus Medical Incorporation, et al., No. 17-cv-00458-JSW) alleging violations of federal securities laws was filed in the United States District Court for the Northern District of California, naming as defendants the Company and certain officers and a director. In July 2017, plaintiffs filed an amended complaint with a new lead plaintiff (Costabile v. Natus Medical Incorporation, et al., No. 17-cv-00458-JSW) alleging violations of federal securities laws based on allegedly false and misleading statements. The defendants moved to dismiss the Amended Complaint, and in February 2018 the motion to dismiss was granted with leave to amend. The Company believes that the plaintiffs’ allegations are without merit, and intends to vigorously defend against the claims.  In July 2017, a putative shareholder derivative action was filed in California Superior Court (Mortman v. Gunst, et. al., No. RG17867679) against certain of the Company’s officers and directors and naming the Company as a nominal defendant. The action is based on allegations similar to those in the securities class action litigation described above. The Company believes the likelihood of an unfavorable outcome from these actions is remote.


F-29

21—
Table of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017

22—FAIR VALUE MEASUREMENTS
ASC 820 defines fair value, establishes a framework for measuring fair value and expands disclosures about fair value measurements. Fair value is defined under ASC 820 as the exit price associated with the sale of an asset or transfer of a liability in an orderly transaction between market participants at the measurement date. ASC 820 establishes the following three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value:
Level 1—Quoted prices (unadjusted) in active markets that are accessible at the measurement date for assets or liabilities. The fair value hierarchy gives the highest priority to Level 1 inputs.
Level 2—Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets and liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
Level 3—Unobservable inputs that are used when little or no market data is available. The fair value hierarchy gives the lowest priority to Level 3 inputs.

F-29

TableOn April 1, 2019, as part of Contents
NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Endedthe sale of our Argentinian subsidiary, Medix, we provided a loan to Medix for $2.2 million. This asset was measured at fair value less costs to sell as of December 31, 2017, 20162019 and 2015is classified as Level 3 asset. The loan is classified within other assets on our consolidated balance sheet. Subsequent changes in the fair value of the loan receivable are recorded within our income statement as an operating expense.

 December 31, 2018 Additions Payments Adjustments December 31, 2019
Other assets:         
Loan receivable$
 $2,200
 $
 $(294) $1,906
Total$
 $2,200
 $
 $(294) $1,906
The Company does not have anyderivative financial assets or liabilitiesinstruments described in Note 12 are measured at fair value on a recurring basis.basis and are presented on the consolidated balance sheets at fair value. The table below presents the fair value of the derivative financial instruments as well as the classification on the consolidated balance sheet (in thousands):
 December 31, 2018 Additions Payments Adjustments December 31, 2019
Liabilities:         
Interest Rate Swap$77
 $
 $
 $236
 $313
Total$77
 $
 $
 $236
 $313
We estimate the fair value of the interest rate swaps by calculating the present value of the expected future cash flows of each swap. The calculation incorporated the contractual terms of the derivatives, observable market interest rates which are considered to be Level 2 inputs, and credit risk adjustments, if any, to reflect the counterpart's as well as our nonperformance risk. As of December 31, 2019, there have been no events of default under the interest rate swap agreement.
The following financial instruments are not measured at fair value on the consolidated balance sheet as of December 31, 20172019 and 2016,2018, but require disclosure of fair values: cash and cash equivalents, accounts receivable, and accounts payable. The carrying value of these financial instruments approximates fair values because of the relatively short maturity.
During the third quarterThe carrying amount of 2014, the Company listed the facility in Mundelein, Illinois for sale. This asset was measured atour short-term and long-term debt approximates fair value less cost to sell as of September 30, 2014 based on market price and Level 2 inputs. The book value of this assetinputs since the debt carries a variable interest rate that is tied to the current LIBOR rate plus a spread.

23—SALE OF CERTAIN SUBSIDIARY
We divested our wholly owned subsidiary, Medix, on June 30, 2014 was $3.6 million. The Company expensedApril 2, 2019 via a stock sale to the local managing director, a related party. In exchange for the stock, we received $2.5 thousand in cash and provided Medix with a $2.2 million duringlimited-recourse loan. The loan is secured by a real estate assets of Medix and repayment is conditional upon the third quartersale of 2014 for this impairment. Asthe real estate asset.


F-30

NATUS MEDICAL INCORPORATED
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS-(Continued)
Years Ended December 31, 2019, 2018 and 2017 the Company is carrying the asset as

The held for sale its fair value of $1.4 million.
The Company also has contingent consideration associated with earnouts from acquisitions. Contingent consideration liabilities are classified as Level 3 liabilities, as the Company use unobservable inputs to value them, which is a probability-based income approach. Contingent considerations are classified as accrued liabilities on the consolidated balance sheets. Subsequent changescriteria under GAAP was met in the fair valuefirst quarter of contingent consideration liabilities are recorded within the income statement as2019. As such, we completed an operating expense.
Contingent consideration associated with earnouts from acquisitions is as follows (in thousands):
 December 31, 2016 Additions Payments Adjustments December 31, 2017
Liabilities:         
Contingent consideration$3,043
 $693
 $(2,966) $(623) $147
Total$3,043
 $693
 $(2,966) $(623) $147
The significant unobservable inputs usedasset impairment analysis which resulted in the full impairment of all assets held for sale. We recognized an impairment loss of $24.6 million which included an accrual for the anticipated realization of deferred foreign currency related translation adjustments in accumulated other comprehensive income of $24.8 million, net of tax, and an adjustment of $4.6 million for assets with a book value in excess of their fair value measurementmarket value. Included in the year ended December 31, 2019 is the impact of contingent considerationthe sale of Medix, which was completed as of June 30, 2019, and the deferred foreign currency related totranslation adjustments previously in accumulated other comprehensive income have been released from the acquisitions are annualized revenue forecasts developed bybalance sheet along with the Company considering the probability of achievement of those revenue forecasts. Significant increases (decreases) in these unobservable inputs in isolation would result in a significantly lower (higher) fair value measurement.held for sale accrual.
The Company's Level 2 securities are valued using third-party pricing sources. The pricing services utilize industry standard valuation models, including both income and market-based approaches, for which all significant inputs are observable, either directly or indirectly, to estimate fair value. These inputs include reported trades of and broker/dealer quotes on the same or similar securities, issuer credit spread, benchmark securities, prepayment/default projections based on historical data and other observable inputs. The Company validates the prices provided by its third-party pricing services by understanding the models used, obtaining market values from other pricing sources, analyzing pricing data in certain instances and confirming those securities traded in active markets. See Note 4 to these Consolidated Financial Statements for further information regarding the Company's financial instruments.


ITEM 16.    Form 10-K Summary
Not Applicable.




EXHIBIT INDEX
   Incorporated By Reference   Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date Exhibit Filing Exhibit No. File No. File Date
  S-1 3.1.1
 333-44138 8/18/2000  S-1 3.1.1
 333-44138 8/18/2000
  8-K 3.1
 000-33001 9/13/2012  8-K 3.1
 000-33001 9/13/2012
  8-A 3.1.2
 000-33001 9/6/2002  8-K 3.1
 000-33001 6/7/2019
  8-K 3.1
 000-33001 6/18/2008  8-K 3.1
 000-33001 12/16/2019
  10-Q 3.1
 000-33001 5/9/2012
  S-1/A 4.1
 333-44138 2/9/2001
  8-A 3.1.2
 000-33001 9/6/2002
    
  S-1 10.1
 333-44138 8/18/2000  S-1 10.1
 333-44138 8/18/2000
  8-K 10.1
 000-33001 12/18/2018
  8-K 10.1.1
 000-33001 12/18/2018
  8-K 10.1.2
 000-33001 12/18/2018
  8-K 10.1.3
 000-33001 12/18/2018
  8-K 10.1.4
 000-33001 12/18/2018
  8-K 10.1
 000-33001 1/4/2006  8-K 10.1
 000-33001 1/4/2006
  S-1 10.3.1
 333-44138 8/18/2000  S-1 10.3.1
 333-44138 8/18/2000
  10-Q 10.2
 000-33001 8/9/2006  10-Q 10.2
 000-33001 8/9/2006
  10-K 10.2.3
 000-33001 3/14/2008  10-K 10.2.3
 000-33001 3/14/2008
  10-Q 10.02
 000-33001 5/9/2008  10-Q 10.02
 000-33001 5/9/2008
  S-1 10.4.1
 333-44138 8/18/2000  S-1 10.4.1
 333-44138 8/18/2000
  S-1 10.15
 333-44138 2/9/2001  S-1 10.15
 333-44138 2/9/2001
  S-1 10.15.1
 333-44138 2/9/2001  S-1 10.15.1
 333-44138 2/9/2001
  8-K 10.2
 000-33001 1/4/2006
  14-A 
 000-33001 4/20/2011
  10-Q 10.1
 000-33001 11/7/2011
  10-Q 10.2
 000-33001 11/7/2011
  10-Q 10.3
 000-33001 11/7/2011
  14-A 
 000-33001 4/20/2011
  14-A 
 000-33001 4/20/2011
  10-K 10.10
 000-33001 3/10/2009


Incorporated By Reference

    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
  10-K   000-33001 3/16/2015
  8-K 99.1
 000-33001 4/22/2013
  10-Q 10.1
 000-33001 8/8/2013
  8-K 10.1
 000-33001 10/9/2015
  10-Q   000-33001 2/29/2016
  10-Q 10.2
 000-33001 11/3/2016
  10-Q 10.1
 000-33001 11/3/2016
  10-Q 10.3
 000-33001 11/3/2016
  8-K 16.1
 000-33001 3/28/2014
         
         
         
         
         
         
101.INS# XBRL Instance Document        
101.SCH# XBRL Taxonomy Extension Schema Document        
101.CAL# XBRL Taxonomy Extension Label Calculation Linkbase Document        
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
  8-K 10.2
 000-33001 1/4/2006
  14-A 
 000-33001 4/20/2011
  10-Q 10.1
 000-33001 11/7/2011
  10-Q 10.2
 000-33001 11/7/2011
  10-Q 10.3
 000-33001 11/7/2011
  14-A 
 000-33001 4/20/2011
  14-A 
 000-33001 4/20/2011
  10-K 10.10
 000-33001 3/10/2009
  10-K   000-33001 3/16/2015
  8-K 99.1
 000-33001 4/22/2013
  10-Q 10.16
 000-33001 8/8/2018
  8-K 10.1
 000-33001 10/9/2015
  10-Q   000-33001 2/29/2016
  10-Q 10.2
 000-33001 11/3/2016
  10-Q 10.1
 000-33001 11/3/2016
  10-Q 10.3
 000-33001 11/3/2016
  8-K 99.1
 000-33001 8/29/2018
  10-Q 10.18
 000-33001 11/8/2018
         
         
         

    Incorporated By Reference
Exhibit No. Exhibit Filing Exhibit No. File No. File Date
101.DEF# XBRL Taxonomy Extension Definition Document        
101.LAB# XBRL Taxonomy Extension Label Linkbase Document        
101.PRE# 
101
The following financial information from Natus Medical Incorporated Annual Report on Form 10-K for the fiscal year ended December 31, 2019, formatted in XBRL Taxonomy Extension Presentation Linkbase Document(eXtensible Business Reporting Language): (i) Consolidated Balance Sheets as of December 31, 2019 and December 31, 2018, (ii) Consolidated Statements of Operations for the years ended December 31, 2019, 2018 and 2017, (iii) Consolidated Statements of Comprehensive Income for the years ended December 31, 2019, 2018 and 2017 (iv) Consolidated Statements of Cash Flows for the years ended December 31, 2019, 2018 and 2017, (v) Consolidated Statements of Stockholders’ Equity for the years ended December 31, 2019, 2018 and 2017, and (vi) the Notes to Consolidated Financial Statements.
104The cover page of the Annual Report on Form 10-K formatted in Inline XBRL (included in Exhibit 101).        


*    Indicates a management contract or compensatory plan or arrangement
#     Previously filed with Annual Report on Form 10-K for year ended December 31, 2017