Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
________________________________________________ 
FORM 10-Q
________________________________________________ 
 
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 20202021
OR
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 1-9810

Owens & Minor, Inc.
(Exact name of Registrant as specified in its charter)

Virginia54-1701843
(State or other jurisdiction of
incorporation or organization)
(I.R.S. Employer
Identification No.)
9120 Lockwood BoulevardMechanicsvilleVirginia23116
(Address of principal executive offices)(Zip Code)
Post Office Box 27626,
Richmond, Virginia
23261-7626
(Mailing address of principal executive offices)(Zip Code)
Registrant’s telephone number, including area code (804) 723-7000
    Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $2 par value per shareOMINew York Stock Exchange

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 filing requirements for the past 90 days.    Yes      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       No  
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “larger accelerated filer”, “accelerated filer”, “smaller reporting company” and "emerging growth company" in Rule 12b-2 of the Exchange Act.
Large accelerated filerAccelerated filer
Non-accelerated filer
  (Do not check if a smaller reporting company)
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 Exchange Act).    Yes  ☐   No  
The number of shares of Owens & Minor, Inc.’s common stock outstanding as of October 29, 2020,31, 2021, was 73,512,27975,455,760 shares.



Table of Contents
Owens & Minor, Inc. and Subsidiaries
Index
 
Page
Item 1.
Item 2.
Item 3.
Item 4.
Item 1.
Item 1A.
Item 2.
Item 6.
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Table of Contents
Part I. Financial Information
Item 1. Financial Statements
Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Operations
(unaudited)
 
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended
 September 30,
Nine Months Ended
September 30,
(in thousands, except per share data)(in thousands, except per share data)2020201920202019(in thousands, except per share data)2021202020212020
Net revenueNet revenue$2,187,928 $2,292,752 $6,118,340 $7,020,296 Net revenue$2,502,175 $2,187,928 $7,318,169 $6,118,340 
Cost of goods soldCost of goods sold1,843,589 2,012,130 5,236,035 6,176,537 Cost of goods sold2,173,336 1,843,589 6,146,511 5,236,035 
Gross marginGross margin344,339 280,622 882,305 843,759 Gross margin328,839 344,339 1,171,658 882,305 
Distribution, selling and administrative expensesDistribution, selling and administrative expenses262,538 248,661 758,320 767,986 Distribution, selling and administrative expenses262,457 262,538 849,255 758,320 
Acquisition-related and exit and realignment chargesAcquisition-related and exit and realignment charges6,382 4,522 18,500 14,776 Acquisition-related and exit and realignment charges6,380 6,382 20,967 18,500 
Other operating (income) expense, net(134)1,329 (3,020)2,385 
Other operating income, netOther operating income, net(2,873)(134)(5,016)(3,020)
Operating incomeOperating income75,553 26,110 108,505 58,612 Operating income62,875 75,553 306,452 108,505 
Interest expense, netInterest expense, net20,975 24,050 65,923 75,557 Interest expense, net11,572 20,975 36,784 65,923 
Other expense, net1,093 550 1,387 4,014 
Income (loss) from continuing operations before income taxes53,485 1,510 41,195 (20,959)
Income tax provision (benefit)7,404 (1,910)3,863 (3,726)
Income (loss) from continuing operations, net of tax46,081 3,420 37,332 (17,233)
Loss on extinguishment of debtLoss on extinguishment of debt 308 40,433 2,580 
Other expense (income), netOther expense (income), net799 785 2,397 (1,193)
Income from continuing operations before income taxesIncome from continuing operations before income taxes50,504 53,485 226,838 41,195 
Income tax provisionIncome tax provision6,375 7,404 47,224 3,863 
Income from continuing operations, net of taxIncome from continuing operations, net of tax44,129 46,081 179,614 37,332 
Loss from discontinued operations, net of taxLoss from discontinued operations, net of tax0 (2,196)(58,203)(6,115)Loss from discontinued operations, net of tax —  (58,203)
Net income (loss)Net income (loss)$46,081 $1,224 $(20,871)$(23,348)Net income (loss)$44,129 $46,081 $179,614 $(20,871)
Income (loss) from continuing operations per common share: basic and diluted$0.76 $0.06 $0.61 $(0.28)
Loss from discontinued operations per common share: basic and diluted0 (0.04)(0.95)(0.11)
Net income (loss) per common share: basic and diluted$0.76 $0.02 $(0.34)$(0.39)
Basic income (loss) per common share:Basic income (loss) per common share:
Income from continuing operationsIncome from continuing operations$0.60 $0.76 $2.47 $0.61 
Loss from discontinued operationsLoss from discontinued operations— —  (0.95)
Net income (loss)Net income (loss)$0.60 $0.76 $2.47 $(0.34)
Diluted income (loss) per common share:Diluted income (loss) per common share:
Income from continuing operationsIncome from continuing operations$0.58 $0.76 $2.38 $0.61 
Loss from discontinued operationsLoss from discontinued operations— —  (0.95)
Net income (loss)Net income (loss)$0.58 $0.76 $2.38 $(0.34)
See accompanying notes to consolidated financial statements.
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Table of Contents
Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Comprehensive Income (Loss)
(unaudited)
 
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended
 September 30,
Nine Months Ended September 30,
(in thousands)(in thousands)2020201920202019(in thousands)2021202020212020
Net income (loss)Net income (loss)$46,081 $1,224 $(20,871)$(23,348)Net income (loss)$44,129 $46,081 $179,614 $(20,871)
Other comprehensive income (loss), net of tax:Other comprehensive income (loss), net of tax:Other comprehensive income (loss), net of tax:
Currency translation adjustments (net of income tax of $0 in 2020 and 2019)5,173 (9,038)7,003 (5,793)
Change in unrecognized net periodic pension costs (net of income tax of $47 and $135 in 2020, and $61 and $187 in 2019)167 199 932 593 
Net unrealized gain (loss) on derivative instruments (net of income tax of $831 and income tax benefit of $3,232 in 2020, and $1,225 and $4,866 in 2019)1,681 (1,789)(9,792)(9,464)
Currency translation adjustmentsCurrency translation adjustments(12,014)5,173 (26,724)7,003 
Change in unrecognized net periodic pension costsChange in unrecognized net periodic pension costs395 167 552 932 
Change in gains and losses on derivative instrumentsChange in gains and losses on derivative instruments 1,681 20,044 (9,792)
Total other comprehensive income (loss), net of taxTotal other comprehensive income (loss), net of tax7,021 (10,628)(1,857)(14,664)Total other comprehensive income (loss), net of tax(11,619)7,021 (6,128)(1,857)
Comprehensive income (loss)Comprehensive income (loss)$53,102 $(9,404)$(22,728)$(38,012)Comprehensive income (loss)$32,510 $53,102 $173,486 $(22,728)
See accompanying notes to consolidated financial statements.
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Owens & Minor, Inc. and Subsidiaries
Consolidated Balance Sheets
(unaudited)
 
September 30,December 31,September 30,December 31,
(in thousands, except per share data)(in thousands, except per share data)20202019(in thousands, except per share data)20212020
AssetsAssetsAssets
Current assetsCurrent assetsCurrent assets
Cash and cash equivalentsCash and cash equivalents$77,256 $67,030 Cash and cash equivalents$39,759 $83,058 
Accounts receivable, net of allowances of $20,135 and $21,015688,884 674,706 
Accounts receivable, net of allowances of $19,273 and $19,087Accounts receivable, net of allowances of $19,273 and $19,087759,744 700,792 
Merchandise inventoriesMerchandise inventories1,095,410 1,146,192 Merchandise inventories1,514,387 1,233,751 
Other current assetsOther current assets235,983 79,372 Other current assets84,335 118,264 
Current assets of discontinued operations0 439,983 
Total current assetsTotal current assets2,097,533 2,407,283 Total current assets2,398,225 2,135,865 
Property and equipment, net of accumulated depreciation of $273,403 and $245,718301,299 315,427 
Property and equipment, net of accumulated depreciation of $320,389 and $284,126Property and equipment, net of accumulated depreciation of $320,389 and $284,126308,463 315,662 
Operating lease assetsOperating lease assets143,362 142,219 Operating lease assets184,554 144,755 
GoodwillGoodwill390,395 393,181 Goodwill386,693 394,086 
Intangible assets, netIntangible assets, net251,615 285,018 Intangible assets, net209,789 243,351 
Other assets, netOther assets, net112,911 99,956 Other assets, net96,395 101,920 
Total assetsTotal assets$3,297,115 $3,643,084 Total assets$3,584,119 $3,335,639 
Liabilities and equityLiabilities and equityLiabilities and equity
Current liabilitiesCurrent liabilitiesCurrent liabilities
Accounts payableAccounts payable$946,116 $808,035 Accounts payable$1,118,753 $1,000,186 
Accrued payroll and related liabilitiesAccrued payroll and related liabilities71,406 53,584 Accrued payroll and related liabilities100,171 109,447 
Other current liabilitiesOther current liabilities412,483 231,029 Other current liabilities206,094 236,094 
Current liabilities of discontinued operations0 323,511 
Total current liabilitiesTotal current liabilities1,430,005 1,416,159 Total current liabilities1,425,018 1,345,727 
Long-term debt, excluding current portionLong-term debt, excluding current portion1,099,645 1,508,415 Long-term debt, excluding current portion959,485 986,018 
Operating lease liabilities, excluding current portionOperating lease liabilities, excluding current portion120,025 117,080 Operating lease liabilities, excluding current portion154,009 119,932 
Deferred income taxesDeferred income taxes75,009 40,550 Deferred income taxes37,093 50,641 
Other liabilitiesOther liabilities121,096 98,726 Other liabilities121,509 121,267 
Total liabilitiesTotal liabilities2,845,780 3,180,930 Total liabilities2,697,114 2,623,585 
Commitments and contingenciesCommitments and contingenciesCommitments and contingencies00
EquityEquityEquity
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 63,716 shares and 62,843 shares127,432 125,686 
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 75,429 shares and 73,472 sharesCommon stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 75,429 shares and 73,472 shares150,858 146,944 
Paid-in capitalPaid-in capital262,002 251,401 Paid-in capital434,952 436,597 
Retained earningsRetained earnings116,465 137,774 Retained earnings345,832 167,022 
Accumulated other comprehensive lossAccumulated other comprehensive loss(54,564)(52,707)Accumulated other comprehensive loss(44,637)(38,509)
Total equityTotal equity451,335 462,154 Total equity887,005 712,054 
Total liabilities and equityTotal liabilities and equity$3,297,115 $3,643,084 Total liabilities and equity$3,584,119 $3,335,639 
See accompanying notes to consolidated financial statements.
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Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Cash Flows
(unaudited)
 
Nine Months Ended September 30,Nine Months Ended September 30,
(in thousands)(in thousands)20202019(in thousands)20212020
Operating activities:Operating activities:Operating activities:
Net loss$(20,871)$(23,348)
Adjustments to reconcile net loss to cash provided by operating activities:
Net income (loss)Net income (loss)$179,614 $(20,871)
Adjustments to reconcile net income (loss) to cash provided by operating activities:Adjustments to reconcile net income (loss) to cash provided by operating activities:
Depreciation and amortizationDepreciation and amortization69,494 88,204 Depreciation and amortization68,142 69,494 
Share-based compensation expenseShare-based compensation expense15,275 12,057 Share-based compensation expense19,078 15,275 
Loss on divestitureLoss on divestiture65,472 Loss on divestiture 65,472 
Loss on extinguishment of debtLoss on extinguishment of debt40,433 2,580 
Provision for losses on accounts receivableProvision for losses on accounts receivable9,583 9,759 Provision for losses on accounts receivable19,270 9,583 
Deferred income tax expense (benefit)25,017 (11,989)
Deferred income tax (benefit) expenseDeferred income tax (benefit) expense(18,286)25,017 
Changes in operating lease right-of-use assets and lease liabilitiesChanges in operating lease right-of-use assets and lease liabilities(1,328)(1,280)Changes in operating lease right-of-use assets and lease liabilities1,190 (1,328)
Changes in operating assets and liabilities:Changes in operating assets and liabilities:Changes in operating assets and liabilities:
Accounts receivableAccounts receivable(20,173)73,986 Accounts receivable(84,381)(20,173)
Merchandise inventoriesMerchandise inventories52,605 136,021 Merchandise inventories(284,188)52,605 
Accounts payableAccounts payable136,156 (221,381)Accounts payable120,821 136,156 
Net change in other assets and liabilitiesNet change in other assets and liabilities(69,117)69,756 Net change in other assets and liabilities(8,341)(69,117)
Other, netOther, net6,083 7,320 Other, net20,484 3,503 
Cash provided by operating activitiesCash provided by operating activities268,196 139,105 Cash provided by operating activities73,836 268,196 
Investing activities:Investing activities:Investing activities:
Proceeds from divestitureProceeds from divestiture133,000 Proceeds from divestiture 133,000 
Additions to property and equipmentAdditions to property and equipment(21,678)(31,224)Additions to property and equipment(26,446)(21,678)
Additions to computer softwareAdditions to computer software(4,702)(6,928)Additions to computer software(6,179)(4,702)
Proceeds from sale of property and equipmentProceeds from sale of property and equipment178 220 Proceeds from sale of property and equipment41 178 
Proceeds from cash surrender value of life insurance policiesProceeds from cash surrender value of life insurance policies6,032 Proceeds from cash surrender value of life insurance policies 6,032 
Cash provided by (used for) investing activities112,830 (37,932)
Cash (used for) provided by investing activitiesCash (used for) provided by investing activities(32,584)112,830 
Financing activities:Financing activities:Financing activities:
Proceeds from issuance of debtProceeds from issuance of debt150,000 Proceeds from issuance of debt574,900 150,000 
Repayments under revolving credit facility(107,900)(36,100)
Repayments under revolving credit facility, netRepayments under revolving credit facility, net(90,900)(107,900)
Repayments of debtRepayments of debt(270,399)(40,700)Repayments of debt(553,140)(270,399)
Financing costs paidFinancing costs paid(10,367)(4,313)Financing costs paid(13,912)(10,367)
Cash dividends paidCash dividends paid(467)(5,072)Cash dividends paid(548)(467)
Payment for termination of interest rate swapsPayment for termination of interest rate swaps(15,434)— 
Other, netOther, net(5,822)(3,109)Other, net(18,188)(5,822)
Cash used for financing activitiesCash used for financing activities(244,955)(89,294)Cash used for financing activities(117,222)(244,955)
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents6,721 (2,243)Effect of exchange rate changes on cash and cash equivalents(2,454)6,721 
Net increase in cash, cash equivalents and restricted cash142,792 9,636 
Net (decrease) increase in cash, cash equivalents and restricted cashNet (decrease) increase in cash, cash equivalents and restricted cash(78,424)142,792 
Cash, cash equivalents and restricted cash at beginning of periodCash, cash equivalents and restricted cash at beginning of period84,687 103,367 Cash, cash equivalents and restricted cash at beginning of period134,506 84,687 
Cash, cash equivalents and restricted cash at end of periodCash, cash equivalents and restricted cash at end of period$227,479 $113,003 Cash, cash equivalents and restricted cash at end of period$56,082 $227,479 
Supplemental disclosure of cash flow information:Supplemental disclosure of cash flow information:Supplemental disclosure of cash flow information:
Income taxes received, net of payments$(1,892)$(12,085)
Income taxes paid (received), net of refundsIncome taxes paid (received), net of refunds$83,606 $(1,892)
Interest paidInterest paid$61,271 $76,470 Interest paid$32,035 $61,271 

See accompanying notes to consolidated financial statements.
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Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Changes in Equity
(unaudited)
 
(in thousands, except per share data)(in thousands, except per share data)Common
Shares
Outstanding
Common 
Stock
($2 par value )
Paid-In
Capital
Retained
Earnings
Accumulated
Other
Comprehensive Loss
Total
Equity
(in thousands, except per share data)Common
Shares
Outstanding
Common 
Stock
($2 par value )
Paid-In
Capital
Retained
Earnings
Accumulated
Other
Comprehensive Loss
Total
Equity
Balance, December 31, 2020Balance, December 31, 202073,472 $146,944 $436,597 $167,022 $(38,509)$712,054 
Net incomeNet income69,589 69,589 
Other comprehensive incomeOther comprehensive income7,903 7,903 
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(434)(434)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other1,628 3,256 (6,107)(2,851)
Balance, March 31, 2021Balance, March 31, 202175,100 150,200 430,490 236,177 (30,606)786,261 
Net incomeNet income65,896 65,896 
Other comprehensive lossOther comprehensive loss(2,412)(2,412)
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(187)(187)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other295 591 (2,130)(1,539)
Balance, June 30, 2021Balance, June 30, 202175,395150,791 428,360 301,886 (33,018)848,019 
Net incomeNet income44,129 44,129 
Other comprehensive lossOther comprehensive loss(11,619)(11,619)
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(183)(183)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other34 67 6,592 6,659 
Balance, September 30, 2021Balance, September 30, 202175,429$150,858 $434,952 $345,832 $(44,637)$887,005 
Balance, December 31, 2019Balance, December 31, 201962,843 $125,686 $251,401 $137,774 $(52,707)$462,154 Balance, December 31, 201962,843 $125,686 $251,401 $137,774 $(52,707)$462,154 
Net lossNet loss(11,324)(11,324)Net loss(11,324)(11,324)
Other comprehensive lossOther comprehensive loss(39,405)(39,405)Other comprehensive loss(39,405)(39,405)
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(127)(127)Dividends declared ($0.0025 per share)(127)(127)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other42 84 4,956 5,040 Share-based compensation expense, exercises and other42 84 4,956 5,040 
Balance, March 31, 2020Balance, March 31, 202062,885 125,770 256,357 126,323 (92,112)416,338 Balance, March 31, 202062,885 125,770 256,357 126,323 (92,112)416,338 
Net lossNet loss(55,627)(55,627)Net loss(55,627)(55,627)
Other comprehensive incomeOther comprehensive income30,527 30,527 Other comprehensive income30,527 30,527 
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(156)(156)Dividends declared ($0.0025 per share)(156)(156)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other852 1,704 2,376 4,080 Share-based compensation expense, exercises and other852 1,704 2,376 4,080 
Balance, June 30, 2020Balance, June 30, 202063,737 127,474258,73370,540(61,585)395,162Balance, June 30, 202063,737 127,474 258,733 70,540 (61,585)395,162 
Net incomeNet income46,081 46,081 Net income46,081 46,081 
Other comprehensive incomeOther comprehensive income7,021 7,021 Other comprehensive income7,021 7,021 
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(156)(156)Dividends declared ($0.0025 per share)(156)(156)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other(21)(42)3,269 3,227 Share-based compensation expense, exercises and other(21)(42)3,269 3,227 
Balance, September 30, 2020Balance, September 30, 202063,716 $127,432 $262,002 $116,465 $(54,564)$451,335 Balance, September 30, 202063,716$127,432 $262,002 $116,465 $(54,564)$451,335 
Balance, December 31, 201862,294 $124,588 $238,773 $200,670 $(45,612)$518,419 
Net loss(14,096)(14,096)
Other comprehensive loss(6,423)(6,423)
Dividends declared ($0.0025 per share)(119)(119)
Share-based compensation expense, exercises and other642 1,284 2,774 4,058 
Balance, March 31, 201962,936 125,872 241,547 186,455 (52,035)501,839 
Net loss(10,476)(10,476)
Other comprehensive income2,387 2,387 
Dividends declared ($0.0025 per share)(114)(114)
Share-based compensation expense, exercises and other28 56 3,209 3,265 
Balance, June 30, 201962,964 125,928244,756175,865(49,648)496,901
Net income1,224 1,224 
Other comprehensive loss(10,628)(10,628)
Dividends declared ($0.0025 per share)(175)(175)
Share-based compensation expense, exercises and other(102)(204)4,160 3,956 
Balance, September 30, 201962,862 $125,724 $248,916 $176,914 $(60,276)$491,278 
See accompanying notes to consolidated financial statements.
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Owens & Minor, Inc. and Subsidiaries
Notes to Consolidated Financial Statements
(unaudited)
(in thousands, except per share data, unless otherwise indicated)

Note 1—Summary of Significant Accounting Policies

Basis of Presentation
The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, or our) and contain all adjustments (which are comprised only of normal recurring accruals and use of estimates) necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The Movianto business representsrepresented a component that met accounting requirements to be classified as discontinued operations and held-for-sale beginning December 31, 2019.for the nine months ended September 30, 2020. In accordance with GAAP, the results of operations and financial position of the Movianto business are presented as discontinued operations through June 18, 2020 (the Divestiture Date) and, as such, have been excluded from continuing operations for all periods presented.the nine months ended September 30, 2020. With the exception of Note 3, the Notes to Consolidated Financial Statements reflect the continuing operations of Owens & Minor, Inc. and its subsidiaries. See Note 3 for additional information regarding discontinued operations. The results of operations for interim periods are not necessarily indicative of the results expected for the full year.
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation.
Use of Estimates
The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates.
Cash, Cash Equivalents and Restricted Cash
Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in the United States, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash included in other current assets represents cash held in a designated account as of September 30, 2020 as required by the Fifth Amendment to the Credit Agreement, which stipulates that the cash held within this account is to be used to repay the 2021 Notes or the Term Loans. Restricted cash included in Other assets, net as of September 30, 20202021 represents cashheld in an escrow account as required by the Centers for Medicare & Medicaid Services (CMS) in conjunction with the Bundled Payments for Care Improvement (BPCI) Advanced Program.initiatives.
The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows.
September 30, 2020December 31, 2019
Cash and cash equivalents$77,256 $67,030 
Restricted cash included in Other current assets133,899 
Restricted cash included in Other assets, net16,324 16,261 
Cash of discontinued operations0 1,396 
Total cash, cash equivalents and restricted cash$227,479 $84,687 

September 30, 2021December 31, 2020
Cash and cash equivalents$39,759 $83,058 
Restricted cash included in Other current assets 35,126 
Restricted cash included in Other assets, net16,323 16,322 
Total cash, cash equivalents, and restricted cash$56,082 $134,506 

Note 2—Fair Value

The carrying amounts of cash and cash equivalents, accounts receivable and accounts payable reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The carrying amount of restricted cash also approximates fair value due to its nature. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 6 for the fair value of debt. The fair value of interest rate swaps and foreign currency contracts is determined based on the present value of expected future cash flows considering the risks involved,
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including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 8 for the fair value of derivatives.

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Note 3—Discontinued Operations

On June 18, 2020, we completed the previously announced divestiture of our European logistics business, Movianto (the Divestiture), as well as certain support functions in our Dublin office, to Walden Group SAS (the Buyer) and EHDH (as Buyer’s guarantor) for cash consideration of $133 million. We concluded that the Movianto business met the criteria for discontinued operations as of December 31, 2019 and through the Divestiture Date, as the intention to sell represented a strategic shift and the criteria for held-for-sale were met. Movianto was previously reported in the Global Solutions segment.
Accordingly, the results of operations from the Movianto business are reported in the accompanying consolidated statements of operations as Loss from discontinued operations, net of tax for the three and nine months ended September 30, 2020 and 2019, and the related assets and liabilities are classified as held-for-sale as of December 31, 2019 in the accompanying balance sheet. We are working with the Buyer on a final working capital adjustment that could result in a benefit in an amount up to $42 million. There is no benefit of any such adjustment reflected in our consolidated financial statements as of September 30, 2020.

The following table summarizes the financial results of our discontinued operations for the three and nine months ended September 30, 2020 and 2019:2020:

Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Net revenue$0 $106,265 $226,759 $324,308 
Cost of goods sold0 24,399 53,923 78,729 
Gross margin0 81,866 172,836 245,579 
Distribution, selling, and administrative expenses0 81,565 157,512 245,562 
Loss on divestiture0 65,472 
Acquisition-related and exit and realignment charges0 383 4,825 774 
Other operating income, net0 (20)(388)(492)
Operating loss0 (62)(54,585)(265)
Interest expense, net0 1,887 3,144 5,162 
Loss from discontinued operations before income taxes0 (1,949)(57,729)(5,427)
Income tax provision from discontinued operations0 247 474 688 
Loss from discontinued operations, net of tax$0 $(2,196)$(58,203)$(6,115)
Three Months Ended September 30, 2020Nine Months Ended September 30, 2020
Net revenue$— $226,759 
Cost of goods sold— 53,923 
Gross margin— 172,836 
Distribution, selling, and administrative expenses— 157,512 
Loss on divestiture— 65,472 
Acquisition-related and exit and realignment charges— 4,825 
Other operating income, net— (388)
Operating loss— (54,585)
Interest expense, net— 3,144 
Loss from discontinued operations before income taxes— (57,729)
Income tax provision from discontinued operations— 474 
Loss from discontinued operations, net of tax$— $(58,203)

We suspended depreciation and amortization on assets that are held-for-sale, including right-of-use assets recorded in accordance with ASU No. 2016-02, for the nine months ended September 30, 2020.

All revenue and expense included in discontinued operations during the nine months ended September 30, 2020 relates to activity through the Divestiture Date. No revenue or expense have been recorded in discontinued operations related to the disposal group subsequent to the Divestiture Date.

We have entered into transition services agreements with a subsidiary of the Buyer, pursuant to which we and a subsidiary of the Buyer will provide to each other various transitional services. Certain transition service arrangement costs and reimbursements were recorded during the three and nine months ended September 30, 2020. These amounts2021 and 2020 and were immaterial for the three and nine months endedperiods presented. These arrangements were substantially completed as of September 30, 2020.2021.

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    TheWe had no assets and liabilities of the discontinued Movianto business reflected on the consolidated balance sheetsheets at September 30, 2021 and December 31, 2019 were as follows:2020.
December 31, 2019
Assets of discontinued operations
Cash and cash equivalents$1,396 
Accounts receivable, net78,643 
Merchandise inventories16,058 
Other current assets188,853 
Current assets of discontinued operations284,950 
Property and equipment, net65,710 
Intangible assets, net6,579 
Other assets, net27,431 
Operating lease assets87,425 
Valuation allowance on disposal group classified as held-for-sale(32,112)
Total assets of discontinued operations$439,983 
Liabilities of discontinued operations
Accounts payable$53,981 
Other current liabilities182,980 
Current liabilities of discontinued operations236,961 
Long-term debt, excluding current portion5,523 
Operating lease liabilities, excluding current portion76,270 
Other liabilities4,757 
Total liabilities of discontinued operations$323,511 
    Assets and liabilities held-for-sale as of December 31, 2019 were classified as current since we expected the Divestiture to be completed within one year of the balance sheet date.

The following table provides operating and investing cash flow information for our discontinued operations:

September 30, 2020September 30, 2019
Operating Activities:
Depreciation and amortization$0 $15,466 
Loss on divestiture65,472 
Investing Activities:
Capital expenditures3,027 17,298 
Nine Months Ended September 30, 2020
Operating Activities:
Loss on divestiture$65,472 
Investing Activities:
Capital expenditures3,027

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Note 4—Goodwill and Intangible Assets

The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill through September 30, 2020:
Global SolutionsGlobal ProductsConsolidated
Carrying amount of goodwill, December 31, 2019$283,905 $109,276 $393,181 
Currency translation adjustments(2,786)(2,786)
Carrying amount of goodwill, September 30, 2020$283,905 $106,490 $390,395 
102021:

Global SolutionsGlobal ProductsConsolidated
Carrying amount of goodwill, December 31, 2020$283,905 $110,181 $394,086 
Currency translation adjustments— (7,393)(7,393)
Carrying amount of goodwill, September 30, 2021$283,905 $102,788 $386,693 

Intangible assets at September 30, 20202021 and December 31, 20192020 were as follows:
September 30, 2020December 31, 2019
Customer
Relationships
TradenamesOther
Intangibles
Customer
Relationships
TradenamesOther
Intangibles
Gross intangible assets$268,179 $90,000 $43,238 $270,693 $90,000 $43,055 
Accumulated amortization(113,999)(22,791)(13,012)(92,947)(16,520)(9,263)
Net intangible assets$154,180 $67,209 $30,226 $177,746 $73,480 $33,792 
Weighted average useful life10 years11 years8 years10 years11 years8 years

September 30, 2021December 31, 2020
Customer
Relationships
TradenamesOther
Intangibles
Customer
Relationships
TradenamesOther
Intangibles
Gross intangible assets$265,527 $90,000 $43,313 $270,505 $90,000 $43,245 
Accumulated amortization(139,632)(31,152)(18,267)(121,209)(24,881)(14,309)
Net intangible assets$125,895 $58,848 $25,046 $149,296 $65,119 $28,936 
Weighted average useful life10 years11 years8 years10 years11 years8 years

At September 30, 2020, $67.22021, $51.1 million in net intangible assets were held in the Global Solutions segment and $184.4$159 million were held in the Global Products segment.Amortization expense for intangible assets was $10.2$10.0 million and $10.6$10.2 million for the three months ended September 30, 2021 and 2020, and 2019, respectively,$30.1 million and $31.5 million and $33.4 million for the nine months ended September 30, 20202021 and 2019, respectively.2020.
Based on the current carrying value of intangible assets subject to amortization, estimated amortization expense is $10.4approximately $10 million for the remainder of 2020, $39.8 million for 2021, $38.9$39 million for 2022, $38.7$39 million for 2023, $33.9$34 million for 2024, and $28.2$28 million for 2025.2025 and $27 million for 2026.

Note 5—Exit and Realignment Costs

We periodically incur exit and realignment and other charges associated with optimizing our operations which includes the consolidation of certain distribution and outsourced logistics centers, administrative offices and warehouses, our client engagement center and IT restructuring charges. These charges also include costs associated with our strategic organizational realignment which include management changes,leadership reorganization costs, certain professional fees, and costs to streamline administrative functions and processes.

processes and divestiture related costs.
Exit and realignment charges by segment for the three and nine months ended September 30, 20202021 and 20192020 were as follows:
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Global Solutions segment$2,714 $969 $6,255 $3,149 
Global Products segment2,877 11 3,364 252 
Total exit and realignment charges$5,591 $980 $9,619 $3,401 

Three Months Ended
 September 30,
Nine Months Ended September 30,
2021202020212020
Global Solutions segment$5,352 $2,714 $16,166 $6,255 
Global Products segment1,028 2,877 4,801 3,364 
Total exit and realignment charges$6,380 $5,591 $20,967 $9,619 

1110


The following table summarizes the activity related to exit and realignment cost accruals through September 30, 20202021 and 2019:2020:

Total
Accrued exit and realignment costs, December 31, 20192020$3,146 
Provision for exit and realignment activities:
Information system restructuring costs1,029 
Lease obligations347 
Other781 
Cash payments(2,915)
Accrued exit and realignment costs, March 31, 20212,388
Provision for exit and realignment activities:
Information system restructuring costs1,611 
Lease obligations(126)
Other989 
Cash payments(2,302)
Accrued exit and realignment costs, June 30, 20212,560
Provision for exit and realignment activities:
Information system restructuring costs1,506 
Lease obligations107 
Other3,142 
Cash payments(4,199)
Accrued exit and realignment costs, September 30, 2021$3,116
Accrued exit and realignment costs, December 31, 2019$8,162 
Provision for exit and realignment activities:
Severance1,391 
Information system restructuring costs183 
Lease obligations183202 
Other25553 
Cash payments(5,799)
Accrued exit and realignment costs, March 31, 20204,192
Provision for exit and realignment activities:
Severance809
Information system restructuring costs671
Lease obligations671 219
Other720 501
Cash payments(2,072)
Accrued exit and realignment costs, June 30, 20204,320
Provision for exit and realignment activities:
Severance1,950 
Information system restructuring costs77 
Lease obligations77848 
Other3,5642,716 
Cash payments(7,083)
Accrued exit and realignment costs, September 30, 2020$2,828
Accrued exit and realignment costs, December 31, 2018$7,477 
Provision for exit and realignment activities:
Severance360 
Information system restructuring costs261 
Other83 
Cash payments(2,206)
Accrued exit and realignment costs, March 31, 20195,975 
Provision for exit and realignment activities:
Severance1,008 
Information system restructuring costs705 
Other
Cash payments(2,301)
Accrued exit and realignment costs, June 30, 20195,391 
Provision for exit and realignment activities:
Severance305 
Information system restructuring costs664 
Other11 
Cash payments(2,586)
Accrued exit and realignment costs, September 30, 2019$3,785 
11
Acquisition-related

In addition to the exit and realignment accruals in the preceding table, we also incurred $1.6 million and $11.6 million of costs that were expensed as incurred for the three and nine months ended September 30, 2021, which primarily includes $1.5 million and $9.6 million of wind-down costs related to Fusion5 for the three and nine months ended September 30, 2021.
There were no acquisition-related charges included within acquisition-related and exit and realignment charges presented in our consolidated statements of operations includesfor the three and nine months ended September 30, 2021. Acquisition-related charges within acquisition-related and exit and realignment charges presented in our consolidated statements of operations were $0.8 million and $8.9 million for the three and nine months ended September 30, 2020, and $3.5 million and $11.4 million for the three and nine months ended September 30, 2019, respectively, andwhich consisted primarily of transition costs for the Halyard acquisition.

12We may incur additional charges in 2021 for wind-down costs related to Fusion5.


Note 6—Debt

Debt consists of the following:
September 30, 2020December 31, 2019September 30, 2021December 31, 2020
Carrying AmountEstimated Fair ValueCarrying AmountEstimated Fair ValueCarrying
Amount
Estimated
Fair Value
Carrying
Amount
Estimated
Fair Value
3.875% Senior Notes, due September 2021$178,485 $180,307 $236,234 $229,356 
Term Loan A-2Term Loan A-2$ $ $33,865 $34,390 
Term Loan BTerm Loan B  477,525 486,614 
Receivables Securitization ProgramReceivables Securitization Program196,683 200,000 152,929 155,100 
4.375% Senior Notes, due December 20244.375% Senior Notes, due December 2024244,697 245,122 273,978 212,086 4.375% Senior Notes, due December 2024245,011 261,329 244,780 253,241 
Term A Loans, due July 2022196,489 199,619 377,420 383,050 
Term B Loan, due April 2025478,127 475,913 480,337 442,217 
RevolverRevolver70,000 70,000 177,900 177,900 Revolver12,300 12,300 103,200 103,200 
Receivables Securitization Program147,580 150,000 
4.500% Senior Notes, due March 20294.500% Senior Notes, due March 2029491,430 507,075 — — 
Finance leases and otherFinance leases and other13,371 13,371 13,783 13,783 Finance leases and other15,677 15,677 13,668 13,668 
Total debtTotal debt1,328,749 1,334,332 1,559,652 1,458,392 Total debt961,101 996,381 1,025,967 1,046,213 
Less current maturitiesLess current maturities(229,104)(230,784)(51,237)(51,237)Less current maturities(1,616)(1,616)(39,949)(40,453)
Long-term debtLong-term debt$1,099,645 $1,103,548 $1,508,415 $1,407,155 Long-term debt$959,485 $994,765 $986,018 $1,005,760 

We have $178$246 million, of 3.875% senior notes due in 2021 (the 2021 Notes)excluding deferred financing costs and $245 millionthird party fees, of 4.375% senior notes due in 2024 (the 2024 Notes), with interest payable semi-annually. The 2021 Notes were sold at 99.5% of the principal amount with an effective yield of 3.951%. The 2024 Notes were sold at 99.6% of the principal amount with an effective yield of 4.422%. We have the option to redeem the 2021 Notes and 2024 Notes in part or in whole prior to maturity at a redemption price equal to the greater of 100% of the principal amount or the present value of the remaining scheduled payments discounted at the applicable Benchmark Treasury Rate plus 25 basis points for the 2021 Notes and the applicable Benchmark Treasury Rate(as defined) plus 30 basis points for the 2024 Notes. points.
In June 2020,March 2021, we announced cash tender offers for up to $240issued $500 million, aggregate principal amountexcluding deferred financing costs and third party fees, of our outstanding 20214.500% senior unsecured notes due in 2029 (the 2029 Unsecured Notes), with interest payable semi-annually (the Notes and 2024 Notes. As of the Early Settlement Date of June 22, 2020, $54.1 million of the 2021 Notes and $29.0 million of the 2024Offering). The 2029 Unsecured Notes were repaid. On the Early Settlement Date, the 2021 Notes were redeemedsold at 100% of par,the principal amount with an effective yield of 4.500%. We used a portion of the net proceeds from the Notes Offering to repay our Term B Loan and the 2024 Notes were redeemed at 90%borrowings under our revolving credit facility. In connection with these repayments, we recorded $15.3 million in write-offs of par, resulting in a net gaindeferred financing costs and third party fees within loss on extinguishment of debt for the nine months ended September 30, 2021. No write-offs of $2.9 million. The tender offers remained open through July 2, 2020,deferred financing costs and an additional $0.1 millionthird party fees were recorded for the three months ended September 30, 2021. We may redeem all or part of the 2029 Unsecured Notes prior to March 31, 2024, at a price equal to 100% of the principal amount of the 2029 Unsecured Notes redeemed, plus accrued and unpaid interest, if any, to, but not including, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 10, 2021 (the Indenture). On or after March 31, 2024, we may redeem all or part of the 2029 Unsecured Notes were redeemed at the Base Consideration priceapplicable redemption prices described in the Indenture, plus accrued and unpaid interest, if any, to, but not including, the redemption date. We may also redeem up to 40% of 95% of par by the time the offers closed. Including the tender offer, we used $83.3 million of cash to repurchase $87.9 million aggregate principal amount of the 20212029 Unsecured Notes andat any time prior to March 31, 2024, Notes duringat a redemption price equal to 104.5% with an amount equal to or less than the first nine months of 2020. Consistent with the terms of the Fifth Amendment to the Credit Agreement, we used $54.1 million of thenet cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the saleredemption date.
On March 10, 2021, we terminated our then existing credit agreement and all obligations thereunder were repaid. On that same date, we entered into a new credit agreement with Bank of Movianto to fund the repaymentAmerica, N.A. and a syndicate of the 2021 Notes, which were retired in the second quarter as part of the tender offer. As required by the Fifth Amendment to thelenders (the Credit Agreement, the remaining $78.9 million of proceeds from the sale of Movianto were placed in a designated account and will be used to repurchase a portion of the outstanding 2021 Notes within 210 days of the Divestiture Date or repay a portion of our Term Loans.
We have a Credit Agreement (last amended February 13, 2020)Agreement) with a $400$300 million revolving credit facility and $675 million in outstanding term loans.facility. The interest rate on our revolving credit facility and Term A Loans is based on 1) either the Eurocurrency Rate or the Base Rate plus 2) an Applicable Percentage which varies depending on Consolidated Total Leverage Ratio (each as defineda spread over a benchmark rate (as described in the Credit Agreement). Our credit spread on the revolving credit facility and Term A Loans at September 30, 2020 was Eurocurrency Rate plus 4.25%. Our Term B Loan accrues interest based on 1) either the Eurocurrency Rate or the Base Rate plus 2) an Applicable Percentage of 3.50% per annum for Base Rate Loans and 4.50% per annum for Eurocurrency Rate Loans (each as defined in the Credit Agreement). Our credit spread on the Term B Loan at September 30, 2020 was Eurocurrency Rate plus 4.50%. We are charged a commitment fee of between 12.5 and 25.0 basis points on the unused portion of the revolving credit facility. OurThe Credit Agreement has a “springing maturity date” with respect to the revolving credit facility, the Term A Loans, and the Term B Loan. If the outstanding balance of the 2021 Notes has not been paidmatures in full as of the date 91 days prior to the maturity date of the 2021 Notes, then the Termination Date (as defined in the Credit Agreement) of the revolving credit facility, the Term A Loans, and the Term B Loan shall be the date that is 91 days prior to the maturity date of the 2021 Notes. Likewise, if the outstanding balance of the 2024 Notes has not been paid in full as of the date 91 days prior to the maturity date of the 2024 Notes, the Termination Date of the Term B Loan shall be the date that is 91 days prior to the maturity date of the 2024 Notes.March 2026.
At September 30, 20202021 and December 31, 2019,2020, we had borrowings of $70.0$12.3 million and $177.9$103 million respectively, under the revolver and letters of credit of $9.4 million and $13.9 million and $11.7 million, respectively, outstanding under the Credit Agreement.our revolving credit facilities. At September 30, 20202021 and December
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31, 2019,2020, we had $316.1$278 million and $209.3$283 million respectively, available for borrowing. The December 31, 2019 availability reflected letters of credit associated with discontinued operations of $1.1 million. There were no letters of credit associated with discontinued operations as of September 30, 2020. We also had letters of credit and bank guarantees outstanding for $2.4 million, of which $0.8 million are in process of being transferred to
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the buyer of Movianto, and $1.6$2.2 million and $1.5$1.6 million as of September 30, 20202021 and December 31, 2019, respectively,2020, which supports certain leased facilities as well as other normal business activities in the United States and Europe. These letters of credit and guarantees were issued independentoutside of the Credit Agreement.revolving credit facility.
We also haveentered into a Security and Pledge Agreement (the Security Agreement), dated March 10, 2021, pursuant to which we granted collateral on behalf of the holders of the 2021 Notes, the holders of the 2024 Notes, and the parties secured under the Credit Agreement (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Credit Parties (as defined) in the Credit Parties’ present and future subsidiaries, of each Credit Partysubject to certain customary exceptions, and (b) all present and future personal property and assets of the Credit Parties, subject to certain exceptions. The Fifth Amendment to the Credit Agreement included additional collateral requirements if the Credit Parties, including an obligation to pledge our owned U.S. real estate and the remaining equity interests in foreign subsidiaries.
On February 19, 2020,March 10, 2021, we entered into an amendment to our accounts receivable securitization program (the Receivables Securitization Program). Pursuant to the amended Receivables Securitization Program, the aggregate principal amount of the loans made by the Lenders (as defined) will not exceed $325$450 million outstanding at any time. The interest rate under the Receivables Securitization Program is based on a spread over a benchmark rate (as described in the London Interbank Offered Rate (LIBOR) dependent onThird Amendment to the tranche period thereto and any breakage fees accrued.Receivables Financing Agreement). Under the Receivables Securitization Program, certain of our subsidiaries sell substantially all of their accounts receivable balances to our wholly owned special purpose entity, O&M Funding LLC. The Receivables Securitization Program matures on February 17, 2023. Our Receivables Securitization Program has a “springing maturity date” with respect to the Term A Loans.If the outstanding balance of the Term A loans have not been paid in full as of the date 91 days prior to the maturity date of the Term A Loans, then the Scheduled Termination Date (as defined in the Receivables Financing Agreement) of the Receivables Securitization Program shall be the date that is 91 days prior to the maturity date of the Term A Loans. In February 2020, we drew $150 million from the Receivables Securitization Program to repay portions of the Term A Loans, consistent with the terms of the Fifth Amendment to the Credit Agreement. The Fifth Amendment to the Credit Agreement requires that any additional draws on the Receivables Securitization Program are restricted for use to repay the 2021 Notes or Term A loans to the extent those instruments are outstanding.March 2024.
The Credit Agreement, Receivables Securitization Program, 2024 Notes and Senior2029 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of either agreement.any of the related agreements. The terms of the Credit Agreement also require the companyus to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at September 30, 2020.2021.
As of September 30, 2020,2021, scheduled future principal payments of debt, excluding finance leases and other, were $12.4 million in 2020, $228.5 million in 2021, $218.8 million in 2022, $155.0 million in 2023, $251.0$446 million in 2024, $12.3 million in 2026, and $468.8$500 million thereafter. in 2029. Current maturities at September 30, 2021 include scheduled principal payments within the next 12 months of $44.6 million and $5.0 million for our Term A and Term B Loans, respectively, $1.0$1.6 million in short-termcurrent portion of finance leases, and $178.5 million related to our 2021 Notes.leases.

Note 7—Retirement Plans

We have a noncontributory, unfunded retirement plan for certain retirees in the United States. Certain of our foreign subsidiaries also have defined benefit pension plans covering substantially all of their respective employees.teammates.
The components of net periodic benefit cost for the three and nine months ended September 30, 20202021 and 2019, respectively,2020 were as follows:
 Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Service cost$362 $332 $1,073 $991 
Interest cost498 601 1,488 1,801 
Recognized net actuarial loss214 260 642 780 
Net periodic benefit cost$1,074 $1,193 $3,203 $3,572 
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
2021202020212020
Service cost$693 $362 $2,106 $1,073 
Interest cost443 498 1,337 1,488 
Recognized net actuarial loss353 214 1,060 642 
Net periodic benefit cost$1,489 $1,074 $4,503 $3,203 

Note 8—Derivatives

We are directly and indirectly affected by changes in foreign currency, which may adversely impact our financial performance and are referred to as “market risks.” When deemed appropriate, we use derivatives as a risk management tool to mitigate the potential impact of certain market risks. We do not enter into derivative financial instruments for trading purposes.
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We enter into foreign currency contracts to manage our foreign exchange exposure related to certain balance sheet items that do not meet the requirements for hedge accounting. These derivative instruments are adjusted to fair value at the end of each period through earnings. The gain or loss recorded on these instruments is substantially offset by the remeasurement adjustment on the foreign currency denominated asset or liability.
We pay interest under our Credit Agreement and Receivables Securitization Program, which fluctuate based on changes in our benchmark interest rates. In order to mitigate the risk of increases in benchmark rates, we enter into interest rate swaps whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount. The interest rate swaps were designated as cash flow hedges. Cash flows related to the interest rate swap agreements are included in interest expense.
We determine the fair value of our foreign currency derivatives and our interest rate swaps based on observable market-based inputs or unobservable inputs that are corroborated by market data. We do not view the fair value of our derivatives in isolation, but rather in relation to the fair values or cash flows of the underlying exposure. All derivatives are carried at fair value in our consolidated balance sheets in other current assets net and other current liabilities. We consider the risk of counterparty default to be minimal. We report cash flows from our hedging instruments in the same cash flow statement category as the hedged items.
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The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of September 30, 2020:2021:
Derivative AssetsDerivative LiabilitiesDerivative AssetsDerivative Liabilities
Notional AmountMaturity DateClassificationFair ValueClassificationFair ValueNotional AmountMaturity DateClassificationFair ValueClassificationFair Value
Cash flow hedges
Interest rate swaps$300,000 May 2022 and May 2025Other assets, net$Other liabilities$19,807 
Economic (non-designated) hedgesEconomic (non-designated) hedgesEconomic (non-designated) hedges
Foreign currency contractsForeign currency contracts$28,900 October 2020Other assets, net$149 Other liabilities$Foreign currency contracts$14,400 October 2021Other current assets$92 Other current liabilities$— 

WeIn March 2021, we terminated the remaining $300 million in notional value of interest rate swaps concurrent with the debt financing transaction. In September 2020, we terminated $150 million in notional value of interest rate swaps on September 30, 2020.swaps. The remaining balance of the fair value adjustments of $10.7$25.1 million, which related to these terminated interest rate swaps, within accumulatedAccumulated other comprehensive loss will be recognized in interest expense ratably overwas reclassified to Loss on extinguishment of debt within our consolidated statements of operations for the remaining life of the Term B Loan.

nine months ended September 30, 2021.
The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2019:2020:
Derivative AssetsDerivative Liabilities
Notional AmountMaturity DateClassificationFair ValueClassificationFair Value
Cash flow hedges
Interest rate swaps$450,000 May 2022 and May 2025Other assets, net$Other liabilities$17,436 
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Derivative AssetsDerivative Liabilities
Notional AmountMaturity DateClassificationFair ValueClassificationFair Value
Cash flow hedges
Interest rate swaps$300,000 May 2022 and May 2025Other assets, net$— Other liabilities$17,872 
Economic (non-designated) hedges
Foreign currency contracts$30,300 January 2021Other current assets$151 Other current liabilities$— 

The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2020:2021:
Amount of Gain/(Loss) Recognized in Other Comprehensive Income (Loss)Location of Gain/(Loss) Reclassified from Accumulated Other Comprehensive Loss into IncomeTotal Amount of Income/(Expense) Line Items Presented in the Consolidated Statement of Operations in Which the Effects are RecordedAmount of Gain/(Loss) Reclassified from Accumulated Other Comprehensive Loss into Income
Three Months Ended September 30, 2020Nine Months Ended September 30, 2020Three Months Ended September 30, 2020Nine Months Ended September 30, 2020Three Months Ended September 30, 2020Nine Months Ended September 30, 2020
Interest rate swaps$(515)$(19,913)Interest expense, net$(20,975)$(65,923)$(3,028)$(6,889)
Amount of Gain Recognized in Other Comprehensive Income (Loss)Location of Loss Reclassified from Accumulated Other Comprehensive Loss into IncomeTotal Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are RecordedAmount of Loss Reclassified from Accumulated Other Comprehensive Loss into Income
Three Months Ended September 30, 2021Nine Months Ended September 30, 2021Three Months Ended September 30, 2021Nine Months Ended September 30, 2021Three Months Ended September 30, 2021Nine Months Ended September 30, 2021
Interest rate swaps$— $2,426 Loss on extinguishment of debt$— $(40,433)$— $(25,518)
The amount of ineffectiveness associated with these contracts was immaterial for the periods presented.

The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended September 30, 2019:2020:
Amount of Gain/(Loss) Recognized in Other Comprehensive LossLocation of Gain/(Loss) Reclassified from Accumulated Other Comprehensive Loss into IncomeTotal Amount of Income/(Expense) Line Items Presented in the Consolidated Statement of Operations in Which the Effects are RecordedAmount of Gain/(Loss) Reclassified from Accumulated Other Comprehensive Loss into Income
Three Months Ended September 30, 2019Nine Months Ended September 30, 2019Three Months Ended September 30, 2019Nine Months Ended September 30, 2019Three Months Ended September 30, 2019Nine Months Ended September 30, 2019
Interest rate swaps$(3,356)$(15,933)Interest expense, net$(24,050)$(75,557)$(632)$(1,314)
Foreign currency contracts$(28)$608 Cost of goods sold$(2,012,130)$(6,176,537)$262 $319 
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Amount of Loss Recognized in Other Comprehensive Income (Loss)Location of Loss Reclassified from Accumulated Other Comprehensive Loss into IncomeTotal Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are RecordedAmount of Loss Reclassified from Accumulated Other Comprehensive Loss into Income
Three Months Ended September 30, 2020Nine Months Ended September 30, 2020Three Months Ended September 30, 2020Nine Months Ended September 30, 2020Three Months Ended September 30, 2020Nine Months Ended September 30, 2020
Interest rate swaps$(515)$(19,913)Interest expense, net$(20,975)$(65,923)$(3,028)$(6,889)
The amount of ineffectiveness associated with these contracts was immaterial for the periods presented.

For the three and nine months ended September 30, 2020,2021 we recognized losses of $0.9 million and $2.3$2.5 million respectively, associated with our economic (non-designated) foreign currency contracts. For the three and nine months ended September 30, 2019,2020 we recognized gainslosses of $0.1$0.9 million and $1.1$2.3 million respectively, associated with our economic (non-designated) foreign currency contracts.

We recorded the change in fair value of derivative instruments and the remeasurement adjustment of the foreign currency denominated asset or liability in other operating (income) expense,income, net for our foreign exchange contracts.

Note 9—Income Taxes

The effective tax rate was 13.8%12.6% and 9.4%20.8% for the three and nine months ended September 30, 2020,2021, compared to (126.5)%13.8% and 17.8%9.4% in the same periods of 2019.2020. The change in these rates resulted primarily from an income tax benefit recorded in the first and third quartersquarter of 2020 associated with the Coronavirus Aid, Relief, and Economic Security (CARES) Act and in the third quarter of 2021 associated with the 2017 Tax Cuts and Jobs Act, the mixture of income and losses in jurisdictions in which we operate, and the incremental income tax expensebenefit associated with the vesting of restricted stock. In addition, the provision for income taxes reflects an increase in our reserve for uncertain tax positions for the three and nine months ended September 30, 2020 in connection with the IRS’ audit of our 2015 and 2016 consolidated income tax returns described in the subsequent paragraph. The liability for unrecognized tax benefits was $22.5$23.0 million at September 30, 20202021 and $11.5$20.8 million at December 31, 2019.2020. Included in the liability at September 30, 20202021 and December 31, 20192020 were $1.9$2.7 million and $3.1 million, respectively, of tax positions for which ultimate deductibility is highly certain but for which there is uncertainty about the timing of such deductibility.
On August 26, 2020, we received a Notice of Proposed Adjustment (NOPA) from the Internal Revenue Services (IRS) regarding our 2015 and 2016 Consolidated Income Tax Returns.consolidated income tax returns. On June 30, 2021, we received a NOPA from the IRS regarding our 2017 and 2018 consolidated income tax returns. Within the NOPA,NOPAs, the IRS has asserted that our taxable income for 2015 and 2016the aforementioned years should be higher based on their assessment of the appropriate amount of taxable income that we should report in the United States in connection with our sourcing of products by our foreign subsidiaries for sale in the United
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States by our domestic subsidiaries. Our amount of taxable income in the United States is based on our transfer pricing methodology, which has been consistently applied through the current date. We strongly disagree with the IRS position and will pursue all available administrative and judicial remedies, including those available under the U.S. - Ireland Income Tax Treaty to alleviate double taxation. We regularly assess the likelihood of adverse outcomes resulting from examinations such as this to determine the adequacy of our tax reserves. We believe that we have adequately reserved for this matter and that the final adjudication of this matter will not have a material impact on our consolidated financial position, results of operations or cash flows. However, the ultimate outcome of disputes of this nature is uncertain, and if the IRS were to prevail on its assertions, the additional tax, interest, and any potential penalties could have a material adverse impact on our financial position, results of operations or cash flows.

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Note 10—Net Income (Loss) per Common Share

The following summarizes the calculation of net income (loss) per common share attributable to common shareholders for the three and nine months ended September 30, 20202021 and 2019:2020:
 Three Months Ended September 30,Nine Months Ended
September 30,
(in thousands, except per share data)2020201920202019
Weighted average shares outstanding - basic60,786 60,030 60,983 60,498 
Dilutive shares137
Weighted average shares outstanding - diluted60,923 60,030 60,983 60,498 
Income (loss) from continuing operations$46,081 $3,420 $37,332 $(17,233)
Basic and diluted per share$0.76 $0.06 $0.61 $(0.28)
Loss from discontinued operations$0 $(2,196)$(58,203)$(6,115)
Basic and diluted per share$0 $(0.04)$(0.95)$(0.11)
Net income (loss)$46,081 $1,224 $(20,871)$(23,348)
Basic and diluted per share$0.76 $0.02 $(0.34)$(0.39)

Three Months Ended
 September 30,
Nine Months Ended
 September 30,
(in thousands, except per share data)2021202020212020
Income from continuing operations, net of tax$44,129 $46,081 $179,614 $37,332 
Loss from discontinued operations, net of tax —  (58,203)
Net income (loss)$44,129 $46,081 $179,614 $(20,871)
Weighted average shares outstanding - basic73,215 60,786 72,649 60,983
Dilutive shares2,743 137 2,754  
Weighted average shares outstanding - diluted75,958 60,923 75,403 60,983 
Basic income (loss) per common share:
Income from continuing operations$0.60 $0.76 $2.47 $0.61 
Loss from discontinued operations —  (0.95)
Net income (loss)$0.60 $0.76 $2.47 $(0.34)
Diluted income (loss) per common share:
Income from continuing operations$0.58 $0.76 $2.38 $0.61 
Loss from discontinued operations —  (0.95)
Net income (loss)$0.58 $0.76 $2.38 $(0.34)

Note 11—Shareholders' Equity

In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50$50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of September 30, 2020, 02021, no shares were issued and $50$50.0 million of common stock remained available under the at-the-market equity financing program.
On October 6, 2020, we completed a follow-on equity offering as further described in Note 15 - Subsequent Events.
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Note 12—Accumulated Other Comprehensive Loss

The following table shows the changes in accumulated other comprehensive loss by component for the three and nine months ended September 30, 20202021 and 2019:2020: 
Retirement PlansCurrency
Translation
Adjustments
DerivativesTotal
Accumulated other comprehensive loss, June 30, 2020$(13,926)$(23,471)$(24,188)$(61,585)
Other comprehensive income (loss) before reclassifications5,173 (516)4,657 
Income tax40 40 
Other comprehensive income (loss) before reclassifications, net of tax5,173 (476)4,697 
Amounts reclassified from accumulated other comprehensive loss214 3,028 3,242 
Income tax(47)(871)(918)
Amounts reclassified from accumulated other comprehensive loss, net of tax167 2,157 2,324 
Other comprehensive income167 5,173 1,681 7,021 
Accumulated other comprehensive loss, September 30, 2020$(13,759)$(18,298)$(22,507)$(54,564)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, June 30, 2019$(7,752)$(29,306)$(12,590)$(49,648)
Other comprehensive loss before reclassifications(9,038)(3,384)(12,422)
Income tax1,314 1,314 
Other comprehensive loss before reclassifications, net of tax(9,038)(2,070)(11,108)
Amounts reclassified from accumulated other comprehensive loss260 370 630 
Income tax(61)(89)(150)
Amounts reclassified from accumulated other comprehensive loss, net of tax199 281 480 
Other comprehensive income (loss)199 (9,038)(1,789)(10,628)
Accumulated other comprehensive loss, September 30, 2019$(7,553)$(38,344)$(14,379)$(60,276)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, December 31, 2019$(14,691)$(25,301)$(12,715)$(52,707)
Other comprehensive loss before reclassifications(8,577)(19,913)(28,490)
Income tax5,113 5,113 
Other comprehensive loss before reclassifications, net of tax(8,577)(14,800)(23,377)
Amounts reclassified from accumulated other comprehensive loss1,067 15,580 6,889 23,536 
Income tax(135)(1,881)(2,016)
Amounts reclassified from accumulated other comprehensive loss, net of tax932 15,580 5,008 21,520 
Other comprehensive income (loss)932 7,003 (9,792)(1,857)
Accumulated other comprehensive loss, September 30, 2020$(13,759)$(18,298)$(22,507)$(54,564)
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Retirement PlansCurrency
Translation
Adjustments
DerivativesTotalRetirement PlansCurrency
Translation
Adjustments
DerivativesTotal
Accumulated other comprehensive loss, December 31, 2018$(8,146)$(32,551)$(4,915)$(45,612)
Accumulated other comprehensive loss, June 30, 2021Accumulated other comprehensive loss, June 30, 2021$(18,290)$(14,728)$— $(33,018)
Other comprehensive loss before reclassificationsOther comprehensive loss before reclassifications(5,793)(15,325)(21,118)Other comprehensive loss before reclassifications— (12,014)— (12,014)
Income taxIncome tax5,204 5,204 Income tax— — — — 
Other comprehensive loss before reclassifications, net of taxOther comprehensive loss before reclassifications, net of tax(5,793)(10,121)(15,914)Other comprehensive loss before reclassifications, net of tax— (12,014)— (12,014)
Amounts reclassified from accumulated other comprehensive lossAmounts reclassified from accumulated other comprehensive loss780 995 1,775 Amounts reclassified from accumulated other comprehensive loss500 — — 500 
Income taxIncome tax(187)(338)(525)Income tax(105)— — (105)
Amounts reclassified from accumulated other comprehensive loss, net of taxAmounts reclassified from accumulated other comprehensive loss, net of tax593 657 1,250 Amounts reclassified from accumulated other comprehensive loss, net of tax395 — — 395 
Other comprehensive income (loss)Other comprehensive income (loss)593 (5,793)(9,464)(14,664)Other comprehensive income (loss)395 (12,014)— (11,619)
Accumulated other comprehensive loss, September 30, 2019$(7,553)$(38,344)$(14,379)$(60,276)
Accumulated other comprehensive loss, September 30, 2021Accumulated other comprehensive loss, September 30, 2021$(17,895)$(26,742)$ $(44,637)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, June 30, 2020$(13,926)$(23,471)$(24,188)$(61,585)
Other comprehensive income (loss) before reclassifications— 5,173 (516)4,657 
Income tax— — 40 40 
Other comprehensive income (loss) before reclassifications, net of tax— 5,173 (476)4,697 
Amounts reclassified from accumulated other comprehensive loss214 — 3,028 3,242 
Income tax(47)— (871)(918)
Amounts reclassified from accumulated other comprehensive loss, net of tax167 — 2,157 2,324 
Other comprehensive income167 5,173 1,681 7,021 
Accumulated other comprehensive loss, September 30, 2020$(13,759)$(18,298)$(22,507)$(54,564)

Retirement PlansCurrency
Translation
Adjustments
DerivativesTotal
Accumulated other comprehensive loss, December 31, 2020$(18,447)$(18)$(20,044)$(38,509)
Other comprehensive (loss) income before reclassifications— (26,724)2,426 (24,298)
Income tax— — (611)(611)
Other comprehensive (loss) income before reclassifications, net of tax— (26,724)1,815 (24,909)
Amounts reclassified from accumulated other comprehensive loss704 — 25,518 26,222 
Income tax(152)— (7,289)(7,441)
Amounts reclassified from accumulated other comprehensive loss, net of tax552 — 18,229 18,781 
Other comprehensive income (loss)552 (26,724)20,044 (6,128)
Accumulated other comprehensive loss, September 30, 2021$(17,895)$(26,742)$ $(44,637)
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Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, December 31, 2019$(14,691)$(25,301)$(12,715)$(52,707)
Other comprehensive loss before reclassifications— (8,577)(19,913)(28,490)
Income tax— — 5,113 5,113 
Other comprehensive loss before reclassifications, net of tax— (8,577)(14,800)(23,377)
Amounts reclassified from accumulated other comprehensive loss1,067 15,580 6,889 23,536 
Income tax(135)— (1,881)(2,016)
Amounts reclassified from accumulated other comprehensive loss, net of tax932 15,580 5,008 21,520 
Other comprehensive income (loss)932 7,003 (9,792)(1,857)
Accumulated other comprehensive loss, September 30, 2020$(13,759)$(18,298)$(22,507)$(54,564)

We include amounts reclassified out of accumulated other comprehensive loss related to defined benefit pension plans as a component of net periodic pension cost recorded in Other expense (income), net. For the three and nine months ended September 30, 2020, we reclassified$0.2 million and $1.1 million, which included $0.4 million as a result of the Divestiture, respectively, of actuarial net losses. Amounts reclassified from accumulated other comprehensive loss for the nine months ended September 30, 2020 include currency translation adjustments released as a result of the Divestiture. For the three and nine months ended September 30, 2019, we reclassified $0.3 million and $0.8 million, respectively, of actuarial net losses.

Note 13—Segment Information

We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under 2 segments: Global Solutions and Global Products. The Global Solutions segment includes our United States distribution businesses (Medical Distribution and Patient Direct), outsourced logistics and value-added services business. Global Products manufactures and sources medical surgical products through our production and kitting operations.
We evaluate the performance of our segments based on their operating income excluding intangible amortization and acquisition-related and exit and realignment charges certain purchase price fair value adjustments, and other substantive items that, either as a result of their nature or size, would not be expected to occur as part of our normal business operations on a regular basis.
Segment assets exclude inter-segment account balances as we believe their inclusion would be misleading and not meaningful. We believe all inter-segment sales are at prices that approximate market.

The following tables present financial information by segment:
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The following tables present financial information by segment:
Three Months Ended
September 30,
Nine Months Ended
September 30,
2020201920202019
Net revenue:
Global Solutions$1,865,182 $2,047,379 $5,261,415 $6,305,448 
Global Products473,797 359,835 1,235,391 1,070,808 
Total segment net revenue2,338,979 2,407,214 6,496,806 7,376,256 
Inter-segment revenue
Global Products(151,051)(114,462)(378,466)(355,960)
       Total inter-segment revenue(151,051)(114,462)(378,466)(355,960)
Consolidated net revenue$2,187,928 $2,292,752 $6,118,340 $7,020,296 
Operating income:
Global Solutions$10,972 $24,916 $8,522 $64,292 
Global Products89,923 16,897 160,268 42,570 
Inter-segment eliminations(8,718)(243)(10,322)774 
Intangible amortization(10,242)(10,614)(31,463)(33,395)
Acquisition-related and exit and realignment charges(6,382)(4,522)(18,500)(14,776)
Other (1)
0 (324)0 (853)
Consolidated operating income$75,553 $26,110 $108,505 $58,612 
Depreciation and amortization:
Global Solutions$9,572 $11,477 $31,273 $31,756 
Global Products11,118 13,128 38,221 40,982 
Discontinued operations0 4,697 0 15,466 
Consolidated depreciation and amortization$20,690 $29,302 $69,494 $88,204 
Capital expenditures:
Global Solutions$3,582 $2,743 $7,545 $7,280 
Global Products10,656 6,791 15,808 13,574 
Discontinued operations0 3,087 3,027 17,298 
Consolidated capital expenditures$14,238 $12,621 $26,380 $38,152 
(1) 2019 included interest cost and net actuarial losses related to the U.S. Retirement Plan as well as Software as a Service (SaaS) implementation costs associated with the upgrading of our global IT platforms in connection with the redesign of our global information system strategy.
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
2021202020212020
Net revenue:
Segment net revenue
Global Solutions$2,022,919 $1,865,182 $5,850,007 $5,261,415 
Global Products679,067 473,797 2,026,385 1,235,391 
Total segment net revenue2,701,986 2,338,979 7,876,392 6,496,806 
Inter-segment revenue
Global Products(199,811)(151,051)(558,223)(378,466)
       Total inter-segment revenue(199,811)(151,051)(558,223)(378,466)
Consolidated net revenue$2,502,175 $2,187,928 $7,318,169 $6,118,340 
Operating income:
Global Solutions$20,366 $10,972 $47,729 $8,522 
Global Products51,327 89,923 310,242 160,268 
Inter-segment eliminations7,587 (8,718)(475)(10,322)
Intangible amortization(10,025)(10,242)(30,077)(31,463)
Acquisition-related and exit and realignment charges(6,380)(6,382)(20,967)(18,500)
Consolidated operating income$62,875 $75,553 $306,452 $108,505 
Depreciation and amortization:
Global Solutions$9,951 $9,572 $29,678 $31,273 
Global Products12,691 11,118 38,464 38,221 
Consolidated depreciation and amortization$22,642 $20,690 $68,142 $69,494 
Capital expenditures:
Global Solutions$5,752 $3,582 $14,776 $7,545 
Global Products8,192 10,656 17,849 15,808 
Discontinued operations —  3,027 
Consolidated capital expenditures$13,944 $14,238 $32,625 $26,380 



September 30, 2021December 31, 2020
Total assets:
Global Solutions$2,135,865 $2,117,372 
Global Products1,408,495 1,135,209 
Segment assets3,544,360 3,252,581 
Cash and cash equivalents39,759 83,058 
Consolidated total assets$3,584,119 $3,335,639 


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September 30, 2020December 31, 2019
Total assets:
Global Solutions$2,161,158 $2,205,134 
Global Products1,058,701 930,937 
Segment assets3,219,859 3,136,071 
Discontinued operations0 439,983 
Cash and cash equivalents77,256 67,030 
Consolidated total assets$3,297,115 $3,643,084 
The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services.
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Net revenue:
United States$2,101,074 $2,200,284 $5,872,143 $6,774,965 
International86,854 92,468 246,197 245,331 
Consolidated net revenue$2,187,928 $2,292,752 $6,118,340 $7,020,296 
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Three Months Ended September 30,Nine Months Ended September 30,
2021202020212020
Net revenue:
United States$2,380,794 $2,101,074 $6,900,222 $5,872,143 
International121,381 86,854 417,947 246,197
Consolidated net revenue$2,502,175 $2,187,928 $7,318,169 $6,118,340 

Note 14—Recent Accounting Pronouncements
In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework— Changes to the Disclosure Requirements for Fair Value Measurement. This ASU modifies the disclosure requirements for fair value measurements by removing the requirement to disclose the amount and reasons for transfers between Level 1 and Level 2 of the fair value hierarchy and the policy for timing of such transfers. This ASU expands the disclosure requirements for Level 3 fair value measurements, primarily focused on changes in unrealized gains and losses included in other comprehensive income (loss). We adopted ASU No. 2018-13 effective beginning January 1, 2020. Its adoption did not have a material impact on our consolidated financial statements.
In August 2018, the FASB issued ASU No. 2018-14, Compensation—Retirement Benefits—Defined Benefit Plans—General (Subtopic 715-20): Disclosure Framework—Changes to the Disclosure Requirements for Defined Benefit Plans. ASU 2018-14 removes disclosures that no longer are considered cost beneficial, clarifies the specific requirements of disclosures and adds disclosure requirements identified as relevant for companies with defined benefit retirement plans. The amendments in ASU No. 2018-14 are effective for fiscal years ending after December 15, 2020 and we do not expect this to have a material impact on our consolidated financial statements.
In August 2018, the FASB issued ASU No. 2018-15, Intangibles—Goodwill and Other (Topic 350): Internal-Use Software. This standard aligns the requirements for capitalizing implementation costs incurred in a cloud computing arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software. We adopted ASU No. 2018-15 effective beginning January 1, 2020. Its adoption did not have a material impact on our consolidated financial statements.

In December 2019, the FASB issued ASU No. 2019-12, Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes, eliminates certain exceptions within ASC 740, Income Taxes, and clarifies certain aspects of the current guidance to promote consistency among reporting entities. ASU No. 2019-12 is effective for fiscal years beginning after December 15, 2020. Most amendments within the standard are required to be applied on a prospective basis, while certain amendments must be applied on a retrospective or modified retrospective basis. We do not expect this to have a material impact on our consolidated financial statements.
In March 2020, the FASB issued ASU No. 2020-03, Codification Improvements to Financial Instruments. The Standard is part of FASB’s ongoing project to improve and clarify its Accounting Standards Codification and avoid unintended application. The items addressed are not expected to significantly affect current practice or create a significant administrative cost for most entities. The amendment is divided into issues 1 to 7 with different effective dates as follows: The amendments related to Issue 1, Issue 2, Issue 4, and Issue 5 are conforming amendments. The amendments are effective upon issuance of this update. The amendment related to Issue 3 is a conforming amendment that affects the guidance related to the amendments in ASU No. 2016-01, Financial Instruments-Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and
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Financial Liabilities. The effective date of this update for the amendments to ASU No. 2016-01 is for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years. The amendments related to Issue 6 and Issue 7 affect the guidance in the amendments in ASU No. 2016-13, Financial 5 Instruments-Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. For entities that have not yet adopted the amendments related to ASU No. 2016-13, the effective dates and the transition requirements for these amendments are the same as the effective date and transition requirements in ASU No. 2016-13, which will be effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. We adopted ASU No. 2020-032019-12 effective beginning January 1, 2020 for Issues 1 through 5.2021. Its adoption did not have a material impact on our consolidated financial statements. We are currently evaluating the potential impact of adopting this guidance for Issues 6 and 7 on our consolidated financial statements and disclosures.
In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criteria are met. The amendments apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued because of reference rate reform. The amendments are effective for all entities as of March 12, 2020 through December 31, 2022.Our current debt agreements contemplate a transition from LIBOR to another benchmark rate in the event that LIBOR ceases to exist. We do not expect the transition to have a material impact on our consolidated financial statements.
In October 2020, the FASB issued ASU No. 2020-10, Codification Improvements, to improve consistency by amending the FASB Accounting Standards Codification (the Codification) to include all disclosure guidance in the appropriate disclosure sections. This ASU also clarifies application of various provisions in the Codification by amending and adding new headings, cross referencing to other guidance, and refining or correcting terminology. The amendments in this ASU do not change GAAP and, therefore, are not expected to result in a significant change in practice. We adopted ASU No. 2020-10 effective beginning January 1, 2021. Its adoption did not have a material impact on our consolidated financial statements.
There have been no further changes in our significant accounting policies from those contained in our Annual Report on Form 10-K for the year ended December 31, 2019.2020.

Note 15—Subsequent Events
On October 6, 2020, we completed a follow-on equity offering wherein we sold an aggregate of 8,475,000 shares of our common stock at an offering price of $20.50, resulting in net proceeds to us of approximately $165 million, after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions. Pursuant to the underwriting agreement, we granted the underwriters an option to purchase up to an additional 1,271,250 shares of our common stock, which the underwriters exercised in full. Inclusive of this exercised option, net proceeds to us were approximately $190 million, after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions.
We used the proceeds from the follow-on equity offering to repay the remaining $109 million outstanding balance of Term Loan A-1 at par on October 8, 2020, to repay $52 million of our Term Loan A-2 at par on October 15, 2020, and to repay $30 million of borrowings under the revolving credit facility.
On October 30, 2020, we issued a notice of redemption to redeem all of our outstanding 2021 Notes on November 30, 2020 (the “Redemption Date”). The redemption price will include accrued and unpaid interest to, but not including, the Redemption Date, and a redemption premium, equal to the greater of (i) 100% of the principal amount of the 2021 Notes to be redeemed or (ii) the sum of the present values of the remaining scheduled payments of principal and interest thereon (exclusive of interest accrued to the Redemption Date) discounted to the Redemption Date on a semi-annual basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate plus 25 basis points.

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

The following discussion and analysis describes results of operations and material changes in the financial condition of Owens & Minor, Inc. and its subsidiaries since December 31, 2019.2020. Trends of a material nature are discussed to the extent known and considered relevant. This discussion should be read in conjunction with the consolidated financial statements, related notes thereto, and management’s discussion and analysis of financial condition and results of operations included in our Annual Report on Form 10-K for the year ended December 31, 2019.2020.
Overview and Divestiture of Movianto
Owens & Minor, Inc., along with its subsidiaries, (we, us, or our) is a leading global healthcare solutions company. On June 18, 2020 (the Divestiture Date), we completed the previously announced divestiture of our European logistics business, Movianto (the Divestiture), as well as certain support functions in our Dublin, Ireland office, to Walden Group SAS (the Buyer) and EHDH (as Buyer’s guarantor) for cash consideration of $133 million. The Divestiture provides us with a greater ability to focus on and invest in our differentiated products, services and U.S. distribution businesses. A portion of the net proceeds was used to repurchase $54.1 million of our 2021 Notes through a tender offer (see Note 6, “Debt”). We recorded a loss of $65.5 million in connection with the Divestiture for the nine months ended September 30, 2020.
We have entered into transition services agreements with a subsidiary of the Buyer, pursuant to which we and a subsidiary of the Buyer will provide to each other various transitional services.Transition service expenses and reimbursements were immaterial for the three and nine months ended September 30, 2020.
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As a result of the Divestiture, the results of operations from our Movianto business are reported as “Loss from discontinued operations, net of tax” throughfor the Divestiture Datethree and the related assets and liabilities were classified as “held-for-sale” in the consolidated balance sheet as of December 31, 2019.nine months ended September 30, 2020. See Note 3, “Discontinued Operations,” of the Notes to Consolidated Financial Statements for further information. Unless otherwise indicated, the following information relates to continuing operations.
Income (loss) from continuing operations per diluted share was $0.58 and $2.38 for the three and nine months ended September 30, 2021 as compared to $0.76 and $0.61 for the three and nine months ended September 30, 2020, respectively, as compared to $0.062020. Global Solutions segment operating income was $20.4 million and $(0.28)$47.7 million for the three and nine months ended September 30, 2019, respectively. Global Solutions segment operating income was2021, compared to $11.0 million and $8.5 million for the three and nine months ended September 30, 2020, respectively, compared to $24.92020. These increases were a
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result of strong revenue growth, leveraging our fixed costs, and operating efficiencies. Global Products segment operating income was $51.3 million and $64.3$310 million for the three and nine months ended September 30, 2019, respectively. The declines were a result of lower revenues in part from a reduction in elective surgeries as2021, compared to prior year. Global Products segment operating income was $89.9 million and $160.3$160 million for the three and nine months ended September 30, 2020, respectively, compared to $16.9 million and $42.6 million2020. The decrease for the three months ended September 30, 2021 was primarily the result of the timing of glove cost pass-through, accelerating inflationary pressures, including commodities, transportation, and labor, partially offset by revenue growth. The increase for the nine months ended September 30, 2019, respectively. The increases were2021 was a result of higher revenues from greater market demand for personal protective equipment and(PPE) sales, favorable timing of cost pass-through on gloves, productivity initiatives, favorable product mix, combined with continued operating efficienciesand improved fixed cost leverage, partially offset by higher commodity prices and rising transportation costs, compared to 2019.the prior year.

COVID-19 Update

We are closely monitoring the impact of COVID-19the 2019 novel coronavirus (COVID-19), including the related Delta variant, on all aspects of our business, including how it impacts our customers, teammates, suppliers, vendors and distribution channels. We have taken actions to protect our teammates while maintaining business continuity as we respond to the needs from this global pandemic. We will continue to actively monitor the situation and may take further actions that alter our business operations as may be required by federal, state or local authorities or that we determine are in the best interests of our teammates, customers, suppliers and shareholders.
Revenue infor the first nine months ended September 30, 2021 of 2020 of $6.1$7.3 billion continues to be impacted by COVID-19 and includes a significant overall impact from COVID-19 relatedthe effective response to the reductionongoing recovery of surgicalelective procedures, beginning in mid-March, which was partially offset by a greater demandhigher sales of PPE, and pass-through of elevated glove costs.Operating income for personal protective equipment (PPE). Operating incomethe nine months ended September 30, 2021 also benefited from improved productivity and increased manufacturing output related to PPE, favorable product mix and operating efficiencies. We haveIn 2020, we expanded our PPE production operations to 24 hours a day, 7 days a week, and have taken measures to increase and improve our production such as retooling existing equipment, installing and optimizing new production lines and ramping up our new non-woven fabric machinery. We have delivered nearly 11 billion units of PPE, of which approximately 4 billion units were produced with materials manufactured in our American factories or Owens & Minor owned facilities, since January 2020. We expect that we will continue servicing our customers' needs related to the heightened demand for our PPE as a result of various factors, including the implementation of new regulations and healthcare protocols calling for increased use of PPE, healthcare professional preference for medical grade PPE, stockpile PPE demand and the creation of new channels for PPE demand in healthcare, non-healthcare and international markets.
We are evaluating various government-sponsored COVID-response stimulus, relief, and production initiatives such asIn March 2020, under the Defense Production Act (DPA), we were awarded a contract with the U.S. Department of Health and recent Coronavirus Aid, Relief and Economic Security (CARES) Act.Human Services to produce N-95 respirator masks in an effort to replenish the Strategic National Stockpile. In April 2020, also under the DPA, the U.S. Department of Defense initiated a technology investment agreement with us involving up to $30$30.0 million of anticipated funding of assets to expand capacity to supply N-95 respirator masks to the U.S. government. The
nature of the agreement provides a program of expedited partial funding to begin expansion while final terms are completed.masks. Through September 30, 2020, approximately $20.4 million2021, substantially all of the anticipated funding had been expended and reimbursed in accordance with this arrangement. In addition, as allowed under the CARES Act, we filed for $13.0 million and $17.6 million income tax refunds with the Internal Revenue Service (IRS) related to the carryback of net operating losses (NOL) incurred in 2018 and 2019, respectively. As of September 30, 2020, the $13.0 million refund was received and the $17.6 million refund was included in other current assets on our consolidated balance sheet. In connection with these NOL carryback items, we recorded a $7.0 million and $12.2 million benefit to the income tax benefit for the three and nine months ended September 30, 2020.
We are unable to predict the lengthtiming of the pandemic and the full impact that COVID-19 will have on our future operating results, financial position and operating resultscash flows due to numerous variables and continued uncertainties. Travel, transportation, and business operation restrictions arising from virus containment efforts of governments around the world have continued to impact our operations in certain locations, including within Asia. Essential activity exceptions from these restrictions have allowed us to continue to operate but virus containment efforts have resulted in additional direct costs from supply chain challenges. Although we have experienced growth in sales volumes for certain of our products (such as PPE) during the COVID-19 pandemic, as well as improved productivity and manufacturing output, there can be no assurance that such growth rates, increased sales volumes or other improvements will be maintained during or following the COVID-19 pandemic.
Results of Operations

Net revenue.


Three Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Global Solutions$2,022,919 $1,865,182 $157,737 8.5 %
Global Products679,067 473,797 205,270 43.3 %
Inter-segment(199,811)(151,051)(48,760)(32.3)%
Net revenue$2,502,175 $2,187,928 $314,247 14.4 %

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Results of Operations

Net revenue.
Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Global Solutions$1,865,182 $2,047,379 $(182,197)(8.9)%
Global Products473,797 359,835 113,962 31.7 %
Inter-segment(151,051)(114,462)(36,589)(32.0)%
Net revenue$2,187,928 $2,292,752 $(104,824)(4.6)%
Nine Months Ended September 30,ChangeNine Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Global SolutionsGlobal Solutions$5,261,415 $6,305,448 $(1,044,033)(16.6)%Global Solutions$5,850,007 $5,261,415 $588,592 11.2 %
Global ProductsGlobal Products1,235,391 1,070,808 164,583 15.4 %Global Products2,026,385 1,235,391 790,994 64.0 %
Inter-segmentInter-segment(378,466)(355,960)(22,506)(6.3)%Inter-segment(558,223)(378,466)(179,757)(47.5)%
Net revenueNet revenue$6,118,340 $7,020,296 $(901,956)(12.8)%Net revenue$7,318,169 $6,118,340 $1,199,829 19.6 %

The change in net revenue for the three and nine months ended September 30, 20202021 reflected our market share gains, the impact of a reduction in elective surgical procedures, primarily dueeffective response to the impactongoing recovery of COVID-19, and lower distribution revenueselective procedures, higher sales of surgical & infection prevention (S&IP) products, pass-through of elevated glove costs, as a result of customer non-renewals that occurredwell as continued strong performance in 2019. These were partially offset by revenue growth in Global Products from increased demand for PPE and growth in Byram, our Home HealthcarePatient Direct business. Foreign currency translation had a favorable impact on net revenue of $1.9$1.8 million and $23.5 million for the three months ended September 30, 2020 and an unfavorable impact on net revenue of $1.7 million for the nine months ended September 30, 2020,2021 as compared to the prior year.

Cost of goods sold.
Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Cost of goods sold$1,843,589 $2,012,130 $(168,541)(8.4)%

Nine Months Ended September 30,ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Cost of goods soldCost of goods sold$5,236,035 $6,176,537 $(940,502)(15.2)%Cost of goods sold$2,173,336 $1,843,589 $329,747 17.9 %

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Cost of goods sold$6,146,511 $5,236,035 $910,476 17.4 %

Cost of goods sold includes the cost of the product (net of supplier incentives and cash discounts) and all costs incurred for shipments of products from manufacturers to our distribution centers for all customer arrangements where we are the primary obligor and bear risk of general and physical inventory loss. These are sometimes referred to as distribution contracts. Cost of goods sold also includes direct and certain indirect labor, material and overhead costs associated with our Global Products business.segment. There is no cost of goods sold associated with our fee-for-service arrangements. Cost of goods sold compared to prior year reflects changes in sales activity, including sales mix.mix, and accelerating inflationary pressures.

Gross margin.

Three Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Gross margin$328,839 $344,339 $(15,500)(4.5)%
As a % of net revenue13.14 %15.74 %

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Gross margin$1,171,658 $882,305 $289,353 32.8 %
As a % of net revenue16.01 %14.42 %
Gross margin decrease in the three months ended September 30, 2021 was driven by the timing of glove cost pass-through and accelerating inflationary pressures, partially offset by revenue growth. Gross margin increase in the nine months ended September 30, 2021 was driven by revenue growth, market dynamics including timing of glove price and cost changes, an overall improved sales mix and operating efficiencies, partially offset by accelerating inflationary pressures. Foreign
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Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Gross margin$344,339 $280,622 $63,717 22.7 %
As a % of net revenue15.74 %12.24 %
Nine Months Ended September 30,Change
(Dollars in thousands)20202019$%
Gross margin$882,305 $843,759 $38,546 4.6 %
As a % of net revenue14.42 %12.02 %
Grosscurrency translation had an unfavorable impact on gross margin inof $6.2 million and $0.8 million for the three and nine months ended September 30, 2020 were impacted by improved sales mix and productivity, operating efficiencies in Global Products and a favorable impact from foreign currency translation of $5.4 million and $1.1 million, respectively.2021 as compared to the prior year.

Operating expenses.
Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Distribution, selling and administrative expenses$262,538 $248,661 $13,877 5.6 %
As a % of net revenue12.00 %10.85 %
Acquisition-related and exit and realignment charges$6,382 $4,522 $1,860 41.1 %
Other operating (income) expense, net$(134)$1,329 $(1,463)(110.1)%

Nine Months Ended September 30,ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Distribution, selling and administrative expensesDistribution, selling and administrative expenses$758,320 $767,986 $(9,666)(1.3)%Distribution, selling and administrative expenses$262,457 $262,538 $(81)— %
As a % of net revenueAs a % of net revenue12.39 %10.94 %As a % of net revenue10.49 %12.00 %
Acquisition-related and exit and realignment chargesAcquisition-related and exit and realignment charges$18,500 $14,776 $3,724 25.2 %Acquisition-related and exit and realignment charges$6,380 $6,382 $(2)— %
Other operating (income) expense, net$(3,020)$2,385 $(5,405)(226.6)%
Other operating income, netOther operating income, net$(2,873)$(134)$(2,739)(2,044.0)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Distribution, selling and administrative expenses$849,255 $758,320 $90,935 12.0 %
As a % of net revenue11.60 %12.39 %
Acquisition-related and exit and realignment charges$20,967 $18,500 $2,467 13.3 %
Other operating income, net$(5,016)$(3,020)$(1,996)(66.1)%

Distribution, selling and administrative (DS&A) expenses include labor and warehousing costs associated with our distribution and outsourced logistics services and all costs associated with our fee-for-service arrangements. Shipping and handling costs are primarily included in DS&A expenses and include costs to store, move, and prepare products for shipment, as well as costs to deliver products to customers.
Overall DS&A expenses were affected by revenue growth, changes in incentive compensation, teammate benefits, accelerating inflationary pressures, and operational efficiencies for the revenue declinethree and change in mix and investments innine months ended September 30, 2021. In addition, overall DS&A expenses were affected by charitable contributions for the business, partially offset by operational efficiencies.nine months ended September 30, 2021. DS&A expenses also included an unfavorable impact for foreign currency translation of $0.3$0.1 million and $2.3 million for the three months ended September 30, 2020 and a favorable impact for foreign currency translation of $0.3 million for the nine months ended September 30, 2020.

2021.
Acquisition-related and exit and realignment charges presented in our consolidated statements of operations of $6.4 million and $21.0 million for the three and nine months ended September 30, 2021 consisted primarily of wind-down costs related to Fusion5, leadership reorganization costs, IT restructuring charges, and other costs related to the reorganization of the U.S. operations. Acquisition-related charges within acquisition-related and exit and realignment charges presented in our consolidated statements of operations were $0.8 million and $8.9 million for the three and nine months ended September 30, 2020, compared to $3.5 million and $11.4 million for the same periods of 2019. Acquisition-related charges in 2020 and 2019 consistwhich consisted primarily of transition costs for the Halyard acquisition. Exit and realignment charges were $5.6 million and $9.6 million for the three and nine months ended September 30, 2020 compared to $1.0 million and $3.4 million for the same periodsconsisted primarily of 2019. Amounts in 2020 were associated with severance from reduction in force, post divestiture costs related to the Movianto business, and other costs related to the reorganization of the U.S. commercial, operations and executive teams. Amounts
The change in 2019 were associated with severance costs,other operating income, net for the establishmentthree and nine months ended September 30, 2021 includes the impact of our client engagement center, and IT restructuring charges.higher foreign currency transaction gains as compared to the prior year.

Interest expense, net.

Three Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Interest expense, net$11,572 $20,975 $(9,403)(44.8)%
Effective interest rate4.17 %5.64 %
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The change in other operating (income) expense, net was attributed primarily to higher foreign currency transaction gains compared to prior year, gain on legal settlement, and lower software as a service implementation expenses due to the adoption of ASU No. 2018-15 as of January 1, 2020. See Note 14 in Notes to Consolidated Financial Statements.

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Interest expense, net$36,784 $65,923 $(29,139)(44.2)%
Effective interest rate4.72 %6.35 %
Interest expense, net and the effective interest rate fo.
Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Interest expense, net$20,975 $24,050 $(3,075)(12.8)%
Effective interest rate5.64 %6.04 %
Nine Months Ended September 30,Change
(Dollars in thousands)20202019$%
Interest expense, net$65,923 $75,557 $(9,634)(12.8)%
Effective interest rate6.35 %7.38 %
Interest expense, net forr the three and nine months ended September 30, 20202021 decreased primarily due to a reduction inof debt and a decrease in our effectivelower interest rate, which were partially offset by the amortization of additional deferred financing costs as a result of the Fifth Amendment to the Credit Agreement in February 2020.rates. See Note 6 in Notes to Consolidated Financial Statements.

Other expense, net.Loss on extinguishment of debt.
Three Months Ended September 30,Change
(Dollars in thousands)20202019$%
Other expense, net$1,093 $550 $543 98.7 %

Nine Months Ended September 30,ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Other expense, net$1,387 $4,014 $(2,627)(65.4)%
Loss on extinguishment of debtLoss on extinguishment of debt$ $308 $(308)(100.0)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Loss on extinguishment of debt$40,433 $2,580 $37,853 1,467.2 %

Other expense, net for the three months ended September 30, 2020 and September 30, 2019 primarily relate to interest cost and net actuarial losses related to the U.S. Retirement Plan. Other expense, netLoss on extinguishment of debt for the nine months ended September 30, 20202021 includes the write-off of deferred financing costs and third party fees incurred,associated with the debt financing in March 2021 of $15.3 million and amounts reclassified from accumulated other comprehensive loss as a result of the termination of our interest costrate swaps of $25.1 million. Loss on extinguishment of debt for the three and net actuarial losses related tonine months ended September 30, 2020 primarily includes the U.S. Retirement Plan,write-off of deferred financing costs and third party fees, offset by a gain from the surrender of company-owned life insurance policies and gain on extinguishment of debt related to the partial repurchase of our 2021 and 2024 Notes.

Other expense (income), net.

Three Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Other expense (income), net$799 $785 $14 1.8 %

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20212020$%
Other expense (income), net$2,397 $(1,193)$3,590 300.9 %

Other expense (income), net for the three and nine months ended September 30, 2019 includes2021 and 2020 represents interest cost and net actuarial losses related to our retirement plans. Other expense (income), net for the nine months ended September 30, 2020 includes a gain from the U.S. Retirement Plan, the write-offsurrender of deferred financing costs associated with the revolving credit facility as a result of the Fourth Amendment to the Credit Agreement in February 2019, and gain on extinguishment of debt related to the partial repurchase of our 2021 Notes.company-owned life insurance policies.

Income taxes.
Three Months Ended September 30,ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Income tax provision (benefit)$7,404 $(1,910)$9,314 487.6 %
Income tax provisionIncome tax provision$6,375 $7,404 $(1,029)(13.9)%
Effective tax rateEffective tax rate13.8 %-126.5 %Effective tax rate12.6 %13.8 %

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Nine Months Ended September 30,ChangeNine Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20202019$%(Dollars in thousands)20212020$%
Income tax provision (benefit)$3,863 (3,726)$7,589 203.7 %
Income tax provisionIncome tax provision$47,224 $3,863 $43,361 1,122.5 %
Effective tax rateEffective tax rate9.4 %17.8 %Effective tax rate20.8 %9.4 %

The change in the effective tax ratesrate for the three and nine months ended September 30, 2021 compared to 2019the same periods in 2020 resulted primarily from an income tax benefit recorded in the first and third quartersquarter of 2020 associated with the Coronavirus Aid, Relief, and Economic Security (CARES) Act year over year changesand in the third quarter of 2021 associated with the 2017 Tax Cuts and Jobs Act, the mixture of income and losses in jurisdictions in which we operate, and the incremental income tax expensebenefit associated with the vesting of restricted stock. In addition, the provision for income taxes reflects an increase in our reserve for uncertain tax positions for the three and nine months ended September 30, 2020 in connection with the IRS’ audit of our 2015 and 2016 consolidated income tax returns described in Note 9 in the Notes to Consolidated Financial Statements.

Financial Condition, Liquidity and Capital Resources

Financial condition. We monitor operating working capital through days sales outstanding (DSO) and merchandise inventory turnover.days. We estimate a hypothetical increase (decrease) in DSO of one day would result in a decrease (increase) in our cash balances, an increase (decrease) in borrowings against our revolving credit facility or Receivables Securitization Program, or a combination thereof of approximately $24$27 million.
The majority of our cash and cash equivalents are held in cash depository accounts with major banks in the United States, Europe, and Asia. Changes in our working capital can vary in the normal course of business based upon the timing of inventory purchases, collections of accounts receivable, and payments to suppliers.
September 30, 2020December 31, 2019ChangeSeptember 30, 2021December 31, 2020Change
(Dollars in thousands)(Dollars in thousands)$%(Dollars in thousands)$%
Cash and cash equivalentsCash and cash equivalents$77,256 $67,030 $10,226 15.3 %Cash and cash equivalents$39,759 $83,058 $(43,299)(52.1)%
Accounts receivable, net of allowancesAccounts receivable, net of allowances$688,884 $674,706 $14,178 2.1 %Accounts receivable, net of allowances$759,744 $700,792 $58,952 8.4 %
Consolidated DSO (1)
Consolidated DSO (1)
27.7 27.1 
Consolidated DSO (1)
27.3 26.0
Merchandise inventoriesMerchandise inventories$1,095,410 $1,146,192 $(50,782)(4.4)%Merchandise inventories$1,514,387 $1,233,751 $280,636 22.7 %
Consolidated inventory turnover (2)
6.8 6.6 
Inventory days (2)
Inventory days (2)
64.1 57.8
Accounts payableAccounts payable$946,116 $808,035 $138,081 17.1 %Accounts payable$1,118,753 $1,000,186 $118,567 11.9 %
    (1) Based on period end accounts receivable and net revenue for the quarterquarters ended September 30, 2021 and December 31, 2020
    (2) Based on average inventoryperiod end merchandise inventories and annualized costscost of goods sold for the quarterquarters ended September 30, 20202021 and year ended December 31, 20192020

Liquidity and capital expenditures. The following table summarizes our consolidated statements of cash flows for the nine months ended September 30, 20202021 and 2019,2020, which relates to continuing operations and discontinued operations:
(Dollars in thousands)20202019
Net cash provided by (used for):
Operating activities$268,196 $139,105 
Investing activities112,830 (37,932)
Financing activities(244,955)(89,294)
Effect of exchange rate changes6,721 (2,243)
Net increase in cash, cash equivalents and restricted cash$142,792 $9,636 

(Dollars in thousands)20212020
Net cash provided by (used for):
Operating activities$73,836 $268,196 
Investing activities(32,584)112,830 
Financing activities(117,222)(244,955)
Effect of exchange rate changes(2,454)6,721 
Net (decrease) increase in cash, cash equivalents and restricted cash$(78,424)$142,792 

Cash provided by operating activities in the first nine months of 2021 and 2020 reflected fluctuations in net income along with favorable changes in working capital.
Cash provided byused for investing activities in the first nine months of 2021 and 2020 included cash consideration received of $133.0 million from the sale of Movianto, proceeds of $6.0 million from the surrender of company-owned life insurance policies, and capital expenditures of $32.6 million and $26.4 million for our strategic and operational efficiency initiatives associated with property and equipment, investments for increased manufacturing capacity in the Americas, and capitalized software. Cash used forprovided by investing activities in 2019the first nine months of 2020 included capital expenditures for our strategiccash consideration received of $133 million from the sale of Movianto and operational efficiency initiatives associated with property and equipment and capitalized software.proceeds of $6.0 million from the surrender of company-owned life insurance policies.
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CashCash used for financing activities in the first nine months of 20202021 included dividend payments of $0.5 million and net repayments of $107.9$90.9 million under our revolving credit facility, compared to $5.1$0.5 million and $36.1$108 million respectively, for the same period of 2019.2020. We also had proceeds from borrowings of $150.0$575 million related to the 2029 Unsecured Notes and Accounts Receivable Securitization Program for the first nine months of 2021, compared to $150 million related to the Accounts Receivable Securitization Program infor the first nine months of 2020. Financing activities also included repayments of $270.4$553 million infor the first nine months of 20202021 on our term loans, 2021 and 2024 Notes, and Accounts Receivable Securitization Program, compared to $40.7$270 million in the same period of 2019 2020 on our term loans (under the Credit Agreement) and 2021 and 2024 Notes. We used $83.3 million of cash to repurchase $87.9 million aggregate principal amount of the 2021 and 2024 Notes during the first nine months of 2020. We also paid $13.9 million in financing costs in the first nine months of 2021, as compared to $10.4 million in financing costs for the same period of 2020. In addition, we paid $15.4 million to terminate the remaining $300 million in notional value of interest rate swaps during the first nine months of 2021. Payments for taxes related to the Februaryvesting of restricted stock awards were $19.3 million and $3.6million for the first nine months of 2021 and 2020, Accounts Receivable Securitization Program and the February 2020 Fifth Amendment to the Credit Agreement, as compared to $4.3 millionwhich are included in financing costs related to the February 2019 Fourth Amendment to the Credit Agreement.Other, net.

Capital resources. Our sources of liquidity include cash and cash equivalents, a revolving credit facility under our Credit Agreement with Bank of America, N.A, JPMorgan Chase Bank, N.A., Wells Fargo Bank, N.A.,as an administrative agent and collateral agent, and a syndicate of financial institutions, as lenders (the Credit Agreement), and the Receivables Securitization Program. The Credit Agreement provides a revolving borrowing capacity of $400$300 million. The interest rate on our revolving credit facility and Term A Loans is based on 1) either the Eurocurrency Rate or the Base Rate plus 2) an Applicable Percentage which varies depending on Consolidated Total Leverage Ratio (each as defineda spread over a benchmark rate (as described in the Credit Agreement). Our credit spread on the revolving credit facility and Term A Loans at September 30, 2020 was Eurocurrency Rate plus 4.25%. Our Term B Loan accrues interest based on 1) either the Eurocurrency Rate or the Base Rate plus 2) an Applicable Percentage of 3.50% per annum for Base Rate Loans, and 4.50% per annum for Eurocurrency Rate Loans (each as defined in the Credit Agreement). Our credit spread on the Term B Loan at September 30, 2020 was Eurocurrency Rate plus 4.50%. We are charged a commitment fee of between 12.5 and 25.0basis points on the unused portion of the revolving credit facility.The Credit Agreement matures in March 2026.
At September 30, 20202021 and December 31, 2019,2020, we had borrowings of $70.0$12.3 million and $177.9$103 million, respectively, under the revolver and letters of credit of $9.4 million and $13.9 million and $11.7 million, respectively, outstanding under the Credit Agreement.our credit agreements. At September 30, 20202021 and December 31, 2019,2020, we had $316.1$278 million and $209.3$283 million, respectively, available for borrowing. The December 31, 2019 availability reflected letters of credit associated with discontinued operations of $1.1 million. There were no letters of credit associated with discontinued operations as of September 30, 2020. We also had letters of credit and bank guarantees outstanding for $2.4 million, of which $0.8 million are in process of being transferred to the buyer of Movianto, and $1.6$2.2 million and $1.5$1.6 million as of September 30, 20202021 and December 31, 2019, respectively,2020, which supports certain leased facilities as well as other normal business activities in the United States and Europe. These letters of credit and guarantees were issued independentoutside of the Credit Agreement.revolving credit facility.
We also haveentered into a Security and Pledge Agreement (the Security Agreement), dated March 10, 2021, pursuant to which we granted collateral on behalf of the holders of the 2021 Notes, the holders of the 2024 Notes, and the parties secured under the Credit Agreement (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Credit Parties (as defined) in the Credit Parties’ present and future subsidiaries, of each Credit Partysubject to certain customary exceptions, and (b) all present and future personal property and assets of the Credit Parties, subject to certain exceptions. The Fifth Amendment to the Credit Agreement included additional collateral requirements if the Credit Parties, including an obligation to pledge our owned U.S. real estate and the remaining equity interests in foreign subsidiaries.
Our Credit Agreement has a “springing maturity date” with respect to the revolving credit facility, the Term A Loans, and the Term B Loan. If the outstanding balance of the 2021 Notes has not been paid in full as of the date 91 days prior to the maturity date of the 2021 Notes, then the Termination Date (as defined in the Credit Agreement) of the revolving credit facility, the Term A Loans, and the Term B Loan shall be the date that is 91 days prior to the maturity date of the 2021 Notes. Likewise, if the outstanding balance of the 2024 Notes has not been paid in full as of the date 91 days prior to the maturity date of the 2024 Notes, the Termination Date of the Term B Loan shall be the date that is 91 days prior to the maturity date of the 2024 Notes.
On February 19, 2020,March 10, 2021, we entered into an amendment to our accounts receivable securitization program (the Receivables Securitization Program). Pursuant to the amended Receivables Securitization Program, the aggregate principal amount of the loans made by the Lenders (as defined) will not exceed $325$450 million outstanding at any time. The interest rate under the Receivables Securitization Program is based on a spread over a benchmark rate (as described in the London Interbank Offered Rate (LIBOR) dependent onThird Amendment to the tranche period thereto and any breakage fees accrued.Receivables Financing Agreement). Under the Receivables Securitization Program, certain of our subsidiaries sell substantially all of their accounts receivable balances to our wholly owned special purpose entity, O&M Funding LLC. The Receivables Securitization Program matures on February 17, 2023. Our Receivables Securitization Program has a “springing maturity date” with respect to the Term A Loans.If the outstanding balance of the Term A loans have not been paid in full as of the date 91 days prior to the maturity date of the Term A Loans, then the Scheduled Termination Date (as defined in the Receivables Financing Agreement) of the Receivables Securitization Program shall be the date that is 91 days prior to the maturity date of the Term A Loans. In February 2020, we drew $150 million from the Receivables Securitization Program to repay portions of the Term A Loans, consistent with the terms of the Fifth Amendment to the Credit Agreement. The Fifth Amendment to theMarch 2024.
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Credit Agreement requires that any additional draws on the Receivables Securitization Program are restricted for use to repay the 2021 Notes or Term A loans to the extent those instruments are outstanding.
The Credit Agreement, Receivables Securitization Program, 2024 Notes and Senior2029 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of either agreement.any of the related agreements. The terms of the Credit Agreement also require the companyus to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at September 30, 2020.
Current maturities include scheduled principal payments within the next 12 months of $44.6 million and $5.0 million for our Term A and Term B Loans, respectively, $1.0 million in short-term finance leases, and $178.5 million related to our 2021 Notes.2021.
In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50$50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of September 30, 20202021 no shares were issued and $50$50.0 million of common stock remained available under the at-the-market equity financing program.
On October 6, 2020, we completed a follow-on equity offering wherein we sold an aggregate of 8,475,000 shares ofWe regularly evaluate market conditions, our common stock at an offering price of $20.50, resulting in net proceedsliquidity profile and various financing alternatives to us of approximately $165 million, after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions. Pursuant to the underwriting agreement, we granted the underwriters an option to purchase up to an additional 1,271,250 shares ofenhance our common stock, which the underwriters exercised in full. Inclusive of this exercised option, net proceeds to us were approximately $190 million, after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions.
We used the proceeds from the follow-on equity offering to repay the remaining $109 million outstanding balance of Term Loan A-1 at par on October 8, 2020, to repay $52 million of our Term Loan A-2 at par on October 15, 2020, and to repay $30 million of borrowings under the revolving credit facility.
On October 30, 2020, we issued a notice of redemption to redeem all of our outstanding 2021 Notes on November 30, 2020 (the “Redemption Date”). The redemption price will include accrued and unpaid interest to, but not including, the Redemption Date, and a redemption premium, equal to the greater of (i) 100% of the principal amount of the 2021 Notes to be redeemed or (ii) the sum of the present values of the remaining scheduled payments of principal and interest thereon (exclusive of interest accrued to the Redemption Date) discounted to the Redemption Date on a semi-annual basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate plus 25 basis points.
capital structure. From time to time, we may enter into transactions to repay, repurchase or redeem our outstanding indebtedness (including by means of open market purchases, privately negotiated repurchases, tender or exchange offers and/or repayments or redemptions pursuant to the debt’s terms). Our ability to consummate any such transaction will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. We cannot provide any assurance as to if or when we will consummate any such transactions or the terms of any such transaction.
The third quarter dividend of $0.0025 per share was paid in September 2020.2021. The payment of future dividends remains within the discretion of the Board of Directors and will depend upon our results of operations, financial condition, capital requirements, current and future limitations under our Credit Agreement (as amended) and other factors.
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We believe available financing sources, including cash generated by operating activities and borrowings under the Credit Agreement and Receivables Securitization Program, will be sufficient to fund our working capital needs, capital expenditures, long-term strategic growth, payments under long-term debt and lease arrangements, payments of quarterly cash dividends, debt repurchases and other cash requirements. While we believe that we will have the ability to meet our financing needs in the foreseeable future, changes in economic conditions may impact (i) the ability of financial institutions to meet their contractual commitments to us, (ii) the ability of our customers and suppliers to meet their obligations to us or (iii) our cost of borrowing.
We earn a portion of our operating income in foreign jurisdictions outside the United States. Our cash and cash equivalents held by our foreign subsidiaries totaled $32.0$28.7 million and $52.9$72.0 million at September 30, 20202021 and December 31, 2019, respectively.2020. We continue to remain permanently reinvested in our foreign subsidiaries, with the exception of a subsidiary in Thailand. We have no specific plans to indefinitely reinvest the unremitted earnings of our foreign subsidiary located in Thailand as of September 30, 2020.2021. As such, we have recorded withholding tax liabilities that would be incurred upon future distribution to the U.S. There are no unrecognized deferred taxes as there is no outside basis difference unrelated to unremitted earnings for Thailand. We will continue to evaluate our foreign earnings repatriation policy in 20202021 for all our foreign subsidiaries.

Guarantor and Collateral Group Summarized Financial Information

We are providing the following information in compliance with Rule 13-01, “Financial Disclosures about Guarantors and Issuers of Guaranteed Securities” and Rule 13-02 of Regulation S-X, of with respect to our 2024 Notes. See Note 6 of the accompanying consolidated financial statements for additional information regarding the terms of the 2024 Notes.
The following tables present summarized financial information for Owens & Minor, Inc. and the guarantors of Owens & Minor, Inc.’s 2024 Notes (together, "the Guarantor Group"), on a combined basis with intercompany balances and transactions between entities in the Guarantor Group eliminated. The guarantor subsidiaries are 100% owned by Owens & Minor, Inc. Separate financial statements of the guarantor subsidiaries are not presented because the guarantees by our guarantor subsidiaries are full and unconditional, as well as joint and several.
Summarized financial information of the Guarantor Group is as follows:
Summarized Consolidated Statement of Operations - Guarantor GroupNine Months Ended September 30, 2021
(Dollars in thousands)
Net revenue(1)
$7,197,318
Gross margin1,086,054
Operating income265,888
Income from continuing operations, net of tax158,735
Net income158,735
(1)Includes $297 million in sales to non-guarantor subsidiaries for the nine months ended September 30, 2021.

Summarized Consolidated Balance Sheets - Guarantor GroupSeptember 30, 2021December 31, 2020
(Dollars in thousands)
Total current assets$1,428,986 $1,559,248 
Total assets2,950,802 2,943,125 
Current liabilities1,456,508 1,374,800 
Total liabilities2,500,939 2,465,894 

The following tables present summarized financial information for Owens & Minor, Inc. and the subsidiaries of Owens & Minor, Inc.’s 2024 Notes pledged that constitute a substantial portion of collateral (together, "the Collateral Group"), on a combined basis with intercompany balances and transactions between entities in the Collateral Group eliminated. The pledged subsidiaries are 100% owned by Owens & Minor, Inc. No trading market for the subsidiaries included in the Collateral Group exists.
Summarized financial information of the Collateral Group is as follows:
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Summarized Consolidated Balance Sheets - Collateral GroupSeptember 30, 2021December 31, 2020
(Dollars in thousands)
Total current assets$1,517,670 $1,651,460 
Total assets2,703,556 2,851,226 
Current liabilities1,422,746 1,356,024 
Total liabilities2,498,158 2,480,953 

The results of operations of the Collateral Group are not materially different from the corresponding amounts presented in our consolidated statements of operations.

Recent Accounting Pronouncements

For a discussion of recent accounting pronouncements, see our Annual Report on Form 10-K for the year ended December 31, 20192020 and Note 14 in the Notes to Consolidated Financial Statements, included in this Quarterly Report on Form 10-Q for the quarterly period ended on September 30, 2020.2021.

Forward-looking Statements

Certain statements in this discussion constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Although we believe our expectations with respect to the forward-looking statements are based upon reasonable assumptions within the bounds of our knowledge of our business and operations, all forward-looking statements involve risks and uncertainties and, as a result, actual results could differ materially from those projected, anticipated or implied by these statements. Such forward-looking statements involve known and unknown risks, including, but not limited to:
our ability to achieve revenue and operating income goals may be affected by: COVID-19 related factors, risks and challenges, including among others, the length of time that the pandemic continues, and any worsening of the pandemic, including through any new variant strains of the underlying virus, or future pandemics, related governmental responses, the effectiveness, availability, and public acceptance of vaccines, a decrease in revenue ultimately resulting in less cash flow, longer duration in receivables collection, the need to expedite payments to important suppliers may grow, shifts in demand away from certain products we manufacture and distribute, reduced workforces which may be caused by, but not limited to, the temporary inability of the workforce to work due to illness, quarantine, or government vaccine and other mandates, or temporary production and distribution center and office closures due to reduced workforces or government vaccine and other mandates, availability of raw materials, potential resulting labor negotiations or disputes, changes in the types and numbers of businesses that compete with us, including non-traditional competitors, and the aggressiveness of that competition, impacts of the pandemic or future pandemics on other third parties with whom we conduct business, the healthcare industry, and the broader business environment, and trends in elective surgeries and other healthcare spending not directly associated with COVID-19;
competitive pressures in the marketplace, including intense pricing pressure;
our ability to retain existing and attract new customers in a market characterized by significant customer consolidation and intense cost-containment initiatives;
our dependence on sales to certain customers or the loss or material reduction in purchases by key customers;
our dependence on distribution of product of certain suppliers;
our ability to successfully identify, manage or integrate acquisitions;
our ability to successfully manage our international operations, including risks associated with changes in international trade regulations, foreign currency volatility, changes in regulatory conditions, deteriorating economic conditions, adverse tax consequences, and other risks of operating in international markets;
uncertainties related to and our ability to adapt to changes in government regulations, including healthcare laws and regulations;
risks arising from possible violations of legal, regulatory or licensing requirements of the markets in which we operate;
uncertainties related to general economic, regulatory and business conditions;
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our ability to successfully implement our strategic initiatives;
the availability of and modifications to existing supplier funding programs and our ability to meet the terms to qualify for certain of these programs;
the effect of price volatility in the commodities markets, including fuel price fluctuations, on our operating costs and supplier product prices;
our ability to adapt to changes in product pricing and other terms of purchase by suppliers of product;
the ability of customers and suppliers to meet financial commitments due to us;
changes in manufacturer preferences between direct sales and wholesale distribution;
changing trends in customer profiles and ordering patterns and our ability to meet customer demand for additional value-added services;
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our ability to manage operating expenses and improve operational efficiencies in response to changing customer profiles;
our ability to meet performance targets specified by customer contracts under contractual commitments;
availability of and our ability to access special inventory buying opportunities;
the ability of business partners and financial institutions to perform their contractual responsibilities;
our ability to continue to obtain financing, obtain financing at reasonable rates and to manage financing costs and interest rate risk, and our ability to refinance, extend or repay our substantial indebtedness;
the risk that information systems are interrupted or damaged or fail for any extended period of time, that new information systems are not successfully implemented or integrated, or that there is a data security breach in our information systems;
the risk that a decline in business volume or profitability could result in an impairment of goodwill or other long-lived assets;
our ability to timely or adequately respond to technological advances in the medical supply industry;
the costs associated with and outcome of outstanding and any future litigation, including product and professional liability claims;
adverse changes in U.S. and foreign tax laws and the outcome of outstanding tax contingencies and legislative and tax proposals;
our ability to successfully implement the expense reduction and productivity and efficiency increasing initiatives;
our ability to continue to comply with the terms and conditions of Byram Healthcare’s Corporate Integrity Agreement;
the potentially adverse impact of the United Kingdom’s withdrawal from the European Union; and
other factors detailed from time to time in the reports we file with the SEC, including those described in “Item 1A. Risk Factors” of our Annual Report on Form 10-K for the year ended December 31, 2019, as updated and supplemented by Item 8.01 of2020, our Current Report on Form 8-K filed with the SEC on March 27, 2020 and our Quarterly Report on Form 10-Q for the quarterly periodthree months ended March 31, 2020.2021, and our Form 10-Q for the three and six months ended June 30, 2021.
We undertake no obligation to update or revise any forward-looking statements, except as required by applicable law.

Item 3. Quantitative and Qualitative Disclosures About Market Risk

We are subject to price risk for our raw materials, the most significant of which relates to the cost of polypropylene and nitrile used in the manufacturing processes of our Global Products segment. Prices of the commodities underlying these raw materials are volatile and have fluctuated significantly in recent years and in the future may contribute to fluctuations in our results of operations. The ability to hedge these commodity prices is limited.
In the normal course of business, we are exposed to foreign currency translation and transaction risks. Our business transactions outside of the United States are primarily denominated inin the Euro,euro, Malaysian ringgit, Mexican peso, Thai baht and Mexican Peso.other currencies. We may use foreign currency forwards, swaps and options, where possible, to manage our risk related to certain foreign currencycurrency fluctuations.
We are exposed to market risk from changes in interest rates related to our borrowing under our Credit Agreement and Receivables Securitization Program. However, we enter into interest rate swap agreements to manage our exposure to interest rate changes. We had $675 million in borrowings under our term loans, $70 $12.3 million in borrowings under our revolving credit facility, $148$197 million in
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borrowings under our Receivables Securitization Program and $14$9.4 million in letters of credit under the Credit Agreement at September 30, 2020. After considering the effects of interest rate swap agreements outstanding as of September 30, 2020, we2021. We estimate an increase in interest rates of 100 basis points would result in a potential reduction in future pre-tax earnings of approximately $6$2.2 million per year based on our borrowings outstanding at September 30, 2020.2021.
Due to the nature and pricing of our Global Solutions segment distribution services, we are exposed to potential volatility in fuel prices. Our strategies for helping to mitigate our exposure to changing domestic fuel prices have included using trucks with improved fuel efficiency. We benchmark our domestic diesel fuel purchase prices against the U.S. Weekly Retail On-Highway Diesel Prices (benchmark) as quoted by the U.S. Energy Information Administration. The benchmark averaged $2.58$3.16 and $3.06$2.58 per gallon in the first nine months of 20202021 and 2019, respectively.2020. Based on our fuel consumption in the first
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nine months of 2020,2021, we estimate that every 10 cents per gallon increase in the benchmark would reduce our Global Solutions segment operating income by approximately $0.2 million on an annualized basis.

Item 4. Controls and Procedures

We carried out an evaluation, with the participation of management, including our principal executive officer and principal financial officer, of the effectiveness of our disclosure controls and procedures (pursuant to Rule 13a-15(e) under the Securities Exchange Act of 1934, as amended) as of the end of the period covered by this report. Based upon that evaluation, the principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective as of September 30, 2020.2021. There was no change in our internal control over financial reporting that occurred during the period of this report that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

Part II. Other Information

Item 1. Legal Proceedings

Certain legal proceedings pending against us are described in our Annual Report on Form 10-K for the year ended December 31, 2019.2020. Through September 30, 2020,2021, there have been no material developments in any legal proceedings reported in such Annual Report.

Item 1A. Risk Factors
Certain
The following description of risk factors that we believe could affectupdates and supplements risk factors associated with our business and prospects are describedpreviously disclosed in our Annual Report on Form 10-K for the year ended December 31, 2019 and2020, our Form 10-Q for the three months ended March 31, 2021, and our Form 10-Q for the three and six months ended June 30, 2021. These risk factors are in addition to those mentioned in other parts of this report and are not all of the risks that we face. We could also be affected by risks that we currently are not aware of or that we currently do not consider material to our business.

We are subject to risks related to public health crises or future outbreaks of health crises or other adverse public health developments such as the global pandemic associated with the 2019 novel coronavirus (COVID-19).
As a global healthcare solutions company, we are impacted by public health crises such as the global pandemic associated with COVID-19. The outbreak has significantly increased uncertainty and unpredictability of global economic conditions and the demand for and supply of raw materials and finished goods required for our operations. In addition, public and private sector policies and initiatives to reduce the transmission of COVID-19, such as the imposition of travel restrictions, the adoption of remote working and vaccination mandates, have impacted or may in the future impact our operations. In these challenging and dynamic circumstances, we continue to work to protect our teammates and the public, maintain business continuity and sustain our operations, including ensuring the safety and protection of the people who work in our production and distribution centers across the world, many of whom support the manufacturing and delivery of products that are critical in response to the global pandemic. We may restrict the operations of our production and distribution centers if we deem it necessary or if recommended or mandated by governmental authorities which would have an adverse impact on us. There is a risk that revenues will decrease ultimately resulting in less cash flow, we may see longer duration in receivables collection, and the need to expedite payments to important suppliers may grow. COVID-19 has impacted and may further impact our supply chains relative to global demand for our facial protection, nitrile gloves, and protective apparel products. COVID-19 has also affected and may further affect the ability of suppliers and vendors to provide products and services to us or to do so at acceptable quality levels or prices. Some of these factors could increase the demand for our products, while others could decrease demand or make it more difficult for us to serve customers. For example, the significant reduction in elective surgical procedures, which began mid-March of 2020, resulted in a material negative impact on our revenue for 2020. Through September Any worsening of the COVID-19 pandemic or future outbreaks could result in similar reductions in elective surgical procedures or otherwise
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reduce demand for our products, any of which could have a material negative impact on our revenues and profit for future periods.
Although we have experienced significant growth in sales volumes for certain of our products (such as PPE) during the COVID-19 pandemic, as well as improved productivity and manufacturing output, there can be no assurance that such growth rates, increased sales volumes or other improvements will be maintained during or following the COVID-19 pandemic. We may also see a decline in such growth rates and sales volumes when the impact of the pandemic subsides and the healthcare system returns to a more normalized state. In particular, demand for such products may also decline as government-sponsored COVID-19 response stimulus, relief and production initiatives, such as those under the Defense Production Act (DPA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act, expire. An accelerated shift of demand away from certain of our products and services could also adversely impact our revenues and profit margins.
Furthermore, COVID-19 has impacted and may further impact the broader economies of affected countries, including negatively impacting economic growth, the proper functioning of financial and capital markets, foreign currency exchange rates, and interest rates. For example, the continued spread of COVID-19 has led to disruption and volatility in the global capital markets, which increases the cost of capital and adversely impacts access to capital. Due to the speed with which the situation is developing and the uncertainty of its duration, any future outbreaks, similar pandemics, the timing of recovery, travel restrictions, business closures or business disruptions, a recession, depression or other sustained adverse market event resulting from the spread of the COVID-19 and the effectiveness of actions taken in the United States and other countries to contain and treat the disease, we are not able at this time to predict the extent to which the COVID-19 pandemic, or any future outbreaks or similar pandemics, may have been noa material effect on our financial or operational results. However, the following adverse risks exist:
Actions by the United States government or other foreign government could affect our business. These actions include purchasing products that we make or sell, imposing new product standards or allowing the use of alternative products, instituting regulatory requirements to purchase only locally manufactured products, exercising control over manufacturing or distribution operations, including use of the DPA, taking trade actions including the imposition or removal of tariffs or import / export controls, subsidizing the supply of products, imposition of vaccine mandates or other actions;
Quarantine decisions by public or private entities may influence our ability to operate or our ability to ship or receive products. For example, if shipping companies cease or reduce land or sea freight channels, raw material and finished good deliveries may be slowed or stopped;
Our customers may change their payment patterns or lose their ability to pay invoices, which could have a material adverse impact on our cash flow;
Our suppliers may increase pricing or impose new purchasing requirements, such as minimum purchase quantities or pay-in-advance payment terms, which could have a material adverse impact on our cash flow;
Raw materials or finished goods that we require for our operations may not be available, or pricing for such items may increase beyond the willingness of our customers to pay;
New competitors may enter our market, including both small and large scale manufacturers;
COVID-19 illness among our workers in manufacturing or distribution operations could impact our operations or compel the closure of one or more facilities for an unknown period of time. Labor relations in our facilities related to COVID-19 could also negatively impact our operations;
We may invest in additional manufacturing capacity for which demand slows in the future, which could have a material adverse impact on our cash flow; and
Technology infrastructure failures could materially inhibit our operations that currently include a substantial portion of remote work. For example, voice or data line failures resulting from natural, manmade or cyber-attack could impair our ability to operate.
We have incurred additional costs to ensure we meet the needs of our customers, including increasing our workforce in order to produce or distribute certain essential products for our customers, providing personal protective equipment to our workforce, incremental shipping and transportation costs, incremental technology costs, and additional cleaning costs throughout our facilities. We expect to continue to incur additional costs, which may be significant as we continue to implement operational changes in response to this pandemic, any future outbreaks or similar pandemics. Further, our management is focused on mitigating COVID-19, which has required and will continue to require, a large investment of time and resources across our enterprise and will delay other value added services and strategic initiatives. Additionally, some of our teammates are currently working remotely. An extended period of remote work arrangements, and any worsening of the COVID-19 pandemic, or future outbreaks, could strain our business continuity plans, introduce operational risk, factors describedincluding but not limited to cybersecurity risks, and impair our ability to manage our business. If we do not respond appropriately to the pandemic, any future outbreaks or similar pandemics, or if customers do not perceive our response to be adequate for the United States or our international markets, we could suffer damage to our reputation and our brands, which could adversely affect our business.
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The impact of COVID-19 may also exacerbate other risks discussed in suchItem 1A. Risk Factors in our Annual Report on Form 10-K, any of which could have a material effect on us. This situation is changing rapidly and also no material changes in the risk factors described in the First Quarter 2020 Form 10-Q quarterly report.additional impacts may arise that we are not aware of currently.

Item 2. Unregistered Sales of Equity Securities, Use of Proceeds and Issuer Purchases of Equity Securities

In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50$50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of September 30, 2020, 02021, no shares were issued and $50$50.0 million of common stock remained available under the at-the-market equity financing program.

On October 6, 2020, we completed a follow-on equity offering wherein we sold an aggregate of 8,475,000 shares of our common stock at an offering price of $20.50, resulting in net proceeds to us of approximately $165 million, after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions. Pursuant to the underwriting agreement, we granted the underwriters an option to purchase up to an additional 1,271,250 shares of our common stock, which the underwriters exercised in full. Inclusive of this exercised option, net proceeds to us were approximately $190 million after deducting expenses relating to the follow-on equity offering, including the underwriters’ discounts and commissions.

Item 6. Exhibits

(a)Exhibits
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3.1
4.1
4.2
4.3
10.1
10.2
10.3
22.1
22.2
31.1  
31.2  
32.1  
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32.2  
101.INS  Inline XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCH  Inline XBRL Taxonomy Extension Schema Document
101.CAL  Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF  Inline XBRL Taxonomy Definition Linkbase Document
101.LAB  Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE  Inline XBRL Taxonomy Extension Presentation Linkbase Document
104Cover Page Interactive Data File (formatted as inline XBRL and contained in Exhibit 101)
* Certain exhibits and schedules have been omitted pursuant to Item 601(b)(2) of Regulation S-K. We hereby undertake to furnish copies of such omitted materials supplementally upon request by the SEC.
** Management contract or compensatory plan or arrangement
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
 
 Owens & Minor, Inc.
 (Registrant)
Date:November 2, 20203, 2021 /s/ Edward A. Pesicka
 Edward A. Pesicka
 President, & Chief Executive Officer & Director
Date:November 2, 20203, 2021 /s/ Andrew G. Long
 Andrew G. Long
 Executive Vice President & Chief Financial Officer
 
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