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 March 31,September 30, 2022
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 April 28,October 27, 2022 was 76,109,25976,234,454 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 5.
Item 6.
2


Table of Contents
Part I. Financial Information
Item 1. Financial Statements
Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Operations
(unaudited)
     
Three Months Ended
 March 31,
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
(in thousands, except per share data)(in thousands, except per share data)20222021(in thousands, except per share data)2022202120222021
Net revenueNet revenue$2,406,952 $2,326,534 Net revenue$2,497,401 $2,502,175 $7,404,368 $7,318,169 
Cost of goods soldCost of goods sold2,033,504 1,883,783 Cost of goods sold1,984,122 2,173,336 5,985,136 6,146,511 
Gross marginGross margin373,448 442,751 Gross margin513,279 328,839 1,419,232 1,171,658 
Distribution, selling and administrative expensesDistribution, selling and administrative expenses279,740 292,701 Distribution, selling and administrative expenses445,259 262,457 1,177,812 849,255 
Acquisition-related and exit and realignment chargesAcquisition-related and exit and realignment charges33,548 5,963 Acquisition-related and exit and realignment charges8,898 6,380 50,048 20,967 
Other operating income, netOther operating income, net(899)(2,605)Other operating income, net(1,125)(2,873)(5,020)(5,016)
Operating incomeOperating income61,059 146,692 Operating income60,247 62,875 196,392 306,452 
Interest expense, netInterest expense, net12,019 13,672 Interest expense, net39,869 11,572 87,727 36,784 
Loss on extinguishment of debtLoss on extinguishment of debt 40,433 Loss on extinguishment of debt —  40,433 
Other expense, netOther expense, net783 569 Other expense, net783 799 2,347 2,397 
Income before income taxesIncome before income taxes48,257 92,018 Income before income taxes19,595 50,504 106,318 226,838 
Income tax provisionIncome tax provision8,978 22,429 Income tax provision7,098 6,375 25,937 47,224 
Net incomeNet income$39,279 $69,589 Net income$12,497 $44,129 $80,381 $179,614 
Net income per common share:Net income per common share:Net income per common share:
BasicBasic$0.53 $0.98 Basic$0.17 $0.60 $1.08 $2.47 
DilutedDiluted$0.52 $0.98 Diluted$0.16 $0.58 $1.05 $2.38 
See accompanying notes to consolidated financial statements.
3

Table of Contents
Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Comprehensive Income
(unaudited)
 
Three Months Ended
 March 31,
Three Months Ended
September 30,
Nine Months Ended
September 30,
(in thousands)(in thousands)20222021(in thousands)2022202120222021
Net incomeNet income$39,279 $69,589 Net income$12,497 $44,129 $80,381 $179,614 
Other comprehensive (loss) income, net of tax:
Other comprehensive income (loss) net of tax:Other comprehensive income (loss) net of tax:
Currency translation adjustmentsCurrency translation adjustments(787)(12,262)Currency translation adjustments(19,986)(12,014)(39,604)(26,724)
Change in unrecognized net periodic pension costsChange in unrecognized net periodic pension costs189 121 Change in unrecognized net periodic pension costs288 395 774 552 
Change in gains and losses on derivative instrumentsChange in gains and losses on derivative instruments 20,044 Change in gains and losses on derivative instruments9,167 — 11,931 20,044 
Total other comprehensive (loss) income, net of tax(598)7,903 
Total other comprehensive (loss), net of taxTotal other comprehensive (loss), net of tax(10,531)(11,619)(26,899)(6,128)
Comprehensive incomeComprehensive income$38,681 $77,492 Comprehensive income$1,966 $32,510 $53,482 $173,486 
    
See accompanying notes to consolidated financial statements.
4

Table of Contents
Owens & Minor, Inc. and Subsidiaries
Consolidated Balance Sheets
(unaudited)
 
March 31,December 31,September 30,December 31,
(in thousands, except per share data)(in thousands, except per share data)20222021(in thousands, except per share data)20222021
AssetsAssetsAssets
Current assetsCurrent assetsCurrent assets
Cash and cash equivalentsCash and cash equivalents$211,298 $55,712 Cash and cash equivalents$76,770 $55,712 
Accounts receivable, net of allowances of $20,714 and $18,003775,779 681,564 
Accounts receivable, net of allowances of $11,016 and $18,003Accounts receivable, net of allowances of $11,016 and $18,003751,970 681,564 
Merchandise inventoriesMerchandise inventories1,447,383 1,495,972 Merchandise inventories1,508,443 1,495,972 
Other current assetsOther current assets118,889 88,564 Other current assets104,734 88,564 
Total current assetsTotal current assets2,553,349 2,321,812 Total current assets2,441,917 2,321,812 
Property and equipment, net of accumulated depreciation of $344,569 and $334,500586,668 317,235 
Property and equipment, net of accumulated depreciation of $414,920 and $334,500Property and equipment, net of accumulated depreciation of $414,920 and $334,500575,799 317,235 
Operating lease assetsOperating lease assets278,205 194,006 Operating lease assets275,833 194,006 
GoodwillGoodwill1,657,159 390,185 Goodwill1,631,336 390,185 
Intangible assets, netIntangible assets, net494,888 209,745 Intangible assets, net464,077 209,745 
Other assets, netOther assets, net137,700 103,568 Other assets, net149,620 103,568 
Total assetsTotal assets$5,707,969 $3,536,551 Total assets$5,538,582 $3,536,551 
Liabilities and equityLiabilities and equityLiabilities and equity
Current liabilitiesCurrent liabilitiesCurrent liabilities
Accounts payableAccounts payable$1,115,400 $1,001,959 Accounts payable$1,156,230 $1,001,959 
Accrued payroll and related liabilitiesAccrued payroll and related liabilities95,995 115,858 Accrued payroll and related liabilities106,618 115,858 
Other current liabilitiesOther current liabilities442,900 226,204 Other current liabilities339,526 226,204 
Total current liabilitiesTotal current liabilities1,654,295 1,344,021 Total current liabilities1,602,374 1,344,021 
Long-term debt, excluding current portionLong-term debt, excluding current portion2,635,314 947,540 Long-term debt, excluding current portion2,547,059 947,540 
Operating lease liabilities, excluding current portionOperating lease liabilities, excluding current portion221,612 162,241 Operating lease liabilities, excluding current portion215,022 162,241 
Deferred income taxesDeferred income taxes110,319 35,310 Deferred income taxes83,473 35,310 
Other liabilitiesOther liabilities138,807 108,938 Other liabilities123,817 108,938 
Total liabilitiesTotal liabilities4,760,347 2,598,050 Total liabilities4,571,745 2,598,050 
Commitments and contingenciesCommitments and contingencies00Commitments and contingencies
EquityEquityEquity
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 76,086 shares and 75,433 shares152,172 150,865 
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 76,217 shares and 75,433 sharesCommon stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 76,217 shares and 75,433 shares152,434 150,865 
Paid-in capitalPaid-in capital409,741 440,608 Paid-in capital413,894 440,608 
Retained earningsRetained earnings426,898 387,619 Retained earnings467,999 387,619 
Accumulated other comprehensive lossAccumulated other comprehensive loss(41,189)(40,591)Accumulated other comprehensive loss(67,490)(40,591)
Total equityTotal equity947,622 938,501 Total equity966,837 938,501 
Total liabilities and equityTotal liabilities and equity$5,707,969 $3,536,551 Total liabilities and equity$5,538,582 $3,536,551 
See accompanying notes to consolidated financial statements.
5

Table of Contents
Owens & Minor, Inc. and Subsidiaries
Consolidated Statements of Cash Flows
(unaudited)
Three Months Ended March 31,
(in thousands)20222021
Operating activities:
Net income$39,279 $69,589 
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization24,125 22,900 
Share-based compensation expense5,403 5,182 
Loss on extinguishment of debt 40,433 
Provision for losses on accounts receivable5,628 8,462 
Deferred income tax benefit(69)(5,865)
Changes in operating lease right-of-use assets and lease liabilities(462)448 
Changes in operating assets and liabilities:
Accounts receivable(12,919)(45,919)
Merchandise inventories58,098 (89,393)
Accounts payable(6,967)18,742 
Net change in other assets and liabilities(33,165)(1,666)
Other, net748 2,510 
Cash provided by operating activities79,699 25,423 
Investing activities:
Acquisition, net of cash acquired(1,576,278)— 
Additions to property and equipment(9,609)(5,048)
Additions to computer software(1,352)(1,575)
Other, net3 
Cash used for investing activities(1,587,236)(6,619)
Financing activities:
Proceeds from issuance of debt1,691,000 500,000 
Borrowings (repayments) under revolving credit facility, net and accounts receivable securitization program41,700 (21,600)
Repayments of debt (523,140)
Financing costs paid(33,744)(11,700)
Cash dividends paid (181)
Payment for termination of interest rate swaps (15,434)
Other, net(34,762)(8,339)
Cash provided by (used for) financing activities1,664,194 (80,394)
Effect of exchange rate changes on cash, cash equivalents and restricted cash(669)(2,139)
Net increase (decrease) in cash, cash equivalents and restricted cash155,988 (63,729)
Cash, cash equivalents and restricted cash at beginning of period72,035 134,506 
Cash, cash equivalents and restricted cash at end of period$228,023 $70,777 
Supplemental disclosure of cash flow information:
Income taxes paid, net of refunds$4,478 $898 
Interest paid$12,626 $10,255 

Nine Months Ended September 30,
(in thousands)20222021
Operating activities:
Net income$80,381 $179,614 
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization155,438 68,142 
Share-based compensation expense15,765 19,078 
Loss on extinguishment of debt 40,433 
Provision for losses on accounts receivable5,289 19,270 
Deferred income tax expense (benefit)2,991 (18,286)
Changes in operating lease right-of-use assets and lease liabilities922 1,190 
Gain on sale and dispositions of property and equipment(17,002) 
Changes in operating assets and liabilities:
Accounts receivable7,417 (84,381)
Merchandise inventories(6,823)(284,188)
Accounts payable30,424 120,821 
Net change in other assets and liabilities(45,423)(8,341)
Other, net8,666 20,484 
Cash provided by operating activities238,045 73,836 
Investing activities:
Acquisition, net of cash acquired(1,684,607)— 
Additions to property and equipment(109,275)(26,446)
Additions to computer software(5,873)(6,179)
Proceeds from sale of property and equipment29,720 41 
Other, net(1,670) 
Cash used for investing activities(1,771,705)(32,584)
Financing activities:
Proceeds from issuance of debt1,691,000 574,900 
Borrowings (repayments) under revolving credit facility, net and accounts receivable securitization program30,000 (90,900)
Repayments of debt(3,000)(553,140)
Borrowings under amended accounts receivable securitization program697,700 — 
Repayments under amended accounts receivable securitization program(770,700)— 
Financing costs paid(42,602)(13,912)
Cash dividends paid (548)
Payment for termination of interest rate swaps (15,434)
Other, net(41,813)(18,188)
Cash provided by (used for) financing activities1,560,585 (117,222)
Effect of exchange rate changes on cash, cash equivalents and restricted cash(5,752)(2,454)
Net increase (decrease) in cash, cash equivalents and restricted cash21,173 (78,424)
Cash, cash equivalents and restricted cash at beginning of period72,035 134,506 
Cash, cash equivalents and restricted cash at end of period$93,208 $56,082 
Supplemental disclosure of cash flow information:
Income taxes paid, net of refunds$33,568 $83,606 
Interest paid$61,889 $32,035 
Noncash investing activity:
Unpaid purchases of property and equipment and software at end of period$63,158 $— 
See accompanying notes to consolidated financial statements.
6

Table of Contents
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, 2021Balance, December 31, 202175,433 $150,865 $440,608 $387,619 $(40,591)$938,501 Balance, December 31, 202175,433 $150,865 $440,608 $387,619 $(40,591)$938,501 
Net incomeNet income39,279 39,279 Net income39,279 39,279 
Other comprehensive lossOther comprehensive loss(598)(598)Other comprehensive loss(598)(598)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other653 1,307 (30,867)(29,560)Share-based compensation expense, exercises and other653 1,307 (30,867)(29,560)
Balance, March 31, 2022Balance, March 31, 202276,086 $152,172 $409,741 $426,898 $(41,189)$947,622 Balance, March 31, 202276,086 152,172 409,741 426,898 (41,189)947,622 
Net incomeNet income28,604 28,604 
Other comprehensive lossOther comprehensive loss(15,770)(15,770)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other85 171 (1,968)(1,797)
Balance, June 30, 2022Balance, June 30, 202276,171 152,343 407,773 455,502 (56,959)958,659 
Net incomeNet income12,497 12,497 
Other comprehensive lossOther comprehensive loss(10,531)(10,531)
Share-based compensation expense, exercises and otherShare-based compensation expense, exercises and other46 91 6,121 6,212 
Balance, September 30, 2022Balance, September 30, 202276,217 $152,434 $413,894 $467,999 $(67,490)$966,837 
Balance, December 31, 2020Balance, December 31, 202073,472 $146,944 $436,597 $167,022 $(38,509)$712,054 Balance, December 31, 202073,472 $146,944 $436,597 $167,022 $(38,509)$712,054 
Net incomeNet income69,589 69,589 Net income69,589 69,589 
Other comprehensive incomeOther comprehensive income7,903 7,903 Other comprehensive income7,903 7,903 
Dividends declared ($0.0025 per share)Dividends declared ($0.0025 per share)(434)(434)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)Share-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 Balance, 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, 202175,395 150,791 428,360 301,886 (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 
See accompanying notes to consolidated financial statements.
7

Table of Contents
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, our or the Company) and contain all adjustments (which are comprised only of normal recurring accruals and use of estimates) necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year.
To better reflect how we go to market as well as certain changes to the leadership team, organizational structure, budgeting and financial reporting processes which drive changes to segment reporting, we have organized ourOur business into 2has two distinct segments: Products & Healthcare Services and Patient Direct. Products & Healthcare Services provides distribution, outsourced logistics and value-added services, and manufactures and sources medical surgical products through our production and kitting operations. Patient Direct expands our business along the continuum of care through delivery of disposable medical supplies sold directly to patients and home health agencies and is a leading provider of integrated home healthcare equipment and related services in the United States. Beginning with the quarter ended March 31, 2022, we now reporthave reported financial results using this 2two segment structure and have recastour prior year segment results on the same basis.
On March 29, 2022, we completed the acquisition of 100% of Apria, Inc. pursuant to the Agreement and Plan of Merger dated January 7, 2022, in exchange for approximately $1.7 billion, net of cash acquired. Refer to Note 3 for additional details.
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,North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash included in Other assets, net as of March 31,September 30, 2022 and December 31, 2021 primarily represents cash held in an escrow account as required by the Centers for Medicare & Medicaid Services (CMS) in conjunction with the Bundled Payments for Care Improvement (BPCI) initiatives related to wind-down costs of Fusion5.
The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows.
March 31, 2022December 31, 2021September 30, 2022December 31, 2021
Cash and cash equivalentsCash and cash equivalents$211,298 $55,712 Cash and cash equivalents$76,770 $55,712 
Restricted cash included in Other assets, netRestricted cash included in Other assets, net16,725 16,323 Restricted cash included in Other assets, net16,438 16,323 
Total cash, cash equivalents, and restricted cashTotal cash, cash equivalents, and restricted cash$228,023 $72,035 Total cash, cash equivalents, and restricted cash$93,208 $72,035 
Patient
Property and Equipment, net
Patient equipment, which is included within propertyProperty and equipment net, isare stated at cost less accumulated depreciation. Depreciation and amortization expense for financial reporting purposes is computed on a straight-line method over the estimated useful lives of the assets or, for capital leases and leasehold improvements, over the term of the lease, if shorter. In general, the estimated useful lives for computing depreciation and reservesamortization are three to 15 years for non-recoverablemachinery and obsoleteequipment, five to 40 years for buildings, one to 10 years for patient equipment.equipment, and up to 15 years for leasehold and land improvements. Straight-line and accelerated methods of depreciation are used for income tax purposes. Normal maintenance and repairs are expensed as incurred, and renovations and
8


Table of Contents
betterments are capitalized. We suspend depreciation and amortization on assets that are held for sale. In addition, we record capital-related government grants earned as reductions to the cost of property and equipment; and associated unpaid liabilities and grant proceeds receivable are considered non-cash changes in such balances for purposes of preparation of our consolidated statements of cash flows. Patient equipment consists of medical equipment rented to patients on a month-to-month basis. Patient equipment depreciation is generally placed for rent; however, it could also beclassified in our consolidated statements of operations within cost of goods sold to customers. Onceas the rented equipment is returnedrented to us,patients as part of our primary operations within the patientPatient Direct segment.
Revenue Recognition
Our revenue is primarily generated from sales contracts with customers. Under most of our distribution and product sales arrangements, our performance obligations are limited to delivery of products to a customer upon receipt of a purchase order. For these arrangements, we recognize revenue at the point in time when shipment is completed, as control passes to the customer upon product receipt.
Revenue for activity-based fees and other services is recognized over time as activities are performed. Depending on the specific contractual provisions and nature of the performance obligation, revenue from services may be recognized on a straight-line basis over the term of the service, on a proportional performance model, based on level of effort, or when final deliverables have been provided.
Our contracts sometimes allow for forms of variable consideration including rebates, discounts, performance guarantees, and implicit price concessions. In these cases, we estimate the amount of consideration to which we will be entitled in exchange for transferring the product or service to the customer. Rebates and customer discounts are estimated based on contractual terms or historical experience and we maintain an accrual for rebates or discounts that have been earned but are unpaid. When we have implicit price concessions, we determine the variable consideration under the expected value method as part of determining the sales transaction price using historical reimbursement experience, historical sales returns, and other operating trends.
In most cases, we record revenue gross, as we are the primary obligor. When we act as an agent in a sales arrangement and do not bear a significant portion of inventory risks, primarily for our outsourced logistics business, we record revenue net of product cost. Sales taxes collected from customers and remitted to governmental authorities are excluded from revenues.
Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is assessedgenerated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and repairedcommences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental revenue, less estimated adjustments, is recognized as necessary. Patientearned on a straight-line basis over the noncancellable lease term. We recorded $148 million and $299 million in revenue related to equipment is typically leasedwe rent to subsequent patients if its condition is suitable.
8


Table of Contents
for the three and nine months ended September 30, 2022. Equipment rental revenue was not material in the prior year.

Note 2—Fair Value

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

Note 3—Acquisition
On March 29, 2022 (the Acquisition Date), we completed the acquisition of 100% of Apria, Inc. (Apria) pursuant to the Agreement and Plan of Merger (Apria Acquisition) dated January 7, 2022, in exchange for approximately $1.7 billion, including $108 million owed to holders of Apria stock awards as of March 31, 2022 that was paid in April 2022, net of $144 million of cash acquired. The purchase was funded with a combination of debt and cash on hand. At the time of the Apria Acquisition, each share of Apria’s common stock was converted into the right to receive $37.50 in cash. Apria is a leading provider of integrated home healthcare equipment and related services in the United States. This business is reported as part of the Patient Direct segment.
The following table presents the preliminary estimated fair value of the assets acquired and liabilities assumed recognized as of the Acquisition Date. The fair value and useful lives of tangible and intangible assets acquired have been
9


Table of Contents
estimated based on various valuation methods, including the income and cost approach, using several significant unobservable inputs including, but not limited to projected cash flows and a review of publicly available data for transactions involving companies deemed comparable to the Company.discount rate. These inputs are considered Level 3 inputs. The allocation of purchase price to assets and liabilities acquired is not yet complete, as valuations of tangible and intangible assets and liabilities are still in process. The updated preliminary purchase price allocation resulted in an approximate $8.3 million reduction in intangible amortization expense during the three months ended September 30, 2022 that would have been recognized in previous periods if the adjustment to provisional amounts were recognized as of the Acquisition Date. This reduction resulted from a reallocation of intangible assets value to those with longer useful lives as compared to the purchase price allocation originally estimated as of the Acquisition Date.
Preliminary Fair Value Currently Estimated as of Acquisition Date
Assets acquired:
Current assets$142,136 
Goodwill1,267,079 
Intangible assets295,466 
Other non-current assets371,320 
Total assets2,076,001 
Liabilities assumed:
Current liabilities241,266 
Noncurrent liabilities150,128 
Total liabilities391,394 
Fair value of net assets acquired, net of cash$1,684,607 
Preliminary Fair Value Originally Estimated as of Acquisition Date(1)
Differences Between Prior and the Current Periods Preliminary Fair Value EstimatePreliminary Fair Value Currently Estimated as of Acquisition Date
Assets acquired:
Current assets$142,136 $(1,968)$140,168 
Goodwill1,267,079 (17,601)1,249,478 
Intangible assets295,466 17,334 312,800 
Other non-current assets371,320 (11,149)360,171 
Total assets$2,076,001 $(13,384)$2,062,617 
Liabilities assumed:
Current liabilities$241,266 $5,012 $246,278 
Noncurrent liabilities150,128 (18,396)131,732 
Total liabilities391,394 (13,384)378,010 
Fair value of net assets acquired, net of cash$1,684,607 $— $1,684,607 

(1) As previously reported in our first quarter 2022 Form 10-Q.
Current assets acquired includes $89.3 million in fair value of receivables, which reflects the approximate amount contractually owed. We are amortizing the preliminary fair value of acquired intangible assets, primarily customer contracts, trade names andrelationships, including payor and capitated relationships, and trade names over their estimated weighted average useful lives of twoone to 15 years.
Goodwill of $1.3$1.2 billion, which we assigned to our Patient Direct segment, consists largely of expected opportunities to expand into new markets and further develop a presence in the home healthcare business. NaNneApproximately $32 million of the goodwill recognized is expected to be deductible for income tax purposes.
The following table provides pro forma results of net revenue and net (loss) income for the three and nine months ended March 31,September 30, 2022 and 2021 as if Apria was acquired on January 1, 2021. The pro forma results below are not necessarily indicative of the results that would have been if the acquisition had occurred on the dates indicated, nor are the pro forma results indicative of results which may occur in the future.
9
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
Net revenue$2,497,401 $2,789,372 $7,681,481 $8,166,919 
Net income (loss)$12,497 $66,935 $(39,696)$227,540 


Table of Contents
Three Months Ended March 31,
20222021
Net revenue$2,684,065 $2,601,808 
Net (loss) income$(90,182)$74,133 
Pro forma net loss of $90.2$39.7 million for the threenine months ended March 31,September 30, 2022 includes pro forma adjustments for interest expense of $20.8 million and amortization of intangible assets of $20.3 million.$10.9 million, which reflects the updated preliminary purchase price allocation. The Propro forma net loss also includes $39.4 million in seller transaction expenses and stock compensation expense associated with $108 million owed to the holders of Apria stock awards in connection with the Apria Acquisition. The amount of revenueRevenue and net income of Apria since the Acquisition Date for the three months ended September 30, 2022 included in the consolidated statement of operations were $310 million and $0.7 million, respectively.Revenue and net loss of Apria since the Acquisition Date included in the consolidated statement of operations for the threenine months ended March 31,September 30, 2022 have not been separately disclosed, as the effects were not material to our consolidated financial statements.$620 million and $38.4 million, respectively.

10


Table of Contents
Note 4—Goodwill and Intangible Assets

In connection with our new segment structure, which began in the first quarter of 2022, goodwill is now reported as part of Products & Healthcare Services or Patient Direct. There was no change to our underlying reporting units as part of that segment change and therefore no reallocation of goodwill. The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill through March 31,September 30, 2022:

Products & Healthcare ServicesPatient DirectConsolidatedProducts & Healthcare ServicesPatient DirectConsolidated
Carrying amount of goodwill, December 31, 2021Carrying amount of goodwill, December 31, 2021$106,280 $283,905 $390,185 Carrying amount of goodwill, December 31, 2021$106,280 $283,905 $390,185 
Acquisition— 1,267,079 1,267,079 
AcquisitionsAcquisitions(532)1,249,478 1,248,946 
Currency translation adjustmentsCurrency translation adjustments(105)— (105)Currency translation adjustments(7,795)— (7,795)
Carrying amount of goodwill, March 31, 2022$106,175 $1,550,984 $1,657,159 
Carrying amount of goodwill, September 30, 2022Carrying amount of goodwill, September 30, 2022$97,953 $1,533,383 $1,631,336 

Intangible assets subject to amortization at March 31,September 30, 2022 and December 31, 2021 were as follows:

March 31, 2022December 31, 2021September 30, 2022December 31, 2021
Customer
Relationships
TradenamesOther
Intangibles
Customer
Relationships
TradenamesOther
Intangibles
Customer
Relationships
TradenamesOther
Intangibles
Customer
Relationships
TradenamesOther
Intangibles
Gross intangible assetsGross intangible assets$275,429 $156,937 $271,761 $275,526 $90,000 $43,189 Gross intangible assets$434,582 $202,000 $79,062 $275,526 $90,000 $43,189 
Accumulated amortizationAccumulated amortization(152,465)(35,351)(21,423)(146,168)(33,242)(19,560)Accumulated amortization(182,741)(45,203)(23,623)(146,168)(33,242)(19,560)
Net intangible assetsNet intangible assets$122,964 $121,586 $250,338 $129,358 $56,758 $23,629 Net intangible assets$251,841 $156,797 $55,439 $129,358 $56,758 $23,629 
Weighted average useful lifeWeighted average useful life10 years11 years5 years10 years11 years8 yearsWeighted average useful life12 years10 years7 years10 years11 years8 years

At March 31,September 30, 2022 and December 31, 2021, $158$142 million and $164 million in net intangible assets were held in the Products & Healthcare Services segment and $337$322 million and $45.7 million were held in the Patient Direct segment. Amortization expense for intangible assets was $10.3$14.3 million and $10.0 million for the three months ended March 31,September 30, 2022 and 2021 and $55.5 million and $30.1 million for the nine months ended September 30, 2022 and 2021. At March 31,September 30, 2022, customer relationships, tradenames, and other intangibles includesinclude preliminary estimated fair values of payor relationships, customer list and other intangible assets acquired as part of the Apria Acquisition.
Based on the current carrying value of intangible assets subject to amortization, estimated amortization expense is approximately $96$22 million for the remainder of 2022, $126$82 million for 2023, $67$65 million for 2024, $42$55 million for 2025, $41$54 million for 2026 and $38$47 million for 2027.

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
10


Table of Contents
realignment which include leadership reorganization costs, certain professional fees, and costs to streamline administrative functions and processes and divestiture related costs.
Exit and realignment charges by segment for the three and nine months ended March 31,September 30, 2022 and 2021 were as follows:
Three Months Ended
 March 31,
Three Months Ended
 September 30,
Nine Months Ended
September 30,
202220212022202120222021
Products & Healthcare ServicesProducts & Healthcare Services$1,199 $5,963 Products & Healthcare Services$1,983 $5,091 $4,396 $18,933 
Patient DirectPatient Direct483 — Patient Direct 1,289 483 2,034 
Total exit and realignment chargesTotal exit and realignment charges$1,682 $5,963 Total exit and realignment charges$1,983 $6,380 $4,879 $20,967 
11


Table of Contents
The following table summarizes the activity related to exit and realignment cost accruals through March 31,September 30, 2022 and 2021:
Total
Accrued exit and realignment costs, December 31, 2021$8,306 
Provision for exit and realignment activities:
Severance811 
Other871 
Cash payments(6,903)
Accrued exit and realignment costs, March 31, 20223,085
Provision for exit and realignment activities:
Severance246 
Other968 
Cash payments(3,477)
Accrued exit and realignment costs, June 30, 2022822
Provision for exit and realignment activities:
Other1,251 
Cash payments(1,693)
Accrued exit and realignment costs, September 30, 2022$3,085380 
Accrued exit and realignment costs, December 31, 2020$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$2,3883,116 
In addition to the exit and realignment accruals in the preceding table, we also incurred $3.8$0.7 million of costs that were expensed as incurred for the three and nine months ended March 31, 2021, including $3.2 millionSeptember 30, 2022, which related to an increase in reserves associated with certain retained assets of Fusion5, $0.5Fusion5. We incurred $1.6 million in impairment chargesand $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 our client engagement center,Fusion5 for the three and $0.1 million in other asset charges.nine months ended September 30, 2021.
12


Table of Contents
Acquisition-related charges within acquisition-related and exit and realignment charges presented in our consolidated statements of operations were $31.9$6.9 million and $45.2 million for the three and nine months ended March 31,September 30, 2022, which consisted primarily of costs related to the Apria acquisition.Acquisition. There were 0no acquisition-related charges included within acquisition-related and exit and realignment charges presented in our consolidated statements of operations for the three and nine months ended March 31,September 30, 2021.
We do not expect material additional costs in 2022 for activities that were initiated through March 31,September 30, 2022.

11


Table of Contents
Note 6—Debt

Debt consists of the following:
March 31, 2022December 31, 2021September 30, 2022December 31, 2021
Carrying
Amount
Estimated
Fair Value
Carrying
Amount
Estimated
Fair Value
Carrying
Amount
Estimated
Fair Value
Carrying
Amount
Estimated
Fair Value
Receivables Securitization Program$226,169 $230,000 $197,026 $200,000 
Receivables securitization programReceivables securitization program$153,823 $157,000 $197,026 $200,000 
4.375% Senior Notes, due December 20244.375% Senior Notes, due December 2024245,286 250,068 245,086 263,263 4.375% Senior Notes, due December 2024245,436 239,179 245,086 263,263 
Revolver11,700 11,700 — — 
Term Loan ATerm Loan A489,848 500,000 — — Term Loan A490,278 500,000 — — 
4.500% Senior Notes, due March 20294.500% Senior Notes, due March 2029491,887 478,415 491,656 515,225 4.500% Senior Notes, due March 2029492,469 394,855 491,656 515,225 
Term Loan BTerm Loan B579,080 589,878 — — Term Loan B577,062 585,806 — — 
6.625% Senior Notes, due March 2030583,930 617,484 — — 
6.625% Senior Notes, due April 20306.625% Senior Notes, due April 2030584,934 526,968 — — 
Finance leases and otherFinance leases and other15,615 15,615 15,809 15,809 Finance leases and other17,777 17,777 15,809 15,809 
Total debtTotal debt2,643,515 2,693,160 949,577 994,297 Total debt2,561,779 2,421,585 949,577 994,297 
Less current maturitiesLess current maturities(8,201)(8,100)(2,037)(2,037)Less current maturities(14,720)(14,720)(2,037)(2,037)
Long-term debtLong-term debt$2,635,314 $2,685,060 $947,540 $992,260 Long-term debt$2,547,059 $2,406,865 $947,540 $992,260 

We have $246 million, excluding deferred financing costs and third party fees, of 4.375% senior notes due in December 2024 (the 2024 Notes), with interest payable semi-annually. The 2024 Notes were sold at 99.6% of the principal amount with an effective yield of 4.422%. We have the option to redeem the 2024 Notes in part or in whole prior to maturity at a redemption price equal to the greater of 100% of the principal amount or the present value of the remaining scheduled payments discounted at the applicable Benchmark Treasury Rate (as defined) plus 30 basis points.
In March 2021, we issued $500 million, excluding deferred financing costs and third party fees, of 4.500% senior unsecured notes due in March 2029 (the 2029 Unsecured Notes), with interest payable semi-annually (the Notes Offering). The 2029 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 4.500%. We may redeem all or part of the 2029 Unsecured Notes prior to March 31, 2024, at a price equal to 100% of the principal amount of the 2029 Unsecured Notes redeemed, plus accrued and unpaid interest, if any, to, but not including, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 10, 2021 (the Indenture). On or after March 31, 2024, we may redeem all or part of the 2029 Unsecured Notes at the applicable redemption prices described in the Indenture, plus accrued and unpaid interest, if any, to, but not including, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2029 Unsecured Notes at any time prior to March 31, 2024, at a redemption price equal to 104.5% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date.
On March 29, 2022, we completed the sale of $600 million in aggregate principal amount of our 6.625% senior notes due in April 2030 (the 2030 Unsecured Notes), with interest payable semi-annually. The 2030 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 6.625%.
We may redeem all or part of the 2030 Unsecured Notes, prior to April 1, 2025, at a price equal to 100% of the principal amount of the 2030 Unsecured Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 29, 2022 (the New Indenture.Indenture). From and after April 1, 2025, we may redeem all or part of the 2030 Unsecured Notes at the applicable redemption prices described in the New Indenture, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. We may also redeem up to 40% of the aggregate principal amount of 2030 Unsecured Notes at any time prior to April 1, 2025, at a redemption price equal to 106.625% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date.
The 2029 Unsecured Notes and 2030 Unsecured Notes will beare effectively subordinated to any of our secured indebtedness, including indebtedness under theour credit agreements.
13


Table of Contents
On March 29, 2022, we entered into a term loan credit agreement with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (the Credit Agreement) that provides for 2two new credit facilities (i) a $500 million Term Loan A facility (the Term Loan A), and (ii) a $600 million Term Loan B facility (the Term Loan B). The interest rate on the Term Loan A is based on either the Term SOFR or the Base Rate plus an Applicable Rate which varies depending on the current Debt Ratings or Total Leverage Ratio, determined as to whichever shall result in more favorable
12


Table of Contents
pricing to the Borrowers (each as defined in the Credit Agreement). The interest rate on the Term Loan B is based on either the Term SOFR or the Base Rate plus an Applicable Rate. The Term Loan A will mature in March 2027 and the Term Loan B will mature in March 2029.
On March 29, 2022, we entered into an amendment to our revolving credit agreement, dated as of March 10, 2021 with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (Revolving Credit Agreement). The amendment will (i) increaseincreased the aggregate revolving credit commitments under the Revolving Credit Agreement by $150 million, to an aggregate amount of $450 million and (ii) replacereplaced the Eurocurrency Rate with the Adjusted Term SOFR Rate (each as defined in the Revolving Credit Agreement). The Revolving Credit Agreement matures in March 2027.
At March 31,September 30, 2022, we had no borrowings of $11.7 million and letters of credit of $28.0$27.9 million under our revolving credit facility.Revolving Credit Agreement. At December 31, 2021, we had no borrowings and letters of credit of $9.4 million outstanding under our revolving credit facilities.Revolving Credit Agreement. At March 31,September 30, 2022 and December 31, 2021, we had $410$422 million and $291 million available for borrowing.borrowing under our Revolving Credit Agreement. We also had letters of credit and bank guarantees, which were issued outside of the Revolving Credit FacilityAgreement for $2.1$2.3 million and $2.2 million as of March 31,September 30, 2022 and December 31, 2021, which supports certain leased facilities as well as other normal business activities in the United States and Europe.
WeOn March 29, 2022, we entered into a Security Agreement Supplement pursuant to which the Security and Pledge Agreement (the Security Agreement), dated March 10, 2021 and amended March 29, 2022, pursuantwas supplemented to which we grantedgrant collateral on behalf of the holders of the 2024 Notes, and the parties secured under the credit agreements (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Credit PartiesGrantors (as defined)defined in the Credit Parties’Security Agreement) in the Grantors’ present and future subsidiaries, subject to certain customary exceptions, and (b) all present and future personal property and assets of the Credit Parties,Grantors, subject to certain exceptions.
On March 29, 2022, we entered into an amendment to our accounts receivable securitization program (the Receivables Financing Agreement). Pursuant to the amended Receivables Financing Agreement, the aggregate principal amount of the loans made by the Lenders (as defined) will not exceed $450 million outstanding at any time. The interest rate under the Receivables Financing Agreement is based on a spread over a benchmark SOFR rate (as described in the Fourth Amendment to the Receivables Financing Agreement). Under the Receivables Financing Agreement, 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 Financing Agreement matures in March 2025.
The Revolving Credit Agreement, Term Loan A, Term Loan B, Receivables Financing Agreement, 2024 Notes, 2029 Unsecured Notes, and 2030 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of any of the related agreements. The terms of the credit agreements also require us to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at March 31,September 30, 2022.
As of March 31,September 30, 2022, scheduled future principal payments of debt, excluding finance leases and other, were $4.5$1.5 million in 2022, $15.4 million in 2023, $274 million in 2024, $270of which $254 million is due in December 2024, $197 million in 2025, $43.5 million due in 2026, $415$403 million in 2027, $6.0 million due in 2028, $1.1 billion in 2029, and $600 million in 2030. Current maturities at March 31,September 30, 2022 include $6.3 million in principal payments on our Term Loan A, $6.0 million in principal payments on our Term Loan B and $2.2$2.5 million in current portion of finance leases.

14


Table of Contents
Note 7—Retirement Plans

We have a frozen noncontributory, unfunded retirement plan for certain retirees in the United States (U.S. Retirement Plan). As of March 31,September 30, 2022 and December 31, 2021, the accumulated benefit obligation of the U.S. Retirement Plan was $49.6$48.3 million and $50.2 million. Certain of our foreign subsidiaries also have defined benefit pension plans covering substantially all of their respective teammates.
The components of net periodic benefit cost for the three and nine months ended March 31,September 30, 2022 and 2021 were as follows:
Three Months Ended
 March 31,
20222021
Service cost$633 $704 
Interest cost523 446 
Recognized net actuarial loss267 353 
Net periodic benefit cost$1,423 $1,503 

Three Months Ended
 September 30,
Nine Months Ended
 September 30,
2022202120222021
Service cost$603 $693 $1,853 $2,106 
Interest cost516 443 1,559 1,337 
Recognized net actuarial loss267 353 801 1,060 
Net periodic benefit cost$1,386 $1,489 $4,213 $4,503 


13


Table of Contents


Note 8—Derivatives

We are directly and indirectly affected by changes in foreign currency, which may adversely impact our financial performance and are referred to as “market risks.” When deemed appropriate, we use derivatives as a risk management tool to mitigate the potential impact of certain market risks. We do not enter into derivative financial instruments for trading purposes.
We enter into foreign currency contracts to manage our foreign exchange exposure related to certain balance sheet items that do not meet the requirements for hedge accounting. These derivative instruments are adjusted to fair value at the end of each period through earnings. The gain or loss recorded on these instruments is substantially offset by the remeasurement adjustment on the foreign currency denominated asset or liability.
We pay interest on our Credit Agreement which fluctuates based on changes in our benchmark interest rates. In order to mitigate the risk of increases in benchmark rates, we entered into an interest rate swap agreement whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount. The interest rate swaps were designated as cash flow hedges. Cash flows related to the interest rate swap agreement are included in interest expense.
We determine the fair value of our foreign currency derivatives and interest rate swaps based on observable market-based inputs or unobservable inputs that are corroborated by market data. We do not view the fair value of our derivatives in isolation, but rather in relation to the fair values or cash flows of the underlying exposure. All derivatives are carried at fair value in our consolidated balance sheets in other current assets and other current liabilities.sheets. We consider the risk of counterparty default to be minimal. We report cash flows from our hedging instruments in the same cash flow statement category as the hedged items.
In April 2022, in order to mitigate the risk of increases in benchmark rates, we entered into an interest rate swap agreement whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount.
The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of March 31,September 30, 2022:
Derivative AssetsDerivative LiabilitiesDerivative AssetsDerivative Liabilities
Notional AmountMaturity DateClassificationFair ValueClassificationFair ValueNotional AmountMaturity DateClassificationFair ValueClassificationFair Value
Cash flow hedgesCash flow hedges
Interest rate swapsInterest rate swaps$400,000 March 2027Other assets, net$16,123 Other liabilities$— 
Economic (non-designated) hedgesEconomic (non-designated) hedgesEconomic (non-designated) hedges
Foreign currency contractsForeign currency contracts$20,000 April 2022Other current assets$127 Other current liabilities$— Foreign currency contracts$54,062 October 2022Other current assets$97 Other current liabilities$273 
In March 2021, we terminated the remaining $300 million in notional value of interest rate swaps concurrent with the debt financing transaction. The remaining balance of the fair value adjustments of $25.1 million, which related to these
15


Table of Contents
terminated interest rate swaps, within Accumulated other comprehensive loss was reclassified to Loss on extinguishment of debt within our consolidated statements of operations for the threenine months ended March 31,September 30, 2021.
The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2021:
Derivative AssetsDerivative Liabilities
Notional AmountMaturity DateClassificationFair ValueClassificationFair Value
Economic (non-designated) hedges
Foreign currency contracts$9,700 January 2022Other current assets$81 Other current liabilities$— 

The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and nine months ended March 31,September 30, 2022:
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, 2022Nine months ended September 30, 2022Three months ended September 30, 2022Nine months ended September 30, 2022Three months ended September 30, 2022Nine months ended September 30, 2022
Interest rate swaps$12,153 $14,197 Interest expense, net$39,869 $87,727 $(234)$(1,926)
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, 2021:
Amount of Gain Recognized in Other Comprehensive IncomeLocation 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
Interest rate swaps$2,426 Loss on extinguishment of debt$(40,433)$(25,518)
Amount of Gain Recognized in Other Comprehensive Income (Loss)Location of Loss Reclassified from Accumulated Other Comprehensive Loss into IncomeTotal Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are RecordedAmount of Loss Reclassified from Accumulated Other Comprehensive Loss into Income
Three months ended September 30, 2021Nine months ended September 30, 2021Three months ended September 30, 2021Nine months ended September 30, 2021Three months ended September 30, 2021Nine months ended September 30, 2021
Interest rate swaps$— $2,426 Loss on extinguishment of debt$— $(40,433)$— $(25,518)
The amount of ineffectiveness associated with these contracts was immaterial for the periodperiods presented.
14


Table of Contents

For the three and nine months ended March 31,September 30, 2022 we recognized losses of $1.8 million and $3.2 million associated with our economic (non-designated) foreign currency contracts. For the three and nine months ended September 30, 2021 we recognized losses of $0.1$0.9 million and $1.0$2.5 million associated with our economic (non-designated) foreign currency contracts.
We recorded the change in fair value of derivative instruments and the remeasurement adjustment of the foreign currency denominated asset or liability in other operating income, net for our foreign exchange contracts.

Note 9—Leases

16


Table of Contents
The components of lease expense were as follows:
Three Months Ended
 March 31,
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
Classification20222021Classification2022202120222021
Operating lease costOperating lease costDS&A Expenses$16,100 $14,086 Operating lease costDS&A Expenses$24,231 $15,307 $64,832 $44,098 
Finance lease cost:Finance lease cost:Finance lease cost:
Amortization of lease assetsAmortization of lease assetsDS&A Expenses331 239 Amortization of lease assetsDS&A Expenses318 254 944 675 
Interest on lease liabilitiesInterest on lease liabilitiesInterest expense, net307 307 Interest on lease liabilitiesInterest expense, net304 315 915 916 
Total finance lease costTotal finance lease cost638 546 Total finance lease cost622 569 1,859 1,591 
Short-term lease costShort-term lease costDS&A Expenses116 259 Short-term lease costDS&A Expenses, Cost of goods sold1,207 225 2,363 708 
Variable lease costVariable lease costDS&A Expenses4,729 4,317 Variable lease costDS&A Expenses, Cost of goods sold10,390 4,349 24,418 13,009 
Total lease costTotal lease cost$21,583 $19,208 Total lease cost$36,450 $20,450 $93,472 $59,406 
Variable lease cost consists primarily of taxes, insurance, and common area or other maintenance costs for our leased facilities and patient services equipment which are paid as incurred. Variable lease cost also includes expense associated with patient services equipment, which is based on equipment usage or a percentage of net revenues collected for specific products. Patient equipment lease expense is recorded in cost of goods sold in the consolidated statement of operations.
Supplemental balance sheet information is as follows:
ClassificationMarch 31,
2022
December 31, 2021ClassificationSeptember 30, 2022December 31, 2021
Assets:Assets:Assets:
Operating lease assetsOperating lease assetsOperating lease assets$278,205 $194,006 Operating lease assetsOperating lease assets$275,833 $194,006 
Finance lease assetsFinance lease assetsProperty and equipment, net8,728 8,896 Finance lease assetsProperty and equipment, net10,754 8,896 
Total lease assetsTotal lease assets$286,933 $202,902 Total lease assets$286,587 $202,902 
Liabilities:Liabilities:Liabilities:
CurrentCurrentCurrent
OperatingOperatingOther current liabilities$67,388 $41,817 OperatingOther current liabilities$72,990 $41,817 
FinanceFinanceOther current liabilities2,202 2,037 FinanceOther current liabilities2,470 2,037 
NoncurrentNoncurrentNoncurrent
OperatingOperatingOperating lease liabilities, excluding current portion221,612 162,241 OperatingOperating lease liabilities, excluding current portion215,022 162,241 
FinanceFinanceLong-term debt, excluding current portion11,116 11,314 FinanceLong-term debt, excluding current portion13,023 11,314 
Total lease liabilitiesTotal lease liabilities$302,318 $217,409 Total lease liabilities$303,505 $217,409 
The gross value recorded under finance leases was $20.7$20.0 million and $20.6 million with associated accumulated amortizationdepreciation of $12.0$9.2 million and $11.7 million as of March 31,September 30, 2022 and December 31, 2021. Operating lease assets include $69.1$83.6 million in right-of-use assets and $70.3$86.8 million of operating lease liabilities acquired as a result of theassociated with Apria Acquisition, as of March 31,September 30, 2022.
1517


Table of Contents
Other information related to leases was as follows:
Three Months Ended March 31,Nine Months Ended
September 30,
2022202120222021
Supplemental cash flow informationSupplemental cash flow informationSupplemental cash flow information
Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating and finance leasesOperating cash flows from operating and finance leases$15,965$13,848Operating cash flows from operating and finance leases$63,488$43,687 
Financing cash flows from finance leasesFinancing cash flows from finance leases$397$234Financing cash flows from finance leases$1,115$726 
Right-of-use assets obtained in exchange for new operating and finance lease liabilitiesRight-of-use assets obtained in exchange for new operating and finance lease liabilities$27,300$23,986Right-of-use assets obtained in exchange for new operating and finance lease liabilities$64,325$76,960 
Weighted average remaining lease term (years)Weighted average remaining lease term (years)Weighted average remaining lease term (years)
Operating leasesOperating leases4.65.4Operating leases4.35.2
Finance leasesFinance leases6.27.7Finance leases5.96.9
Weighted average discount rateWeighted average discount rateWeighted average discount rate
Operating leasesOperating leases7.0%8.8%Operating leases6.9%8.6%
Finance leasesFinance leases10.7%12.2%Finance leases10.8%11.0%
Maturities of lease liabilities as of March 31,September 30, 2022 were as follows:
Operating LeasesFinance LeasesTotal
Operating Leases (1)
Finance LeasesTotal
20222022$69,487 $2,094 $71,581 2022$24,060 $675 $24,735 
2023202383,056 2,750 85,806 202393,913 2,693 96,606 
2024202469,605 2,697 72,302 202480,267 2,641 82,908 
2025202549,727 2,631 52,358 202558,612 2,588 61,200 
2026202633,658 2,248 35,906 202641,058 2,506 43,564 
ThereafterThereafter44,571 4,538 49,109 Thereafter49,224 4,774 53,998 
Total lease paymentsTotal lease payments350,104 16,958 367,062 Total lease payments347,134 15,877 363,011 
Less: InterestLess: Interest(61,104)(3,640)(64,744)Less: Interest(59,122)(384)(59,506)
Present value of lease liabilitiesPresent value of lease liabilities$289,000 $13,318 $302,318 Present value of lease liabilities$288,012 $15,493 $303,505 
(1) Operating lease payments exclude $40.2 million of legally binding lease payments for the Morgantown, West Virginia center of excellence for medical supplies and logistics lease signed, but not yet commenced.

    
Note 10—Income Taxes

The effective tax rate was 18.6%36.2% and 24.4% for the three and nine months ended March 31September 30, 2022, compared to 24.4%12.6% and 20.8% in the same quarterperiods of 2021. The change in these rates resulted primarily from the mixture of income and losses in jurisdictions in which we operate, andas well as the incremental incomeutilization of foreign tax benefit associated with the vesting of restricted stock recordedbenefits in the first quarter of 2022.three and nine months ended September 30, 2021. The liability for unrecognized tax benefits was $21.6$22.1 million at March 31,September 30, 2022 and $21.4 million at December 31, 2021. Included in the liability at March 31,September 30, 2022 and December 31, 2021 were $2.7 million of tax positions for which ultimate deductibility is highly certain but for which there is uncertainty about the timing of such deductibility.
On August 26, 2020, we received a Notice of Proposed Adjustment (NOPA) from the Internal Revenue Service (IRS) regarding our 2015 and 2016 consolidated income tax returns. On June 30, 2021, we received a NOPA from the IRS regarding our 2017 and 2018 consolidated income tax returns. Within the NOPAs, the IRS has asserted that our taxable income for the aforementioned years should be higher based on their assessment of the appropriate amount of taxable income that we should report in the United States in connection with our sourcing of products by our foreign subsidiaries for sale in the United States by our domestic subsidiaries. Our amount of taxable income in the United States is based on our transfer pricing methodology, which has been consistently applied through the current date. We strongly disagree with the IRS position and will pursue all available administrative and judicial remedies, including those available under the U.S. - Ireland Income Tax Treaty to alleviate double taxation. We regularly assess the likelihood of adverse outcomes resulting from examinations such as this to determine the adequacy of our tax reserves. We believe that we have adequately reserved for this matter and that the final adjudication of
18


Table of Contents
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,
16


Table of Contents
interest, and any potential penalties could have a material adverse impact on our financial position, results of operations or cash flows.

Note 11—Net Income per Common Share

The following summarizes the calculation of net income per common share attributable to common shareholders for the three and nine months ended March 31,September 30, 2022 and 2021:

Three Months Ended
 March 31,
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
(in thousands, except per share data)(in thousands, except per share data)20222021(in thousands, except per share data)2022202120222021
Net incomeNet income$39,279 $69,589 Net income$12,497 $44,129 $80,381 $179,614 
Weighted average shares outstanding - basicWeighted average shares outstanding - basic73,643 70,834Weighted average shares outstanding - basic74,905 73,21574,376 72,649
Dilutive sharesDilutive shares2,376 104 Dilutive shares1,510 2,743 1,835 2,754 
Weighted average shares outstanding - dilutedWeighted average shares outstanding - diluted76,019 70,938 Weighted average shares outstanding - diluted76,415 75,958 76,211 75,403 
Net income per common share:Net income per common share:Net income per common share:
BasicBasic$0.53 $0.98 Basic$0.17 $0.60 $1.08 $2.47 
DilutedDiluted$0.52 $0.98 Diluted$0.16 $0.58 $1.05 $2.38 

Note 12—Shareholders' Equity

In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of March 31,September 30, 2022, no shares were issued and $50.0 million of common stock remained available under the at-the-market equity financing program.

17


Table of Contents
Note 13—Accumulated Other Comprehensive Loss
The following table shows the changes in accumulated other comprehensive loss by component for the three and nine months ended March 31,September 30, 2022 and 2021: 
Retirement PlansCurrency
Translation
Adjustments
DerivativesTotal
Accumulated other comprehensive loss, December 31, 2021$(14,597)$(25,994)$— $(40,591)
Other comprehensive loss before reclassifications— (787)— (787)
Income tax— — — — 
Other comprehensive loss before reclassifications, net of tax— (787)— (787)
Amounts reclassified from accumulated other comprehensive loss249 — — 249 
Income tax(60)— — (60)
Amounts reclassified from accumulated other comprehensive loss, net of tax189 — — 189 
Other comprehensive income (loss)189 (787)— (598)
Accumulated other comprehensive loss, March 31, 2022$(14,408)$(26,781)$ $(41,189)
Retirement PlansCurrency
Translation
Adjustments
DerivativesTotal
Accumulated other comprehensive (loss) income, June 30, 2022$(14,111)$(45,612)$2,764 $(56,959)
Other comprehensive (loss) income before reclassifications— (19,986)12,153 (7,833)
Income tax— — (3,159)(3,159)
Other comprehensive (loss) income before reclassifications, net of tax— (19,986)8,994 (10,992)
Amounts reclassified from accumulated other comprehensive (loss) income374 — 234 608 
Income tax(86)— (61)(147)
Amounts reclassified from accumulated other comprehensive (loss) income, net of tax288 — 173 461 
Other comprehensive income (loss)288 (19,986)9,167 (10,531)
Accumulated other comprehensive (loss) gain, September 30, 2022$(13,823)$(65,598)$11,931 $(67,490)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, December 31, 2020$(18,447)$(18)$(20,044)$(38,509)
Other comprehensive income (loss) before reclassifications— (12,262)2,426 (9,836)
Income tax— — (611)(611)
Other comprehensive income (loss) before reclassifications, net of tax— (12,262)1,815 (10,447)
Amounts reclassified from accumulated other comprehensive loss156 — 25,518 25,674 
Income tax(35)— (7,289)(7,324)
Amounts reclassified from accumulated other comprehensive loss, net of tax121 — 18,229 18,350 
Other comprehensive income (loss)121 (12,262)20,044 7,903 
Accumulated other comprehensive loss, March 31, 2021$(18,326)$(12,280)$— $(30,606)
19


Table of Contents
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, June 30, 2021$(18,290)$(14,728)$— $(33,018)
Other comprehensive loss before reclassifications— (12,014)— (12,014)
Income tax— — — — 
Other comprehensive loss before reclassifications, net of tax— (12,014)— (12,014)
Amounts reclassified from accumulated other comprehensive loss500 — — 500 
Income tax(105)— — (105)
Amounts reclassified from accumulated other comprehensive loss, net of tax395 — — 395 
Other comprehensive income (loss)395 (12,014)— (11,619)
Accumulated other comprehensive loss, September 30, 2021$(17,895)$(26,742)$— $(44,637)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, December 31, 2021$(14,597)$(25,994)$— $(40,591)
Other comprehensive (loss) income before reclassifications— (39,604)14,197 (25,407)
Income tax— — (3,691)(3,691)
Other comprehensive (loss) income before reclassifications, net of tax— (39,604)10,506 (29,098)
Amounts reclassified from accumulated other comprehensive (loss) income1,009 — 1,926 2,935 
Income tax(235)— (501)(736)
Amounts reclassified from accumulated other comprehensive (loss) income, net of tax774 — 1,425 2,199 
Other comprehensive income (loss)774 (39,604)11,931 (26,899)
Accumulated other comprehensive (loss) gain, September 30, 2022$(13,823)$(65,598)$11,931 $(67,490)
Retirement PlansCurrency Translation AdjustmentsDerivativesTotal
Accumulated other comprehensive loss, December 31, 2020$(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)
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, net.

20


Table of Contents

Note 14—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 2two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our United States distribution business (Medical Distribution), outsourced logistics and value-added services business, and Global Products which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare businesses (Byram and Apria).
We evaluate the performance of our segments based on their operating income excluding intangible amortization and acquisition-related and exit and realignment charges that, either as a result of their nature or size, would not be expected to occur as part of our normal business operations on a regular basis. Segment assets exclude inter-segment account balances as we believe their inclusion would be misleading and not meaningful.
The following tables present financial information by segment:
Three Months Ended
 September 30,
Nine Months Ended
 September 30,
2022202120222021
Net revenue:
Products & Healthcare Services$1,903,356 $2,256,295 $5,964,784 $6,621,560 
Patient Direct594,045 245,880 1,439,584 696,609 
Consolidated net revenue$2,497,401 $2,502,175 $7,404,368 $7,318,169 
Operating income:
Products & Healthcare Services$23,781 $64,415 $174,108 $316,062 
Patient Direct59,666 14,865 127,791 41,434 
Intangible amortization(14,302)(10,025)(55,459)(30,077)
Acquisition-related and exit and realignment charges(8,898)(6,380)(50,048)(20,967)
Consolidated operating income$60,247 $62,875 $196,392 $306,452 
Depreciation and amortization:
Products & Healthcare Services$19,121 $18,868 $57,325 $56,874 
Patient Direct39,030 3,774 98,113 11,268 
Consolidated depreciation and amortization$58,151 $22,642 $155,438 $68,142 
Capital expenditures:
Products & Healthcare Services$9,743 $13,498 $38,804 $31,768 
Patient Direct39,706 446 76,344 857 
Consolidated capital expenditures$49,449 $13,944 $115,148 $32,625 


September 30,
2022
December 31, 2021
Total assets:
Products & Healthcare Services$2,952,570 $3,012,303 
Patient Direct2,509,242 468,536 
Segment assets5,461,812 3,480,839 
Cash and cash equivalents76,770 55,712 
Consolidated total assets$5,538,582 $3,536,551 

18
21


Table of Contents
Three Months Ended
 March 31,
20222021
Net revenue:
Products & Healthcare Services$2,134,041 $2,109,445 
Patient Direct272,911 217,089 
Consolidated net revenue$2,406,952 $2,326,534 
Operating income:
Products & Healthcare Services$89,083 $150,418 
Patient Direct15,793 12,263 
Intangible amortization(10,269)(10,026)
Acquisition-related and exit and realignment charges(33,548)(5,963)
Consolidated operating income$61,059 $146,692 
Depreciation and amortization:
Products & Healthcare Services$18,994 $19,160 
Patient Direct5,131 3,740 
Consolidated depreciation and amortization$24,125 $22,900 
Capital expenditures:
Products & Healthcare Services$10,643 $6,464 
Patient Direct318 159 
Consolidated capital expenditures$10,961 $6,623 


March 31, 2022December 31, 2021
Total assets:
Products & Healthcare Services$2,960,748 $3,012,303 
Patient Direct2,535,923 468,536 
Segment assets5,496,671 3,480,839 
Cash and cash equivalents211,298 55,712 
Consolidated total assets$5,707,969 $3,536,551 

The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services.services:
Three Months Ended March 31,Three Months Ended September 30,Nine Months Ended September 30,
202220212022202120222021
Net revenue:Net revenue:Net revenue:
United StatesUnited States$2,262,019 $2,182,755 United States$2,410,790 $2,380,794 $7,049,382 $6,900,222 
InternationalInternational144,933 143,779 International86,611 121,381 354,986 417,947 
Consolidated net revenueConsolidated net revenue$2,406,952 $2,326,534 Consolidated net revenue$2,497,401 $2,502,175 $7,404,368 $7,318,169 

Note 15—Recent Accounting Pronouncements
On June 16, 2016, the FASB issued ASU No. 2016-13 Financial Instruments - Credit Losses, Measurement of Credit Losses on Financial Instruments, which changes the way entities measure credit losses for most financial assets and certain other instruments that are not measured at fair value through net earnings. This standard will be effective for fiscal years
19


Table of Contents
beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted. We are still evaluating the impact the adoption of ASU No. 2016-13 will have on our consolidated financial statements and related disclosures; however, we do not expect this to have a material impact. Subsequent to the issuance of ASU No. 2016-13, the FASB issued ASU 2018-19, Codification Improvements to Topic 326, Financial Instruments - Credit Losses and ASU No. 2019-05, Financial Instruments - Credit Losses (Topic 326) Targeted Transition Relief. These ASUs do not change the core principle of the guidance in ASU No. 2016-13. Instead these amendments are intended to clarify and improve operability of certain topics included within the credit losses standard. These ASUs will have the same effective date and transition requirements as ASU No. 2016-13.
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 material debt agreements no longer reference LIBOR as a benchmark rate. The transition did not 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.
In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers. ASU 2021-08 requires the company acquiring contract assets and contract liabilities obtained in a business combination to recognize and measure them in accordance with ASC 606, Revenue from Contracts with Customers. At the acquisition date, the company acquiring the business should record related revenue, as if it had originated the contract. Before the update such amounts were recognized by the acquiring company at fair value. The amendments in this ASU are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted, including in interim periods, for any financial statements that have not yet been issued. We adopted ASU 2021-08 prospectively, effective beginning January 1, 2022. Its adoption did not have a material impact on our consolidated financial statements.
In November 2021, the FASB issued ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business
Entities about Government Assistance, which requires certain annual disclosures about transactions with a government that are
accounted for by applying a grant or contribution accounting model by analogy. We adopted ASU No. 2021-10 effective beginning January 1, 2022. Its adoption did not have a material impact on our consolidated financial statements.

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, 2021. 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,
22


Table of Contents
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, 2021.
Overview
Owens & Minor, Inc., along with its subsidiaries, (we, us, or our) is a leading global healthcare solutions company. To better reflect how we go to market as well as certain changes to the leadership team, organizational structure, budgeting and financial reporting processes, we have organized ourOur business intohas two distinct segments: Products & Healthcare Services and Patient Direct. Products & Healthcare Services provides distribution, outsourced logistics and value-added services, and manufactures and sources medical surgical products through our production and kitting operations. Patient Direct expands our business along the continuum of care through delivery of disposable medical supplies sold directly to patients and home health agencies and is a leading provider of integrated home healthcare equipment and related services in the United States. Beginning with the quarter ended March 31, 2022, we now reporthave reported financial results using this two segment structure and have recast our prior yearperiod segment results on the same basis.

20


Table of Contents
On March 29, 2022 (the Acquisition Date), we completed the acquisition of 100% of Apria, Inc. (Apria) pursuant to the Agreement and Plan of Merger (Apria Acquisition) dated January 7, 2022, in exchange for approximately $1.7 billion.billion, net of $144 million of cash acquired. The purchase was funded with a combination of debt and cash on hand. At the time of the Apria Acquisition, each share of Apria’s common stock was converted into the right to receive $37.50 in cash. Apria is a leading provider of integrated home healthcare equipment and related services in the United States. This business is reported as part of the Patient Direct segment.
Net income per diluted share was $0.52$0.16 and $1.05 for the three and nine months ended March 31,September 30, 2022 as compared to $0.98$0.58 and $2.38 for the three and nine months ended March 31,September 30, 2021. Products & Healthcare Services segment operating income was $89.1$23.8 million and $174 million for the three and nine months ended March 31,September 30, 2022, compared to $150.4$64.4 million and $316 million for the three and nine months ended March 31,September 30, 2021. The decrease wasdecreases were primarily the result of overall reduced hospital demand, including reliance on stockpiles built up during the timingCOVID-19 pandemic, the reduction of glove price changes, acceleratingcost pass through, and headwinds created by macroeconomic conditions, including inflationary pressures, including commodities, transportation,supply chain issues, and labor,rising interest rates, partially offset by leveraging our fixed costs,operating efficiencies and operating efficiencies.productivity gains derived from the Owens & Minor business system and changes in accrued incentive compensation. Patient Direct segment operating income was $15.8$59.7 million and $127.8 million for the three and nine months ended March 31,September 30, 2022, compared to $12.3$14.9 million and $41.4 million for the three and nine months ended March 31,September 30, 2021. The increase was primarily the result of the inclusion of Apria in the Patient Direct segment since the Acquisition Date, strong revenue growth in our Byram business, leveraging our fixed costs, and operating efficiencies, partially offset by accelerating inflationary pressures. Net income per diluted share was unfavorably impacted as compared to the prior year by foreign currency translation in the amount of $0.04 and $0.13 for the three and nine months ended September 30, 2022.

COVID-19 Update
We arecontinue to closely monitoringmonitor the impact of the 2019 novel coronavirus (COVID-19), including recentits variants and sub-variants, 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.
We are unable to predict the timing of the pandemic and the full impact that COVID-19 will have on our future operating results, financial position and cash flows due to numerous variables and continued uncertainties. Travel, transportation,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 resultedcreated supply chain challenges resulting in additional direct costs from supply chain challenges.costs. Although we have experienced growth in sales volumes for certain of our products (such as personal protective equipment (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.

Philips Respironics Recall
In June 2021, one of Apria's suppliers, Philips Respironics, announced a voluntary recall (Recall) for continuous and non-continuous ventilators (certain CPAP,continuous positive airway pressure (CPAP), BiLevel positive airway pressure and ventilator devices) related to polyurethane foam used in those devices. The Food and Drug Administration (FDA) has since identified this as a Class I recall, the most serious category of recall. Because we distribute these products and provide related home respiratory services and, in part, due to the substantial number of impacted devices, we will likely devote substantial time
23


Table of Contents
and resources to coordinating recall-relatedRecall-related activity and to supporting our home healthcare patients’ needs. This Recall may cause us to incur significant costs, some or all of which may not be recoverable from the product manufacturer. The Recall may also materially negatively affect our revenues and results of operations as a result of patients not using their impacted devices, current shortages in the availability of both replacement devices for impacted patients and new devices for new patients, patient hesitancy to use respiratory devices generally or other reasons.
We are closely monitoring the impact of the Recall on our business and the uncertainty surrounding the availability and supply of CPAP and ventilators due to the Recall. There is anWhile the equipment shortage in the industry and thehas begun to ease, we do not know whether that will continue. The Recall or other supply chain disruptions may have a future material adverse effect on our financial condition or results of operations, cash flows and liquidity.






21


Table of Contents
Results of Operations

Net revenue.
Three Months Ended
 March 31,
ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Products & Healthcare ServicesProducts & Healthcare Services$2,134,041 $2,109,445 $24,596 1.2 %Products & Healthcare Services$1,903,356 $2,256,295 $(352,939)(15.6)%
Patient DirectPatient Direct272,911 217,089 55,822 25.7 %Patient Direct594,045 245,880 348,165 141.6 %
Net revenueNet revenue$2,406,952 $2,326,534 $80,418 3.5 %Net revenue$2,497,401 $2,502,175 $(4,774)(0.2)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Products & Healthcare Services$5,964,784 $6,621,560 $(656,776)(9.9)%
Patient Direct1,439,584 696,609 742,975 106.7 %
Net revenue$7,404,368 $7,318,169 $86,199 1.2 %

The increase in net revenue in our Patient Direct segment for the three and nine months ended March 31,September 30, 2022 was driven by continued strong performance in our Byram business and the acquisition of Apria on March 29, 2022.2022 and continued strong performance in our Byram business. The increasedecrease in net revenue in our Products & Healthcare Services segment for the three and nine months ended March 31,September 30, 2022 reflected market share gainsoverall reduced hospital demand, including reliance on stockpiles and growth with existing customers, along with an additional sales day, partially offset by a decline in PPE sales.the reduction of glove cost pass through. Foreign currency translation had an unfavorable impact on net revenue of $8.5$12.0 million and $33.2 million for the three and nine months ended March 31,September 30, 2022 as compared to the prior year.

Cost of goods sold.
Three Months Ended
 March 31,
ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Cost of goods soldCost of goods sold$2,033,504 $1,883,783 $149,721 7.9 %Cost of goods sold$1,984,122 $2,173,336 $(189,214)(8.7)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Cost of goods sold$5,985,136 $6,146,511 $(161,375)(2.6)%

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, depreciation of certain property and equipment, product costs, and material and overhead costs associated with our Products & Healthcare Services segment. There is no cost of goods sold associated with our fee-for-service arrangements.costs. Cost of goods sold compared to prior year reflects the inclusion of Apria since the Acquisition Date, changes in sales activity, including salesproduct mix, inflationary pressures, and accelerating inflationary pressures.supply chain issues.

24


Table of Contents
Gross margin.
Three Months Ended
 March 31,
ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Gross marginGross margin$373,448 $442,751 $(69,303)(15.7)%Gross margin$513,279 $328,839 $184,440 56.1 %
As a % of net revenueAs a % of net revenue15.52 %19.03 %As a % of net revenue20.55 %13.14 %

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Gross margin$1,419,232 $1,171,658 $247,574 21.1 %
As a % of net revenue19.17 %16.01 %
Gross margin decreaseincrease in the three and nine months ended March 31,September 30, 2022 was driven by market dynamics including timinginclusion of glove price and cost changesApria in the prior year, accelerating inflationary pressuresPatient Direct segment since the Acquisition Date and sales mix, partially offset by revenue growth.overall reduced hospital demand, including reliance on stockpiles, the reduction of glove cost pass through, inflationary pressures, and supply chain issues. Foreign currency translation had an unfavorable impact on gross margin of $4.0$6.4 million and $17.3 million for the three and nine months ended March 31,September 30, 2022 as compared to the prior year.

Operating expenses.
Three Months Ended
 March 31,
ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Distribution, selling and administrative expensesDistribution, selling and administrative expenses$279,740 $292,701 $(12,961)(4.4)%Distribution, selling and administrative expenses$445,259 $262,457 $182,802 69.7 %
As a % of net revenueAs a % of net revenue11.62 %12.58 %As a % of net revenue17.83 %10.49 %
Acquisition-related and exit and realignment chargesAcquisition-related and exit and realignment charges$33,548 $5,963 $27,585 462.6 %Acquisition-related and exit and realignment charges$8,898 $6,380 $2,518 39.5 %
Other operating income, netOther operating income, net$(899)$(2,605)$1,706 65.5 %Other operating income, net$(1,125)$(2,873)$1,748 60.8 %

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Distribution, selling and administrative expenses$1,177,812 $849,255 $328,557 38.7 %
As a % of net revenue15.91 %11.60 %
Acquisition-related and exit and realignment charges$50,048 $20,967 $29,081 138.7 %
Other operating income, net$(5,020)$(5,016)$(4)(0.1)%

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.arrangements in our Products & Healthcare Services segment. Shipping and handling costs are primarily included in DS&A expenses and include costs to store, move, and prepare products for shipment,
22


Table of Contents
as well as costs to deliver products to customers.Overall DS&A expenses were affected by changesinclusion of Apria in accrued incentive compensation, teammate benefits, charitable contributions,our results since the Acquisition Date, and operational efficiencies, partially offset by higher volume to support revenue growth and accelerating inflationary pressures for the three and nine months ended March 31, 2022.September 30, 2022, partially offset by operating efficiencies and productivity gains derived from the Owens & Minor business system, and changes in accrued incentive compensation. DS&A expenses also included ana favorable impact for foreign currency translation of $0.9$1.8 million and $4.2 million for the three and nine months ended March 31,September 30, 2022.
Acquisition-related charges were $31.9$6.9 million and $45.2 million for the three and nine months ended March 31,September 30, 2022 as compared to no acquisition-related charges for the three and nine months ended March 31,September 30, 2021. Acquisition-related costscharges in 2022 consisted primarily of costs related to the Apria acquisition.Acquisition. Exit and realignment charges were $1.7$2.0 million and $4.9 million for the three and nine months ended March 31,September 30, 2022, which consisted primarily of wind-down costs related to Fusion5 and severance and other charges associated with the reorganization of our segments. Exit and realignment charges were $6.0$6.4 million and $21.0 million for the three and nine months ended March 31,September 30, 2021 whichand consisted primarily of an increase in reserves associated with certain retained assets ofwind-down costs related to Fusion5, leadership reorganization costs, IT restructuring charges, and other costs related to the reorganization of the U.S. commercial, operations and executive teams.operations.
The change in other
25


Table of Contents
Other operating income, net for the three and nine months ended March 31,September 30, 2022 and 2021 includes the impact of foreign currency transaction losses, as compared to foreign currency transaction gains for the three months ended March 31, 2021.gains.

Interest expense, net.
Three Months Ended
 March 31,
Change Three Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Interest expense, netInterest expense, net$12,019 $13,672 $(1,653)(12.1)%Interest expense, net$39,869 $11,572 $28,297 244.5 %
Effective interest rateEffective interest rate4.65 %5.45 %Effective interest rate5.96 %4.17 %

 Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Interest expense, net$87,727 $36,784 $50,943 138.5 %
Effective interest rate5.47 %4.72 %

Interest expense, net and the effective interest rate for the three and nine months ended March 31,September 30, 2022 decreasedincreased primarily due to lower interest rates, partially offset by the increase in debt associated with the Apria Acquisition on March 29, 2022.2022, along with rising market interest rates. See Note 6 in Notes to Consolidated Financial Statements.

Loss on extinguishment of debt.
Three Months Ended
 March 31,
Change
(Dollars in thousands)20222021$%
Loss on extinguishment of debt$ $40,433 $(40,433)(100.0)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Loss on extinguishment of debt$ $40,433 $(40,433)(100.0)%

Loss on extinguishment of debt for the threenine months ended March 31,September 30, 2021 includes the write-off of deferred financing costs and third party fees 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 rate swaps of $25.1 million.

Other expense, net.

Three Months Ended
 March 31,
ChangeThree Months Ended
 September 30,
Change
(Dollars in thousands)(Dollars in thousands)20222021$%(Dollars in thousands)20222021$%
Other expense, netOther expense, net$783 $569 $214 37.6 %Other expense, net$783 $799 $(16)(2.0)%

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Other expense, net$2,347 $2,397 $(50)(2.1)%

Other expense, net for the three and nine months ended March 31,September 30, 2022 and 2021 represents interest cost and net actuarial losses related to our retirement plans.

Income taxes.
Three Months Ended
 March 31,
Change
(Dollars in thousands)20222021$%
Income tax provision$8,978 $22,429 $(13,451)(60.0)%
Effective tax rate18.6 %24.4 %

Three Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Income tax provision$7,098 $6,375 $723 11.3 %
Effective tax rate36.2 %12.6 %
2326


Table of Contents

Nine Months Ended
 September 30,
Change
(Dollars in thousands)20222021$%
Income tax provision$25,937 $47,224 $(21,287)(45.1)%
Effective tax rate24.4 %20.8 %

The change in the effective tax rate for the three and nine months ended March 31,September 30, 2022 compared to the same periodperiods in 2021 resulted primarily from the mixture of income and losses in jurisdictions in which we operate, andas well as the incremental incomeas the utilization of foreign tax benefit associated with the vesting of restricted stock recordedbenefits in the first quarter of 2022.three and nine months ended September 30, 2021.

Financial Condition, Liquidity and Capital Resources

Financial condition. We monitor operating working capital through days sales outstanding (DSO) and merchandise inventory 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 facilityRevolving Credit Agreement (as defined below) or receivables securitization program,Receivables Financing Agreement (as defined below), or a combination thereof of approximately $27 million.
The majority of our cash and cash equivalents are held in cash depository accounts with major banks in the United States,North America, Europe, and Asia. Changes in our working capital can vary in the normal course of business based upon the timing of inventory purchases, collections of accounts receivable, and payments to suppliers.
March 31,
2022
December 31, 2021ChangeSeptember 30, 2022December 31, 2021Change
(Dollars in thousands)(Dollars in thousands)$%(Dollars in thousands)$%
Cash and cash equivalentsCash and cash equivalents$211,298 $55,712 $155,586 279.3 %Cash and cash equivalents$76,770 $55,712 $21,058 37.8 %
Accounts receivable, net of allowancesAccounts receivable, net of allowances$775,779 $681,564 $94,215 13.8 %Accounts receivable, net of allowances$751,970 $681,564 $70,406 10.3 %
Consolidated DSO (1)
Consolidated DSO (1)
24.9 24.6
Consolidated DSO (1)
26.924.6
Merchandise inventoriesMerchandise inventories$1,447,383 $1,495,972 $(48,589)(3.2)%Merchandise inventories$1,508,443 $1,495,972 $12,471 0.8 %
Inventory days (2)
Inventory days (2)
63.7 64.7
Inventory days (2)
69.964.7
Accounts payableAccounts payable$1,115,400 $1,001,959 $113,441 11.3 %Accounts payable$1,156,230 $1,001,959 $154,271 15.4 %
    (1) Based on period end accounts receivable and net revenue for the quarters ended March 31,September 30, 2022 and December 31, 2021, excluding the impact of the Apria Acquisition.2021.
    (2) Based on period end merchandise inventories and cost of goods sold for the quarters ended March 31,September 30, 2022 and December 31, 2021, excluding the impact of the Apria Acquisition.2021.
Liquidity and capital expenditures. The following table summarizes our consolidated statements of cash flows for the threenine months ended March 31,September 30, 2022 and 2021:

(Dollars in thousands)(Dollars in thousands)20222021(Dollars in thousands)20222021
Net cash provided by (used for):Net cash provided by (used for):Net cash provided by (used for):
Operating activitiesOperating activities$79,699 $25,423 Operating activities$238,045 $73,836 
Investing activitiesInvesting activities(1,587,236)(6,619)Investing activities(1,771,705)(32,584)
Financing activitiesFinancing activities1,664,194 (80,394)Financing activities1,560,585 (117,222)
Effect of exchange rate changesEffect of exchange rate changes(669)(2,139)Effect of exchange rate changes(5,752)(2,454)
Net increase (decrease) in cash, cash equivalents and restricted cashNet increase (decrease) in cash, cash equivalents and restricted cash$155,988 $(63,729)Net increase (decrease) in cash, cash equivalents and restricted cash$21,173 $(78,424)

Cash provided by operating activities in the first threenine months of 2022 and 2021 reflected cash generated by net income along with changes in working capital.
Cash used for investing activities in the first threenine months of 2022 included cash paid for the acquisition of Apria of $1.6$1.7 billion and capital expenditures of $11.0$115 million for patient equipment and our strategic and operational efficiency initiatives associated with property and equipmentand capitalized software.software, partially offset by $29.7 million in proceeds related to the sale of property and equipment. Cash used for investing activities in the first threenine months of 2021 included capital expenditures of $6.6$32.6 million for our strategic and operational efficiency initiatives associated with property and equipment, investments for increased manufacturing capacity in the Americas, and capitalized software.
27


Table of Contents
Cash used for financing activities in the first threenine months of 2022 included proceeds from borrowings of $1.7 billion related to the 6.625% senior notes due in 2030 (the 2030 Unsecured Notes), Term Loan A (as defined below), and Term Loan B (as defined below) for the first nine months of 2022, compared to $575 million related to the 4.500% senior unsecured notes due in 2029 (the 2029 Unsecured Notes) and the accounts receivable securitization program for the first nine months of 2021. Borrowings under our revolving credit facility, net and accounts receivable securitization program of $41.7$30.0 million compared to net repayments of $21.6$90.9 million for the same period of 2021. We also had proceeds from borrowingsRepayments of $1.7 billion related todebt in the 2030 Unsecured Notes, Term Loan A, andfirst nine months of 2022 included $3.0 million on our Term Loan B compared to 2021 included repayments of $553 million on our previous Term Loan A-2, previous Term Loan B, 3.875% Senior Notes due 2021 and 2024 Notes, and accounts receivable securitization program. Gross issuances and repayments under our amended accounts receivable securitization program were $697.7 million and $770.7 million for the first threenine months of 2022, compared to $500 million related to the 2029 Unsecured Notes for the first three months of 2021.2022. We also paid $33.7$42.6 million in financing costs in the first threenine months of 2022, as compared to $11.7$13.9 million for the same period of 2021. Payments for taxes related to the vesting of restricted stock awards were $35.7 million and $8.0 million for the first three months of 2022 and 2021, which are included in Other, net. Financing activities in the first three months of 2021 included repayments of $523 million on our previous Term Loan A-2 and previous Term Loan B. In addition, weWe paid $15.4 million to terminate the remaining $300 million in notional value of interest rate swaps during the first threenine months of 2021.
24


Table Payments for taxes related to the vesting of Contentsrestricted stock awards were $44.6 million and $19.3 million for the first nine months of 2022 and 2021, which are included in Other, net.

Capital resources. Our sources of liquidity include cash and cash equivalents, a revolving credit facility with an administrative and collateral agent and a syndicate of financial institutions, as lenders (theour Revolving Credit Agreement),Agreement, and a receivables securitization program.our Receivables Financing Agreement. The Revolving Credit Agreement provides a revolving borrowing capacity of $450 million. We have $1.1 billion in outstanding term loans under a term loan credit agreement (the Credit Agreement). The interest rate on our revolving credit facilityRevolving Credit Agreement is based on a spread over a benchmark rate (as described in the Revolving Credit Agreement). The Revolving Credit Agreement matures in March 2026. The interest rate on the Term Loan A facility (Term Loan A) is based on either the Term SOFR or the Base Rate plus an Applicable Rate which varies depending on the current Debt Ratings or Total Leverage Ratio, determined as to whichever shall result in more favorable pricing to the Borrowers (each as defined in the Credit Agreement). The interest rate on the Term Loan B facility (Term Loan B) is based on either the Term SOFR or the Base Rate plus an Applicable Rate. The Term Loan A will mature in March 2027 and the Term Loan B will mature in March 2029.
At March 31,September 30, 2022, and December 31, 2021, we had no borrowings of $11.7 million and letters of credit of $28.0 million.$27.9 million outstanding under our Revolving Credit Agreement. At December 31, 2021, we had no borrowings and letters of credit of $9.4 million outstanding under our credit agreements.Revolving Credit Agreement. At March 31,September 30, 2022 and December 31, 2021, we had $410$422 million and $291 million, available for borrowing.borrowing under our Revolving Credit Agreement. We also had letters of credit and bank guarantees, which were issued outside of the Revolving Credit FacilityAgreement for $2.1$2.3 million and $2.2 million as of March 31,September 30, 2022 and December 31, 2021, which supports certain leased facilities as well as other normal business activities in the United States and Europe.
WeOn March 29, 2022, we entered into a Security Agreement Supplement pursuant to which the Security and Pledge Agreement (the Security Agreement), dated March 10, 2021 and amended March 29, 2022, pursuantwas supplemented to which we grantedgrant collateral on behalf of the holders of the 2024 Notes, and the parties secured under the credit agreements (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Credit PartiesGrantors (as defined)defined in the Credit Parties’Security Agreement) in the Grantors’ present and future subsidiaries, subject to certain customary exceptions, and (b) all present and future personal property and assets of the Credit Parties,Grantors, subject to certain exceptions.
On March 29, 2022, we entered into an amendment to our accounts receivable securitization program (the Receivables Financing Agreement). Pursuant to the amended Receivables Financing Agreement, the aggregate principal amount of the loans made by the Lenders (as defined) will not exceed $450 million outstanding at any time. The interest rate under the Receivables Financing Agreement is based on a spread over a benchmark SOFR rate (as described in the Fourth Amendment to the Receivables Financing Agreement). Under the Receivables Financing Agreement, 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 Financing Agreement matures in March 2025.
The Revolving Credit Agreement, Term Loan A, Term Loan B, Receivables Financing Agreement, 2024 Notes, 2029 Unsecured Notes, and 2030 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of any of the related agreements. The terms of the credit agreements also require us to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at March 31,September 30, 2022.
In May 2020, we entered into an equity distribution agreement, pursuant to which we may offer and sell, from time to time, shares of our common stock having an aggregate offering price of up to $50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of March 31,September 30, 2022 no shares were issued and $50.0 million of common stock remained available under the at-the-market equity financing program.
28


Table of Contents
We regularly evaluate market conditions, our liquidity profile and various financing alternatives to enhance our 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.
We believe available financing sources, including cash generated by operating activities and borrowings under the Revolving Credit Agreement and Receivables Financing Agreement, will be sufficient to fund our working capital needs, capital expenditures, long-term strategic growth, payments under long-term debt and lease arrangements, 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 subject to repatriation totaled $51.1$25.2 million and $26.9 million at March 31,September 30, 2022 and December 31, 2021. We continue to remain permanently reinvested in our foreign subsidiaries, with the exception of a subsidiary in Thailand. We
25


Table of Contents
have no specific plans to indefinitely reinvest the unremitted earnings of our foreign subsidiary located in Thailand as of March 31,September 30, 2022. 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 2022 for all our foreign subsidiaries.
Impact of Inflation
The cost to manufacture and distribute our products is influenced by the cost of raw materials, finished goods, labor, and transportation. We have recently experienced inflationary pressure and higher costs as a result of the increasing cost of raw materials, finished goods, labor, transportation, and other administrative costs associated with the normal course of business. The increase in cost of raw materials and finished goods are due in part to a shortage in the availability of certain products, the higher cost of shipping, and inflation. We can only pass elevated costs onto customers in an effort to offset inflationary pressures on a limited basis. Future volatility of general price inflation and the impact of inflation on costs and availability of materials, costs for shipping and warehousing and other operational overhead could adversely affect our financial results.

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 GroupThreeNine Months Ended March 31,September 30, 2022
(Dollars in thousands)
Net revenue(1)
$2,320,7857,236,833 
Gross margin326,7421,343,310 
Operating income31,159164,680 
Net income20,74267,007 
(1)Includes $62$200 million in sales to non-guarantor subsidiaries for the threenine months ended March 31,September 30, 2022.

Summarized Consolidated Balance Sheets - Guarantor GroupMarch 31, 2022December 31, 2021
(Dollars in thousands)
Total current assets$1,660,658 $1,449,917 
Total assets4,939,206 2,807,581 
Current liabilities1,700,027 1,399,499 
Total liabilities4,542,949 2,422,542 
29


Table of Contents
Summarized Consolidated Balance Sheets - Guarantor GroupSeptember 30, 2022December 31, 2021
(Dollars in thousands)
Total current assets$1,629,336 $1,449,917 
Total assets4,876,092 2,807,581 
Current liabilities1,677,527 1,399,499 
Total liabilities4,448,037 2,422,542 

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:
Summarized Consolidated Balance Sheets - Collateral GroupSummarized Consolidated Balance Sheets - Collateral GroupMarch 31, 2022December 31, 2021Summarized Consolidated Balance Sheets - Collateral GroupSeptember 30, 2022December 31, 2021
(Dollars in thousands)(Dollars in thousands)(Dollars in thousands)
Total current assetsTotal current assets$1,753,371 $1,514,724 Total current assets$1,692,162 $1,514,724 
Total assetsTotal assets4,907,983 2,729,455 Total assets4,788,819 2,729,455 
Current liabilitiesCurrent liabilities1,650,855 1,341,691 Current liabilities1,599,546 1,341,691 
Total liabilitiesTotal liabilities4,530,738 2,398,694 Total liabilities4,415,095 2,398,694 

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

26


Table of Contents
Recent Accounting Pronouncements

For a discussion of recent accounting pronouncements, see our Annual Report on Form 10-K for the year ended December 31, 2021 and Note 15 in the Notes to Consolidated Financial Statements, included in this Quarterly Report on Form 10-Q for the period ended on March 31,September 30, 2022.

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, 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 consolidation among significant customers, health insurers and/or other industry participants, and intense cost-containment initiatives;
30


Table of Contents
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;
the risk that problems may arise in successfully integrating the businesses of Apria and the Company, which may result in the combined company not operating as effectively and efficiently as expected and the risk that the combined company may be unable to achieve the anticipated synergies or cost savings, or it may take longer than expected to achieve those synergies;
the effect of our acquisition of Apria and any developments relating thereto on our relationships with customers, suppliers and other third parties, as well as our operating results and business;
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;
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;
27


Table of Contents
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;
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;
our financial flexibility may be limited by the restrictive covenants in our credit facilities and existing notes;
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;
we depend on reimbursements by payors, which could lead to delays and uncertainties in the reimbursement process;
the home healthcare industry is highly competitive and fragmented, with limited barriers to entry which may make it susceptible to vertical integration by manufacturers, payors, providers (such as hospital systems) or disruptive new entrants;
the risk that a decline in business volume or profitability could result in an impairment of goodwill or other long-lived assets;assets, which would require us to record a significant charge to earnings in accordance with generally accepted accounting principles;
31


Table of Contents
our ability to timely or adequately respond to technological advances in the medical supply and home healthcare industries and/or product and therapy innovations may make the services we currently provide obsolete or less competitive;
our failure to adequately insure against losses, including from substantial claims and litigation, could have an adverse impact on our operations, financial condition, or prospects;
recalls of any of our products, either voluntarily or at the direction of the Food and Drug Administration or another governmental authority, or safety risks or the discovery of serious safety issues with our products;
our capitation arrangements may prove unprofitable if actual utilization rates exceed our assumptions;
reductions in Medicare, Medicaid and commercial payor reimbursement rates could have a material adverse effect on our results of operations and financial condition;
the costs associated with and outcome of outstanding and any future litigation, including product and professional liability claims;
the market price for our common stock may be highly volatile;
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 initiatives;
our ability to continue to comply with the terms and conditions of Apria’s Corporate Integrity Agreement; 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, 2021.2021 our Form 10-Q for the three months ended March 31, 2022, and our Form 10-Q for the three and six months ended June 30, 2022
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 Products & Healthcare Services segment. Prices of the commodities
28


Table of Contents
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.

We are exposed to risks of changes in shipping and freight costs, including container and other third party fees associated with the transportation of our products. Shipping and freight costs have fluctuated significantly in recent years and in the future may contribute to changes in our results of operations.
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 denominated in the euro, Malaysian ringgit, Mexican peso, Thai baht and other currencies. We may use foreign currency forwards, swaps and options, where possible, to manage our risk related to certain foreign currency fluctuations.
We are exposed to market risk from changes in interest rates related to our borrowing under our Revolving Credit Agreement and Receivables Financing Agreement. Excluding deferred financing costs and third party fees, we had $500 million in borrowings under our Term Loan A, $600$597 million in borrowings under our Term Loan B, $11.7 million inno borrowings under our revolving credit facility, $230Revolving Credit Agreement, $157 million in borrowings under our Receivables Financing Agreement and $28.0 million in letters of credit under the Revolving Credit Agreement at March 31,September 30, 2022. After considering the effects of an interest rate swap agreement entered into during April 2022, we estimate an increase in interest rates of 100 basis points would result in a potential reduction in future pre-tax earnings of approximately $9.4$8.5 million per year based on our borrowings outstanding at March 31,September 30, 2022.
Due to the nature and pricing of our Products & Healthcare Services 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 $4.30$5.00 and $2.91$3.16 per gallon in the first threenine months of 2022 and 2021. Based on our fuel consumption in the first threenine months of 2022, we estimate that every 10 cents per gallon increase in the benchmark would directly reduce our Products & Healthcare Services segment operating income by approximately $0.2$0.4 million on an annualized basis. We are also indirectly exposed to increased shipping and freight costs, including container and other third party fees associated with the transportation of our products due to
32


Table of Contents
changes in fuel prices. Changes in fuel prices have contributed to significant shipping and freight costs in recent years and in the future may contribute to changes in our results of operations.

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 March 31,September 30, 2022. 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. In connection with the Apria Acquisition, we are currently evaluating the acquired processes, information technology systems and other components of internal controls over financial reporting as part of our integration activities which may result in periodic changes. Such changes will be disclosed as required by applicable SEC guidance.
SEC guidance permits the exclusion of an evaluation of the effectiveness of a registrant's disclosure controls and procedures as they relate to the internal control over financial reporting for an acquired business during the first year following such acquisition. In the first quarter of 2022, we acquired Apria, Inc. This acquisition represented $2.1$2.0 billion of total assets and $11.0$620 million of revenues as of and for the threenine months ended March 31,September 30, 2022. Management's evaluation and conclusion as to the effectiveness of the design and operation of the Company's disclosure controls and procedures as of and for the period covered by this report excludes any evaluation of the internal control over financial reporting of Apria, Inc.


Part II. Other Information

29


Table of Contents
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, 2021. Through March 31,September 30, 2022, there have been no material developments in any legal proceedings reported in such Annual Report.

Item 1A. Risk Factors

The following description ofCertain risk factors updates and supplements risk factors associated withthat we believe could affect our business previously disclosedand prospects are described in our Annual Report on Form 10-K for the year ended December 31, 2021. These risk factors are in addition to those mentioned in other parts of this report2021 and are not all ofour Form 10-Q for 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 face increasing competition, accelerating pricing pressure and changes in technology.
The medical/surgical supply distribution industry in the United States is highly competitive and characterized by pricing and margin pressure for our business. We compete with other national distributors and a number of regional and local distributors, as well as customer self-distribution models and, to a lesser extent, certain outsourced logistics companies. Competitive factors within the medical/surgical supply distribution industry include market pricing, the relative bargaining power of provider networks and group purchasing organizations (GPO), total delivered product cost, product availability, the ability to fill and invoice orders accurately, delivery time, range of services provided, efficient product sourcing, inventory management, information technology, electronic commerce capabilities, and the ability to meet customer-specific requirements. Our success is dependent on the ability to compete on the above factors, while managing internal costs and expenses.
The home healthcare industry is also intensely competitive and highly fragmented. There are a large number of providers, including hospital systems, physician specialists and sleep labs, industrial gas manufacturers, home healthcare agencies and health maintenance organizations. There are also relatively few barriers to entry in local home healthcare markets. Hospitals and health systems are routinely looking to provide coverage and better control of post-acute healthcare services, including home healthcare services of the types we provide. In addition, pharmacy benefit managers, such as CVS Health Corporation, are beginning to compete with us in the home healthcare market. Large technology companies, such as Amazon.com, Inc. and Alphabet Inc., have disrupted other supply businesses and, in the case of Amazon.com, Inc. and their new pharmacy offerings, entered the healthcare market or publicly stated their interest in doing so. In the event such companies enter the home healthcare market, we may experience a loss of referrals or revenue.
Some of our competitors may now or in the future have greater financial or marketing resources than we do, or have more effective sales and marketing activities, which may increase pricing pressure and limit our ability to maintain or increase our market share. In addition, in certain markets, competitors may have more effective sales and marketing activities or other products and services that are or perceived to be superior to our own.
It is also possible that major changes in available technology, payor benefit or coverage policies related to those changes, or the preferences of customers, patients and referral sources, may cause our current product offerings to become less competitive or obsolete, and it will be necessary for us to adapt to those changes. Such unanticipated changes could cause us to incur increased capital expenditures and strategies and could have a material adverse effect on our business, results of operations, financial condition and cash flows.
Changing conditions in the United States healthcare industry may impact our results of operations.
A large percentage of our revenue is derived in the United States. We, along with our customers and suppliers, are subject to extensive federal and state regulations relating to healthcare as well as the policies and practices of the private healthcare insurance industry. In recent years,three months ended March 31, 2022. Through September 30, 2022, there have been a number of government and private initiatives to reduce healthcare costs and government spending. Theseno material changes have included an increased reliance on managed care; consolidation of competitors, suppliers and customers; a shift in healthcare provider venues from acute care settings to clinics, physician offices and home care; and the development of larger, more sophisticated purchasing groups. National and regional insurers and managed care organizations are regularly attempting to seek reductions in the prices we charge for our products and services to them and their members, including through direct contracts with healthcare providers, increased oversight and greater enrollment of patientsrisk factors described in managed care programs and preferred provider organizations. We have faced, and expect to continue to face, pricing pressures due to reductions in provider reimbursement for our products and services. In addition, in recent years, the healthcare industry in the United States has experienced and continues to experience significant consolidation in response to cost containment legislation and general market pressures to reduce costs. This consolidation of our customers, health insurers and suppliers generally gives them greater bargaining power to reduce the pricing available to them. All of these changes place additional financial pressure on healthcare provider customers, who in turn seek to reduce the costs and pricing of products and services provided by us. We expect the healthcare industry to continue to change significantly and these potential changes, which may include a reduction in government support of healthcare services, adverse changes in legislation or regulations, and further reductions in healthcare reimbursement practices, could have a material adverse effect on our business, results of operations and financial condition.
30


Table of Contents
We have concentration in and dependence on certain healthcare provider customers and Group Purchasing Organizations. New Group Purchasing Organizations or provider networks and an expansion of the multi-tiered costing structure may place us at a competitive disadvantage.
In 2021, although no single customer accounted for 5% of our consolidated net revenue on a pro forma basis for our acquisition of Apria, our top ten customers in the United States represented approximately 18% of our consolidated net revenue on a pro forma basis for our acquisition of Apria. In addition, in 2021, approximately 63% of our consolidated net revenue on a pro forma basis for our acquisition of Apria was from sales to member hospitals under contract with our largest GPOs: Vizient, Premier and HPG. We could lose a significant healthcare provider customer or GPO relationship if an existing contract expires without being replaced or is terminated by the customer or GPO prior to its expiration. Although the termination of our relationship with a given GPO would not necessarily result in the loss of the member hospitals as customers, any such termination of a GPO relationship, or a significant individual healthcare provider customer relationship, could have a material adverse effect on our results of operations and financial condition.
The medical products industry is subject to a multi-tiered costing structure, which can vary by manufacturer and/or product. Under this structure, certain institutions can obtain more favorable prices for medical products than we are able to obtain. The multi-tiered costing structure continues to expand as many large integrated healthcare providers and others with significant purchasing power, such as GPOs, demand more favorable pricing terms. Additionally, the formation of provider networks and GPOs may shift purchasing decisions to entities or persons with whom we do not have a historical relationship. This may threaten our ability to compete effectively, which could in turn negatively impact our financial results. Although we are seeking to obtain similar terms from manufacturers to obtain access to lower prices demanded by GPO contracts or other contracts, and to develop relationships with provider networks and new GPOs, we cannot assure you that such terms will be obtained or contracts will be executed.
The reliance of our home healthcare business on relatively few vendors for the majority of its patient equipment and supplies and which are to be imposed on certain manufacturers of such items could adversely affect our ability to operate this business.
We currently rely on a relatively small number of vendors to provide us with the majority of our patient equipment and supplies for our home healthcare business. From time to time, we also enter into certain exclusive arrangements with a given vendor for the provision of patient equipment and supplies. Further, some of our supply agreements contain pricing scales that depend on meeting certain order volumes. Our inability to procure certain equipment and supplies, including as a result of failure to maintain and renew certain agreements and access arrangements, could have a materially adverse effect on our results of operations. We often use vendors selectively for quality and cost reasons. Significant price increases, or disruptions in the ability to obtain such equipment and supplies from existing vendors, may force us to increase our prices (which we may be unable to do) or reduce our margins and could force us to use alternative vendors. Any change in the existing vendors we use could cause delays in the delivery of products and possible losses in revenue, which could adversely affect our results of operations. In addition, alternative vendors may not be available, or may not provide their products and services at similar or favorable prices. If we cannot obtain the patient equipment and supplies we currently use, or alternatives at similar or favorable prices, our ability to provide such products may be severely impacted, which could have an adverse effect on our business, financial condition, results of operations, cash flow, capital resources and liquidity.
We are subject to stringent regulatory and licensing requirements, and we have been, are and could become the subject of federal and state investigations and compliance reviews.
We are required to comply with extensive and complex laws and regulations at the federal, state and local government levels in the United States and other countries where we operate. We, and certain of our employees, also are required to hold permits and licenses and to comply with the operational and security standards of various governmental bodies and agencies. Any failure to comply with these laws and regulations or any failure to maintain the necessary permits, licenses or approvals, or to comply with the required standards, could disrupt our operations and/or adversely affect our results of operations and financial condition.
Among the U.S. healthcare related laws that we are subject to include the Anti-kickback Statute, the Stark Law, the False Claims Act and similar state laws relating to fraud, waste and abuse. The requirements of these laws are complex and subject to varying interpretations, and it is possible that regulatory authorities could challenge our policies and practices. If we fail to comply with these laws, we could be subject to federal or state government investigations or qui tam actions (false claims cases initiated by private parties purporting to act on behalf of federal or state governments), which could result in civil or criminal sanctions, including the loss of licenses or the ability to participate in Medicare, Medicaid and other federal and state healthcare programs. Such sanctions and damages could adversely affect our results of operations and financial condition.
Our global operations are also subject to risks of violation of laws, including those that prohibit improper payments to and bribery of government officials and other individuals and organizations. These laws include the U.S. Foreign Corrupt Practices Act, the U.K. Bribery Act and other similar laws and regulations in foreign jurisdictions, any violation of which could result in substantial liability and a loss of reputation in the marketplace. Failure to comply with these laws also could subject us to civil and criminal penalties that could adversely affect our business and results of operations.
31


Table of Contents
Our Patient Direct business is a Medicare-certified supplier and participates in state Medicaid programs. Failure to comply with applicable standards and regulations could result in civil or criminal sanctions, including the loss of our ability to participate in Medicare, Medicaid and other federal and state healthcare programs.
We collect, handle and maintain patient-identifiable health information and other sensitive personal and financial information, which are subject to federal, state and foreign laws that regulate the use and disclosure of such information. Regulations currently in place continue to evolve, and new laws in this area could further restrict our ability to collect, handle and maintain personal or patient information, or could require us to incur additional compliance costs, either of which could have an adverse impact on our results of operations. Violations of federal (such as the Health Insurance Portability and Accountability Act of 1996, as amended, or HIPAA), state or foreign laws (such as the European Union’s General Data Protection Regulation, as amended, or GDPR) concerning privacy and data protection could subject us to civil or criminal penalties, breach of contract claims, costs for remediation and harm to our reputation.
Our operations, including our billing practices and our arrangements with healthcare providers, are also subject to extensive federal and state laws and audits, inquiries and investigations from government agencies. For example, in connection with the settlement agreements resolving the investigation conducted by the U.S. Attorney's Office for the Southern District of New York regarding civil investigative demands, Apria was required to enter into a five-year Corporate Integrity Agreement (CIA) with the Office of Inspector General for the U.S. Department of Health and Human Services. The CIA provides that Apria will, among other things, impose certain oversight obligations on its board of directors, provide certain management certifications, and continue or implement, as applicable certain compliance training and education. The CIA also requires Apria to engage independent third parties to review compliance with the CIA, as well as certain reporting, certification, record retention and notification requirements. Failure to comply with the obligations under the CIA could have material consequences for Apria including monetary penalties or exclusion from participation in federal healthcare programs. Applicable laws may be directed at payments for the products and services we provide, conduct of our operations, preventing fraud and abuse, and billing and reimbursement from government programs such as Medicare and Medicaid and from commercial payors. These laws may have related rules and regulations that are subject to interpretation and may not provide definitive guidance as to their application to our operations, including our arrangements with hospitals, physicians, and other healthcare providers.
Federal and state governments have contracted with private entities to audit and recover revenue resulting from payments made in excess of those permitted by federal and state benefit program rules. These entities include, but are not limited to, Recovery Audit Contractors that are responsible for auditing Medicare claims, Unified Program Integrity Contractors that are responsible for the identification of suspected fraud through medical record review and Medicaid Integrity Contractors, that are responsible for auditing Medicaid claims. We believe audits, inquiries, and investigations from these contractors and others will occur from time to time in the ordinary course of our business. We also may be subject to increased audits from commercial payors and pursuant to federal, civil, and criminal statutes that relate to our billings to commercial payors. Our efforts to be responsive to these audits, inquiries, and investigations may result in substantial costs and divert management’s time and attention away from the operation of our business. Moreover, an adverse outcome with respect to any audit, inquiry or investigation may result in damage to our reputation, or in fines, penalties or other sanctions imposed on us. Such pending or future audits, inquiries, or investigations, or the public disclosure of such matters, could have a material adverse effect on our business, financial condition, results of operations, cash flow, capital resources and liquidity.
Federal and state laws are broadly worded and may be interpreted or applied by prosecutorial, regulatory, or judicial authorities in ways that we cannot predict. Additionally, in many instances, there are only limited publicly available guidelines and methodologies for determining errors with certain audits. As a result, there can be a significant lack of clarity regarding required documentation and audit methodology. The clarity and completeness of each patient medical file, some of which is the work product of physicians not employed by us, is essential to successfully challenging any payment denials.
Accordingly, our arrangements and business practices may be the subject of government scrutiny or be found to violate applicable laws. If federal or state government officials challenge our operations or arrangements with third parties that we have structured based upon our interpretation of these laws, rules, and regulations, such a challenge could potentially disrupt our business operations and we may incur substantial defense costs, even if we successfully defend our interpretation of these laws, rules, and regulations. If the government or third parties successfully challenge our interpretation, such a challenge may have a material adverse effect on our business, financial condition, results of operations, cash flow, capital resources and liquidity.
Our failure to comply with regulatory requirements or receive regulatory clearances or approvals for our medical gas facilities, products or operations could adversely affect our business.
We have a number of medical gas facilities in several states. These facilities are subject to federal and state regulatory requirements. Our medical gas facilities and operations are subject to extensive regulation by the FDA and other federal and state authorities. The FDA regulates medical gases, including medical oxygen, pursuant to its authority under the FFDCA. Among other requirements, the FDA’s cGMP regulations impose certain quality control, documentation, and recordkeeping requirements on the receipt, processing, and distribution of medical gas. Further, in each state where we operate medical gas facilities, we are subject to regulation under state health and safety laws, which vary from state to state. The FDA and state authorities conduct periodic, unannounced inspections at medical gas facilities to assess compliance with the cGMP and other regulations. We expend significant time, money, and resources in an effort to achieve substantial compliance with the cGMP
32


Table of Contents
regulations and other federal and state law requirements at each of our medical gas facilities. There can be no assurance, however, that these efforts will be successful and that our medical gas facilities will achieve and maintain compliance with federal and state laws and regulations. Our failure to achieve and maintain regulatory compliance at our medical gas facilities could result in enforcement action, including warning letters, fines, product recalls or seizures, temporary or permanent injunctions, or suspensions in operations at one or more locations, as well as civil or criminal penalties, all of which could materially harm our business, financial condition, results of operations, cash flow, capital resources, and liquidity.
The medical gas products we manufacture and distribute and certain other products we distribute are subject to extensive regulation by the FDA and other federal and state governing authorities. Compliance with FDA, state, and other requirements regarding production, safety, quality, manufacturing, distribution and marketing is costly and time-consuming, and while we seek to be in full compliance, instances of non-compliance could arise from time to time. We cannot be assured that any of our medical gases will be certified by the FDA. We have applied for, and received, designated gas certifications for our medical gas products. We may not be successful in receiving certification in the future. Other potential product manufacturing-related risks include difficulties or delays in product manufacturing, sales, or marketing, which could affect future results through regulatory actions, shutdowns, approval delays, withdrawals, recalls, penalties, supply disruptions or shortages, reputational harm, product liability, and/or unanticipated costs.
Failure to comply with applicable regulatory requirements could result in administrative enforcement action by the FDA or state agencies, which may include any of the following: adverse publicity; warning or untitled letters; fines; injunctions; consent decrees; civil money penalties; recalls; termination of distribution or seizure of our products; operating restrictions or partial suspension or total shutdown of production; delays in the introduction of products into the market; withdrawals or suspensions of current medical gas certifications or drug approvals, resulting in prohibitions on sales of our products; and criminal prosecution. There is also a risk that we may not adequately implement sustainable processes and procedures to maintain regulatory compliance and to address future regulatory agency findings, should they occur. The FDA may change its policies, adopt additional regulations or revise existing regulations, each of which could prevent or delay certification of our medical gases, or could impact our ability to market a device that was previously certified or cleared by the FDA. Any of these sanctions could result in higher than anticipated costs or lower than anticipated sales and have a material adverse effect on our business, financial condition, results of operations, cash flow, capital resources and liquidity.
Our operations involve the storage, transportation and provision of compressed and liquid oxygen, which carries an inherent risk of rupture or other accidents with the potential to cause substantial loss.
Our operations are subject to the many hazards inherent in the storage, transportation and provision of medical gas products and compressed and liquid oxygen, including ruptures, leaks and fires. These risks could result in substantial losses due to personal injury or loss of life, severe damage to and destruction of property and equipment and pollution or other environmental damage and may result in curtailment or suspension of our related operations. If a significant accident or event occurs, it could adversely affect our business, financial position and results of operations. Additionally, corrective action plans, fines or other sanctions may be levied by government regulators who oversee the storage, transportation and provision of hazardous materials such as compressed or liquid oxygen.
Our capitation arrangements may prove unprofitable if actual utilization rates exceed our assumptions.
From time to time, we enter into capitation arrangements with commercial payors pursuant to which they agree to pay us a set amount (on a per member per month basis for a defined patient population) without regard to the actual services provided. We negotiate the contractual rates in these arrangements with payors based on assumptions regarding average expected utilization of services. If actual utilization rates exceed our assumptions, the profitability of such arrangements may be diminished. Moreover, we may be obligated to perform under such capitation arrangements even if the contractual reimbursement rates are insufficient to cover our costs based on actual levels of utilization.
Our acquisition of Apria has increased our exposure to risks relating to the home healthcare industry.
In 2021, our Patient Direct segment contributed approximately 10% of our consolidated net revenue. On a pro forma basis for the Apria Acquisition, our Patient Direct business would have represented approximately 19% of our consolidated net revenue in 2021. Accordingly, our exposure to risks relating to the home healthcare industry, including those risks previously disclosed in “Item 1A. Risk Factors” of our Annual Report onand First Quarter 2022 Form 10-K for the year ended December 31, 2021, has materially increased following our acquisition of Apria.10-Q.

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 $50.0 million. We intend to use the net proceeds from the sale of our securities offered by this program for the repayment of indebtedness and/or for general corporate and working capital purposes. As of March 31,September 30, 2022, no shares were issued and $50.0 million of common stock remained available under the at-the-market equity financing program.


Item 5. Other Information

On October 28, 2022, the Company’s Board of Directors (the “Board”) adopted and approved, effective immediately, the amended and restated bylaws (as amended and restated, the “Amended and Restated Bylaws”) of the Company. The Amended and Restated Bylaws, among other things:

revise procedures and disclosure requirements for shareholders to provide notice of the nomination of directors (outside of “proxy access”) and the submission of proposals for consideration at meetings of the shareholders of the Company;
33


Table of Contents
clarify the power of the Board to set rules and procedures for, postpone, reschedule or cancel any meeting of shareholders previously scheduled, and clarify the power of the chair of a shareholder meeting to adjourn any meeting of stockholders;
clarify the powers of the Board and the chair of a shareholder meeting to establish rules for the conduct of any meeting of shareholders;
clarify that for the applicability of the plurality voting standard to an election of directors, an election remains “contested” (and the plurality voting standard continues to apply) even if the Board determines that a shareholder’s nomination notice does not comply with the advance notice bylaws;
provide that the size of the Board can be fixed from time to time by resolution of the Board;
adopt a forum selection bylaw to provide that (i) shareholder suits and other derivative actions asserted against the Company or its directors and officers be brought only before the United States District Court for the Eastern District of Virginia and (ii) the U.S. federal district courts shall be the exclusive forum for the resolution of claims under the Securities Act of 1933, as amended; and
make certain other administrative, modernizing, clarifying and conforming changes.

The foregoing description of the Amended and Restated Bylaws is not complete and is qualified in its entirety by reference to the complete text of the Amended and Restated Bylaws, which is filed as Exhibit 3.1 hereto and is incorporated herein by reference.


Item 6. Exhibits

(a)Exhibits
2.1
3.1
4.1
4.2
4.3
4.4
4.5
10.1
10.2
10.322.1
10.4
10.5
10.6
34


Table of Contents
10.7
22.1
22.2
31.1  
31.2  
32.1  
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 iXBRL 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
35


Table of Contents
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:May 3,November 2, 2022 /s/ Edward A. Pesicka
 Edward A. Pesicka
 President, Chief Executive Officer & Director
Date:May 3,November 2, 2022 /s/ Andrew G. LongAlexander J. Bruni
 Andrew G. LongAlexander J. Bruni
 Executive Vice President & Chief Financial Officer
 
36