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
or
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period endedCommission File Number
SeptemberJune 30, 20202021001-39218
CONMED CORPORATION
(Exact name of the registrant as specified in its charter)
Delaware16-0977505
(State or other jurisdiction of incorporation or organization)(I.R.S. Employer Identification No.)
525 French Road11311 Concept BlvdUtica,Largo,New YorkFlorida1350233773
(Address of principal executive offices)(Zip Code)
(315) 797-8375(727) 392-6464
(Registrant's telephone number, including area code)

Securities registered pursuant to Section 12(b) of the Act
Title of each classTrading SymbolName of each exchange on which registered
Common Stock, $0.01 par valueCNMDNYSE
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 every Interactive Data File required to be submitted 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 such files).  

Yes    No

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company or an emerging growth company.  See the definitions of "large accelerated filer", "accelerated filer", "smaller reporting company" and "emerging growth company" in Rule 12b-2 of the Exchange Act (Check one).

Large accelerated filer     Accelerated filer     Non-accelerated filer

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 outstanding of registrant's common stock, as of OctoberJuly 26, 20202021 is 28,601,59929,162,891 shares.



CONMED CORPORATION
QUARTERLY REPORT ON FORM 10-Q
FOR THE QUARTER ENDED SEPTEMBERJUNE 30, 20202021
PART I FINANCIAL INFORMATION
Item NumberPage
   
 
   
 
   
 
   
 
   
 
   
   
   
   
   
PART II OTHER INFORMATION
   
   
   


Table of Contents
PART I FINANCIAL INFORMATION
Item 1.
CONMED CORPORATION
CONSOLIDATED CONDENSED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
(Unaudited, in thousands except per share amounts)
 
Three Months EndedNine Months Ended Three Months EndedSix Months Ended
September 30,September 30, June 30,June 30,
2020201920202019 2021202020212020
Net salesNet sales$237,835 $233,590 $609,631 $690,232 Net sales$255,161 $157,785 $487,837 $371,796 
Cost of salesCost of sales104,137 103,479 284,845 307,492 Cost of sales113,737 85,856 217,964 180,707 
Gross profitGross profit133,698 130,111 324,786 382,740 Gross profit141,424 71,929 269,873 191,089 
Selling and administrative expenseSelling and administrative expense94,380 98,187 274,721 298,140 Selling and administrative expense104,399 84,475 202,739 180,343 
Research and development expenseResearch and development expense9,936 10,985 28,756 33,366 Research and development expense11,318 8,700 21,344 18,820 
Operating expenses Operating expenses104,316 109,172 303,477 331,506  Operating expenses115,717 93,175 224,083 199,163 
Income from operations29,382 20,939 21,309 51,234 
Income (loss) from operationsIncome (loss) from operations25,707 (21,246)45,790 (8,074)
Interest expenseInterest expense11,943 11,174 32,938 32,382 Interest expense9,420 11,401 19,772 20,993 
Other expenseOther expense89 321 266 4,867 Other expense89 178 
Income (loss) before income taxesIncome (loss) before income taxes17,350 9,444 (11,895)13,985 Income (loss) before income taxes16,287 (32,736)26,018 (29,245)
Provision for income taxes10,500 2,474 2,728 299 
Provision (benefit) for income taxesProvision (benefit) for income taxes2,997 (5,336)2,868 (7,772)
Net income (loss)Net income (loss)$6,850 $6,970 $(14,623)$13,686 Net income (loss)$13,290 $(27,400)$23,150 $(21,473)
Comprehensive income (loss)Comprehensive income (loss)$8,976 $4,661 $(16,858)$11,508 Comprehensive income (loss)$17,743 $(24,713)$28,486 $(25,834)
Per share data:Per share data: Per share data: 
Net income (loss)Net income (loss) Net income (loss) 
BasicBasic$0.24 $0.25 $(0.51)$0.48 Basic$0.46 $(0.96)$0.80 $(0.75)
DilutedDiluted0.23 0.23 (0.51)0.47 Diluted0.41 (0.96)0.72 (0.75)
Weighted average common sharesWeighted average common shares Weighted average common shares 
BasicBasic28,583 28,353 28,529 28,280 Basic29,125 28,542 29,052 28,506 
DilutedDiluted29,426 29,792 28,529 29,354 Diluted32,464 28,542 31,964 28,506 
 See notes to consolidated condensed financial statements.
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Table of Contents
CONMED CORPORATION
CONSOLIDATED CONDENSED BALANCE SHEETS
(Unaudited, in thousands except share and per share amounts)
 
September 30,
2020
December 31,
2019
June 30,
2021
December 31,
2020
ASSETSASSETS ASSETS 
Current assets:Current assets: Current assets: 
Cash and cash equivalentsCash and cash equivalents$35,598 $25,856 Cash and cash equivalents$46,388 $27,356 
Accounts receivable, netAccounts receivable, net166,593 189,097 Accounts receivable, net168,966 177,152 
InventoriesInventories182,668 164,616 Inventories211,323 194,868 
Prepaid expenses and other current assetsPrepaid expenses and other current assets19,369 17,794 Prepaid expenses and other current assets16,503 17,278 
Total current assetsTotal current assets404,228 397,363 Total current assets443,180 416,654 
Property, plant and equipment, netProperty, plant and equipment, net112,253 118,883 Property, plant and equipment, net107,722 111,407 
GoodwillGoodwill617,393 618,042 Goodwill618,280 618,440 
Other intangible assets, netOther intangible assets, net509,684 532,800 Other intangible assets, net486,623 501,537 
Other assetsOther assets99,571 108,007 Other assets106,169 103,635 
Total assetsTotal assets$1,743,129 $1,775,095 Total assets$1,761,974 $1,751,673 
LIABILITIES AND SHAREHOLDERS' EQUITYLIABILITIES AND SHAREHOLDERS' EQUITY LIABILITIES AND SHAREHOLDERS' EQUITY 
Current liabilities:Current liabilities: Current liabilities: 
Current portion of long-term debtCurrent portion of long-term debt$16,805 $13,596 Current portion of long-term debt$21,868 $18,415 
Accounts payableAccounts payable57,197 55,968 Accounts payable55,665 53,310 
Accrued compensation and benefitsAccrued compensation and benefits44,869 53,690 Accrued compensation and benefits49,192 50,171 
Other current liabilitiesOther current liabilities60,168 64,833 Other current liabilities71,733 68,305 
Total current liabilitiesTotal current liabilities179,039 188,087 Total current liabilities198,458 190,201 
Long-term debtLong-term debt760,451 755,211 Long-term debt707,808 735,221 
Deferred income taxesDeferred income taxes72,906 74,488 Deferred income taxes57,622 57,875 
Other long-term liabilitiesOther long-term liabilities47,592 46,842 Other long-term liabilities53,587 59,338 
Total liabilitiesTotal liabilities1,059,988 1,064,628 Total liabilities1,017,475 1,042,635 
Commitments and contingenciesCommitments and contingenciesCommitments and contingencies00
Shareholders' equity:Shareholders' equity: Shareholders' equity: 
Preferred stock, par value $0.01 per share;Preferred stock, par value $0.01 per share; Preferred stock, par value $0.01 per share; 
authorized 500,000 shares; NaN outstandingauthorized 500,000 shares; NaN outstandingauthorized 500,000 shares; NaN outstanding
Common stock, par value $0.01 per share;
100,000,000 shares authorized; 31,299,194 shares
issued in 2020 and 2019, respectively
313 313 
Common stock, par value $0.01 per share;
100,000,000 shares authorized; 31,299,194 shares
issued in 2021 and 2020, respectively
Common stock, par value $0.01 per share;
100,000,000 shares authorized; 31,299,194 shares
issued in 2021 and 2020, respectively
313 313 
Paid-in capitalPaid-in capital381,119 379,324 Paid-in capital393,663 382,628 
Retained earningsRetained earnings439,086 470,844 Retained earnings468,924 457,417 
Accumulated other comprehensive lossAccumulated other comprehensive loss(61,512)(59,277)Accumulated other comprehensive loss(58,345)(63,681)
Less: 2,703,178 and 2,876,729 shares of common stock
in treasury, at cost in 2020 and 2019, respectively
(75,865)(80,737)
Less: 2,139,851 and 2,410,045 shares of common stock
in treasury, at cost in 2021 and 2020, respectively
Less: 2,139,851 and 2,410,045 shares of common stock
in treasury, at cost in 2021 and 2020, respectively
(60,056)(67,639)
Total shareholders’ equityTotal shareholders’ equity683,141 710,467 Total shareholders’ equity744,499 709,038 
Total liabilities and shareholders’ equityTotal liabilities and shareholders’ equity$1,743,129 $1,775,095 Total liabilities and shareholders’ equity$1,761,974 $1,751,673 
 See notes to consolidated condensed financial statements.
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CONMED CORPORATION
CONSOLIDATED CONDENSED STATEMENTS OF SHAREHOLDERS' EQUITY
(Unaudited, in thousands except per share amounts)
Common StockPaid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
Common StockPaid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
SharesAmountRetained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
Balance at December 31, 201931,299 $313 $379,324 $470,844 $(59,277)$(80,737)$710,467 
Balance at December 31, 2020Balance at December 31, 202031,299 $313 $382,628 $457,417 $(63,681)$(67,639)$709,038 
Common stock issued under employee plansCommon stock issued under employee plans (7,736) 2,696 (5,040)Common stock issued under employee plans 2,944  5,271 8,215 
Stock-based compensationStock-based compensation 3,032  3,032 Stock-based compensation 3,387  3,387 
Dividends on common stock ($0.20 per share)Dividends on common stock ($0.20 per share)(5,703)(5,703)Dividends on common stock ($0.20 per share)(5,813)(5,813)
Comprehensive income (loss):Comprehensive income (loss):Comprehensive income (loss):
Cash flow hedging gain, netCash flow hedging gain, net3,926 
Pension liability, netPension liability, net631 
Foreign currency translation adjustmentsForeign currency translation adjustments(9,988)Foreign currency translation adjustments(3,674)
Pension liability, net535 
Cash flow hedging gain, net2,405 
Net incomeNet income5,927 Net income9,860 
Total comprehensive loss(1,121)
Balance at March 31, 202031,299 $313 $374,620 $471,068 $(66,325)$(78,041)$701,635 
Total comprehensive incomeTotal comprehensive income10,743 
Balance at March 31, 2021Balance at March 31, 202131,299 $313 $388,959 $461,464 $(62,798)$(62,368)$725,570 
Common stock issued under employee plansCommon stock issued under employee plans(1,150)1,283 133 Common stock issued under employee plans414 2,312 2,726 
Stock-based compensationStock-based compensation3,555 3,555 Stock-based compensation4,290 4,290 
Dividends on common stock ($0.20 per share)Dividends on common stock ($0.20 per share)(5,712)(5,712)Dividends on common stock ($0.20 per share)(5,830)(5,830)
Comprehensive income (loss):Comprehensive income (loss):Comprehensive income (loss):
Cash flow hedging gain, netCash flow hedging gain, net1,221 
Pension liability, netPension liability, net631 
Foreign currency translation adjustmentsForeign currency translation adjustments4,581 Foreign currency translation adjustments2,601 
Pension liability, net535 
Cash flow hedging loss, net(2,429)
Net loss(27,400)
Total comprehensive loss(24,713)
Balance at June 30, 202031,299 $313 $377,025 $437,956 $(63,638)$(76,758)$674,898 
Common stock issued under employee plans562 893 1,455 
Stock-based compensation3,532 3,532 
Dividends on common stock ($0.20 per share)(5,720)(5,720)
Comprehensive income (loss):
Foreign currency translation adjustments4,617 
Pension liability, net535 
Cash flow hedging loss, net(3,026)
Net incomeNet income6,850 Net income13,290 
Total comprehensive incomeTotal comprehensive income8,976 Total comprehensive income17,743 
Balance at September 30, 202031,299 $313 $381,119 $439,086 $(61,512)$(75,865)$683,141 
Balance at June 30, 2021Balance at June 30, 202131,299 $313 $393,663 $468,924 $(58,345)$(60,056)$744,499 
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Table of Contents
Common StockPaid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
Common StockPaid-in
Capital
Retained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
SharesAmountRetained
Earnings
Accumulated
Other
Comprehensive
Loss
Treasury
Stock
Shareholders’
Equity
Balance at December 31, 201831,299 $313 $341,738 $464,851 $(55,737)$(88,895)$662,270 
Common stock issued under employee plans (769) 2,517 1,748 
Stock-based compensation 2,703  2,703 
Dividends on common stock ($0.20 per share)(5,643)(5,643)
Convertible notes discount, net39,145 39,145 
Convertible notes hedge, net(38,829)(38,829)
Issuance of warrants30,567 30,567 
Comprehensive income (loss):
Foreign currency translation adjustments(578)
Pension liability, net547 
Cash flow hedging gain, net106 
Net income1,021 
Total comprehensive income1,096 
Balance at March 31, 201931,299 $313 $374,555 $460,229 $(55,662)$(86,378)$693,057 
Balance at December 31, 2019Balance at December 31, 201931,299 $313 $379,324 $470,844 $(59,277)$(80,737)$710,467 
Common stock issued under employee plansCommon stock issued under employee plans (1,144) 1,894 750 Common stock issued under employee plans (7,736) 2,696 (5,040)
Stock-based compensationStock-based compensation 3,108  3,108 Stock-based compensation 3,032  3,032 
Dividends on common stock ($0.20 per share)Dividends on common stock ($0.20 per share)(5,657)(5,657)Dividends on common stock ($0.20 per share)(5,703)(5,703)
Comprehensive income (loss):Comprehensive income (loss):Comprehensive income (loss):
Cash flow hedging gain, netCash flow hedging gain, net2,405 
Pension liability, netPension liability, net535 
Foreign currency translation adjustmentsForeign currency translation adjustments1,108 Foreign currency translation adjustments(9,988)
Pension liability, net546 
Cash flow hedging loss, net(1,598)
Net incomeNet income5,695 Net income5,927 
Total comprehensive income5,751 
Balance at June 30, 201931,299 $313 $376,519 $460,267 $(55,606)$(84,484)$697,009 
Total comprehensive lossTotal comprehensive loss(1,121)
Balance at March 31, 2020Balance at March 31, 202031,299 $313 $374,620 $471,068 $(66,325)$(78,041)$701,635 
Common stock issued under employee plansCommon stock issued under employee plans (390) 2,307 1,917 Common stock issued under employee plans (1,150) 1,283 133 
Stock-based compensationStock-based compensation 3,008  3,008 Stock-based compensation 3,555  3,555 
Dividends on common stock ($0.20 per share)Dividends on common stock ($0.20 per share)(5,673)(5,673)Dividends on common stock ($0.20 per share)(5,712)(5,712)
Comprehensive income (loss):Comprehensive income (loss):Comprehensive income (loss):
Cash flow hedging loss, netCash flow hedging loss, net(2,429)
Pension liability, netPension liability, net535 
Foreign currency translation adjustmentsForeign currency translation adjustments(4,770)Foreign currency translation adjustments4,581 
Pension liability, net546 
Cash flow hedging gain, net1,915 
Net income6,970 
Total comprehensive income4,661 
Balance at September 30, 201931,299 313 379,137 461,564 (57,915)(82,177)700,922 
Net lossNet loss(27,400)
Total comprehensive lossTotal comprehensive loss(24,713)
Balance at June 30, 2020Balance at June 30, 202031,299 $313 $377,025 $437,956 $(63,638)$(76,758)$674,898 
See notes to consolidated condensed financial statements.

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Table of Contents
CONMED CORPORATION
CONSOLIDATED CONDENSED STATEMENTS OF CASH FLOWS
(Unaudited, in thousands)
Nine Months Ended Six Months Ended
September 30, June 30,
20202019 20212020
Cash flows from operating activities:Cash flows from operating activities: Cash flows from operating activities: 
Net income (loss)Net income (loss)$(14,623)$13,686 Net income (loss)$23,150 $(21,473)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:Adjustments to reconcile net income (loss) to net cash provided by operating activities: Adjustments to reconcile net income (loss) to net cash provided by operating activities: 
DepreciationDepreciation13,617 14,225 Depreciation8,741 9,234 
Amortization of debt discountAmortization of debt discount7,239 6,038 Amortization of debt discount5,031 4,810 
Amortization of deferred debt issuance costsAmortization of deferred debt issuance costs2,697 2,535 Amortization of deferred debt issuance costs2,116 1,686 
AmortizationAmortization40,973 38,837 Amortization27,316 27,392 
Stock-based compensationStock-based compensation10,119 8,819 Stock-based compensation7,676 6,587 
Impairment charges312 
Deferred income taxesDeferred income taxes(786)(5,506)Deferred income taxes(1,781)(9,490)
Loss on early extinguishment of debt300 
Increase (decrease) in cash flows from changes in assets and liabilities:Increase (decrease) in cash flows from changes in assets and liabilities:  Increase (decrease) in cash flows from changes in assets and liabilities:  
Accounts receivableAccounts receivable21,574 10,756 Accounts receivable7,780 43,732 
InventoriesInventories(19,396)(15,645)Inventories(16,693)(13,029)
Accounts payableAccounts payable1,477 (10,104)Accounts payable2,547 (15,703)
Accrued compensation and benefitsAccrued compensation and benefits(8,864)1,728 Accrued compensation and benefits(769)(16,646)
Other assetsOther assets(6,013)(13,202)Other assets(12,289)(3,634)
Other liabilitiesOther liabilities(3,628)1,478 Other liabilities3,798 (4,206)
59,009 40,571 
Net cash provided by operating activitiesNet cash provided by operating activities44,386 54,257 Net cash provided by operating activities56,623 9,260 
Cash flows from investing activities:Cash flows from investing activities: Cash flows from investing activities: 
Proceeds from sale of a facility3,227 
Purchases of property, plant and equipmentPurchases of property, plant and equipment(9,864)(13,875)Purchases of property, plant and equipment(6,103)(6,577)
Payments related to business and asset acquisitions, net of cash acquiredPayments related to business and asset acquisitions, net of cash acquired(3,852)(364,928)Payments related to business and asset acquisitions, net of cash acquired(3,852)
Net cash used in investing activitiesNet cash used in investing activities(10,489)(378,803)Net cash used in investing activities(6,103)(10,429)
Cash flows from financing activities:Cash flows from financing activities: Cash flows from financing activities: 
Payments on term loanPayments on term loan(9,938)(151,000)Payments on term loan(8,281)(6,625)
Proceeds from term loan265,000 
Payments on revolving line of creditPayments on revolving line of credit(142,000)(435,000)Payments on revolving line of credit(161,000)(70,000)
Proceeds from revolving line of creditProceeds from revolving line of credit152,000 370,000 Proceeds from revolving line of credit139,000 108,000 
Proceeds from convertible notes345,000 
Payments related to contingent considerationPayments related to contingent consideration(2,071)(5,687)Payments related to contingent consideration(2,071)
Payments related to debt issuance costsPayments related to debt issuance costs(2,057)(16,210)Payments related to debt issuance costs(2,057)
Dividends paid on common stockDividends paid on common stock(17,099)(16,927)Dividends paid on common stock(11,588)(11,387)
Purchases of convertible notes hedges(51,198)
Proceeds from issuance of warrants30,567 
Other, netOther, net(3,730)3,310 Other, net10,902 (5,090)
Net cash provided by (used in) financing activitiesNet cash provided by (used in) financing activities(24,895)337,855 Net cash provided by (used in) financing activities(30,967)10,770 
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents740 (752)Effect of exchange rate changes on cash and cash equivalents(521)(474)
Net increase in cash and cash equivalentsNet increase in cash and cash equivalents9,742 12,557 Net increase in cash and cash equivalents19,032 9,127 
Cash and cash equivalents at beginning of periodCash and cash equivalents at beginning of period25,856 17,511 Cash and cash equivalents at beginning of period27,356 25,856 
Cash and cash equivalents at end of periodCash and cash equivalents at end of period$35,598 $30,068 Cash and cash equivalents at end of period$46,388 $34,983 
Non-cash investing and financing activities:Non-cash investing and financing activities:Non-cash investing and financing activities:
Dividends payable Dividends payable$5,720 $5,673  Dividends payable$5,830 $5,712 
See notes to consolidated condensed financial statements.
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CONMED CORPORATION
NOTES TO CONSOLIDATED CONDENSED FINANCIAL STATEMENTS
(Unaudited, in thousands except per share amounts)

Note 1 – Operations

CONMED Corporation (“CONMED”, the “Company”, “we” or “us”) is a medical technology company that provides surgical devices and equipment for minimally invasive procedures.  The Company’s products are used by surgeons and physiciansother healthcare professionals in a variety of specialties including orthopedics, general surgery, gynecology, neurosurgery, thoracic surgery and gastroenterology.

Note 2 - Interim Financial Information

The accompanying unaudited consolidated condensed financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles for annual financial statements. The information herein reflects all normal recurring material adjustments, which are, in the opinion of management, necessary to fairly present the results for the periods presented. The consolidated condensed financial statements herein consist of all wholly-owned domestic and foreign subsidiaries with all significant intercompany transactions eliminated. Results for the period ended SeptemberJune 30, 20202021 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020.2021.

The consolidated condensed financial statements and notes thereto should be read in conjunction with the consolidated financial statements and notes for the year ended December 31, 20192020 included in our Annual Report on Form 10-K.

Use of Estimates

Preparation of the consolidated condensed financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated condensed financial statements and the reported amounts of revenue and expenses during the reporting period.

Due to the COVID-19 pandemic, there has been uncertainty and disruption in the global economy and financial markets. We are not aware of any specific event or circumstance that would require an update to our estimates or judgments or a revision of the carrying value of our assets or liabilities as of OctoberJuly 29, 2020,2021, the date of issuance of this Quarterly Report on Form 10-Q. These estimates may change, as new events occur and additional information is obtained. Actual results could differ materially from these estimates under different assumptions or conditions.

5
Note 3 - Business Acquisition

On February 11, 2019 we acquired Buffalo Filter, LLC and all of the issued and outstanding common stock of Palmerton Holdings, Inc. from Filtration Group FGC LLC (the "Buffalo Filter Acquisition") for approximately $365 million in cash. Buffalo Filter develops, manufactures and markets smoke evacuation technologies that are complementary to our general surgery offering. The business combination was funded through a combination of cash on hand and long-term borrowings.

The unaudited pro forma information for the three and nine months ended September 30, 2019, assuming the Buffalo Filter Acquisition occurred as of January 1, 2018 are presented below. This information has been prepared for comparative purposes only and does not purport to be indicative of the results of operations which actually would have resulted had the Buffalo Filter Acquisition occurred on the dates indicated, or which may result in the future.

Three Months Ended September 30,Nine Months Ended September 30,
20192019
Net sales$233,590 $695,250 
Net income8,675 26,045 
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These pro forma results include certain adjustments, primarily due to increases in amortization expense due to fair value adjustments of intangible assets, increases in interest expense due to additional borrowings incurred to finance the acquisition and amortization of debt issuance costs incurred to finance the transaction, and acquisition related costs including transaction costs such as legal, accounting, valuation and other professional services as well as integration costs such as severance and retention.

Acquisition related costs excluded from the determination of pro forma net income for the three months ended September 30, 2019 were $0.2 million in cost of goods sold and $1.5 million in selling and administrative expense and for the nine months ended September 30, 2019 were $1.3 million in cost of goods sold and $11.2 million in selling and administrative expense on the consolidated condensed statements of comprehensive income.

Net sales associated with Buffalo Filter of $13.9 million and $33.4 million have been recorded in the consolidated condensed statements of comprehensive income for the three and nine months ended September 30, 2019, respectively. It is impracticable to determine the earnings recorded in the consolidated condensed statements of comprehensive income for the three and nine months ended September 30, 2019 as these amounts are not separately measured.

In conjunction with the December 2019 acquisition of a distributor, we paid $3.8 million during the nine months ended September 30, 2020.

Note 43 - Revenues
    
The following tables present revenue disaggregated by primary geographic market where the products are sold, by product line and timing of revenue recognition:
Three Months EndedThree Months Ended
June 30, 2021June 30, 2020
 Orthopedic SurgeryGeneral SurgeryTotalOrthopedic SurgeryGeneral SurgeryTotal
Primary Geographic Markets
United States$40,777 $102,813 $143,590 $21,387 $66,038 $87,425 
Europe, Middle East & Africa27,120 20,143 47,263 13,715 16,146 29,861 
Asia Pacific26,284 16,136 42,420 19,799 10,481 30,280 
Americas (excluding the United States)13,712 8,176 21,888 5,582 4,637 10,219 
Total sales from contracts with customers$107,893 $147,268 $255,161 $60,483 $97,302 $157,785 
Timing of Revenue Recognition
Goods transferred at a point in time$97,649 $146,105 $243,754 $53,670 $96,422 $150,092 
Services transferred over time10,244 1,163 11,407 6,813 880 7,693 
Total sales from contracts with customers$107,893 $147,268 $255,161 $60,483 $97,302 $157,785 

Three Months EndedThree Months EndedSix Months EndedSix Months Ended
September 30, 2020September 30, 2019June 30, 2021June 30, 2020
Orthopedic SurgeryGeneral SurgeryTotalOrthopedic SurgeryGeneral SurgeryTotalOrthopedic SurgeryGeneral SurgeryTotalOrthopedic SurgeryGeneral SurgeryTotal
Primary Geographic MarketsPrimary Geographic MarketsPrimary Geographic Markets
United StatesUnited States$38,913 $95,292 $134,205 $42,530 $85,652 $128,182 United States$77,907 $189,625 $267,532 $58,426 $147,847 $206,273 
Europe, Middle East & AfricaEurope, Middle East & Africa53,172 38,688 91,860 39,622 32,761 72,383 
Asia PacificAsia Pacific26,403 15,405 41,808 26,037 16,115 42,152 Asia Pacific52,886 28,798 81,684 40,333 18,805 59,138 
Europe, Middle East & Africa23,104 17,584 40,688 24,692 14,139 38,831 
Americas (excluding the United States)Americas (excluding the United States)13,767 7,367 21,134 17,069 7,356 24,425 Americas (excluding the United States)31,093 15,668 46,761 21,385 12,617 34,002 
Total sales from contracts with customersTotal sales from contracts with customers$102,187 $135,648 $237,835 $110,328 $123,262 $233,590 Total sales from contracts with customers$215,058 $272,779 $487,837 $159,766 $212,030 $371,796 
Timing of Revenue RecognitionTiming of Revenue RecognitionTiming of Revenue Recognition
Goods transferred at a point in timeGoods transferred at a point in time$93,000 $134,745 $227,745 $101,454 $122,620 $224,074 Goods transferred at a point in time$195,339 $270,499 $465,838 $144,222 $210,324 $354,546 
Services transferred over timeServices transferred over time9,187 903 10,090 8,874 642 9,516 Services transferred over time19,719 2,280 21,999 15,544 1,706 17,250 
Total sales from contracts with customersTotal sales from contracts with customers$102,187 $135,648 $237,835 $110,328 $123,262 $233,590 Total sales from contracts with customers$215,058 $272,779 $487,837 $159,766 $212,030 $371,796 
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Nine Months EndedNine Months Ended
September 30, 2020September 30, 2019
Orthopedic SurgeryGeneral SurgeryTotalOrthopedic SurgeryGeneral SurgeryTotal
Primary Geographic Markets
United States$97,339 $243,137 $340,476 $131,120 $243,023 $374,143 
Europe, Middle East & Africa62,726 50,345 113,071 86,199 45,826 132,025 
Asia Pacific66,737 34,211 100,948 74,313 39,217 113,530 
Americas (excluding the United States)35,152 19,984 55,136 47,890 22,644 70,534 
Total sales from contracts with customers$261,954 $347,677 $609,631 $339,522 $350,710 $690,232 
Timing of Revenue Recognition
Goods transferred at a point in time$237,224 $345,068 $582,292 $312,964 $348,972 $661,936 
Services transferred over time24,730 2,609 27,339 26,558 1,738 28,296 
Total sales from contracts with customers$261,954 $347,677 $609,631 $339,522 $350,710 $690,232 
Contract liability balances related to the sale of extended warranties to customers are as follows:

September 30, 2020December 31, 2019
Contract liability$13,317 $14,276 
June 30, 2021December 31, 2020
Contract liability$15,076 $13,666 
    
Revenue recognized during the ninesix months ended SeptemberJune 30, 20202021 and SeptemberJune 30, 20192020 from amounts included in contract liabilities at the beginning of the period were $7.6$6.1 million and $5.5 million, respectively. There were no material contract assets as of SeptemberJune 30, 20202021 and December 31, 2019.2020.

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Note 54 – Comprehensive Income (loss)(Loss)

Comprehensive income (loss) consists of the following:
 
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Net income (loss)Net income (loss)$6,850 $6,970 $(14,623)$13,686 Net income (loss)$13,290 $(27,400)$23,150 $(21,473)
Other comprehensive income (loss):Other comprehensive income (loss):Other comprehensive income (loss):
Cash flow hedging gain (loss), net of income tax (income tax expense (benefit) of $388 and $(774) for the three months ended June 30, 2021 and 2020, respectively, and $1,639 and $(8) for the six months ended June 30, 2021 and 2020, respectively)Cash flow hedging gain (loss), net of income tax (income tax expense (benefit) of $388 and $(774) for the three months ended June 30, 2021 and 2020, respectively, and $1,639 and $(8) for the six months ended June 30, 2021 and 2020, respectively)1,221 (2,429)5,147 (24)
Pension liability, net of income tax (income tax expense of $201 and $170 for the three months ended June 30, 2021 and 2020, respectively, and $402 and $340 for the six months ended June 30, 2021 and 2020, respectively)Pension liability, net of income tax (income tax expense of $201 and $170 for the three months ended June 30, 2021 and 2020, respectively, and $402 and $340 for the six months ended June 30, 2021 and 2020, respectively)631 535 1,262 1,070 
Foreign currency translation adjustmentForeign currency translation adjustment4,617 (4,770)(790)(4,240)Foreign currency translation adjustment2,601 4,581 (1,073)(5,407)
Pension liability, net of income tax (income tax expense of $170 and $174 for the three months ended September 30, 2020 and 2019, respectively, and $510 and $521 for the nine months ended September 30, 2020 and 2019, respectively)535 546 1,605 1,639 
Cash flow hedging gain (loss), net of income tax (income tax expense (benefit) of $(964) and $610 for the three months ended September 30, 2020 and 2019, respectively, and $(972) and $135 for the nine months ended September 30, 2020 and 2019, respectively)(3,026)1,915 (3,050)423 
Comprehensive income (loss)Comprehensive income (loss)$8,976 $4,661 $(16,858)$11,508 Comprehensive income (loss)$17,743 $(24,713)$28,486 $(25,834)

Accumulated other comprehensive loss consists of the following:

Cash Flow
Hedging
Gain (Loss)
Pension
Liability
Cumulative
Translation
Adjustments
Accumulated
Other
Comprehensive
Income (Loss)
Cash Flow
Hedging
Gain (Loss)
Pension
Liability
Cumulative
Translation
Adjustments
Accumulated
Other
Comprehensive
Income (Loss)
Balance, December 31, 2019$493 $(31,691)$(28,079)$(59,277)
Balance, December 31, 2020Balance, December 31, 2020$(5,945)$(36,620)$(21,116)$(63,681)
Other comprehensive income (loss) before reclassifications, net of taxOther comprehensive income (loss) before reclassifications, net of tax(1,916)(790)(2,706)Other comprehensive income (loss) before reclassifications, net of tax2,723 (1,073)1,650 
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
(1,496)2,115 619 
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
3,196 1,664 4,860 
Income taxIncome tax362 (510)(148)Income tax(772)(402)(1,174)
Net current-period other comprehensive income (loss)Net current-period other comprehensive income (loss)(3,050)1,605 (790)(2,235)Net current-period other comprehensive income (loss)5,147 1,262 (1,073)5,336 
Balance, September 30, 2020$(2,557)$(30,086)$(28,869)$(61,512)
Balance, June 30, 2021Balance, June 30, 2021$(798)$(35,358)$(22,189)$(58,345)
Cash Flow
Hedging
Gain (Loss)
Pension
Liability
Cumulative
Translation
Adjustments
Accumulated
Other
Comprehensive
Income (Loss)
Cash Flow
Hedging
Gain (Loss)
Pension
Liability
Cumulative
Translation
Adjustments
Accumulated
Other
Comprehensive
Income (Loss)
Balance, December 31, 2018$4,085 $(31,718)$(28,104)$(55,737)
Balance, December 31, 2019Balance, December 31, 2019$493 $(31,691)$(28,079)$(59,277)
Other comprehensive income (loss) before reclassifications, net of taxOther comprehensive income (loss) before reclassifications, net of tax5,120 (4,240)880 Other comprehensive income (loss) before reclassifications, net of tax770 (5,407)(4,637)
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
(6,193)2,160 (4,033)
Amounts reclassified from accumulated other comprehensive income (loss) before taxa
(1,048)1,410 362 
Income taxIncome tax1,496 (521)975 Income tax254 (340)(86)
Net current-period other comprehensive income (loss)Net current-period other comprehensive income (loss)423 1,639 (4,240)(2,178)Net current-period other comprehensive income (loss)(24)1,070 (5,407)(4,361)
Balance, September 30, 2019$4,508 $(30,079)$(32,344)$(57,915)
Balance, June 30, 2020Balance, June 30, 2020$469 $(30,621)$(33,486)$(63,638)
(a) The cash flow hedging gain (loss) and pension liability accumulated other comprehensive income (loss) components are included in sales or cost of sales and as a component of net periodic pension cost, respectively. Refer to Note 65 and Note 12,11, respectively, for further details.

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Note 65 – Fair Value of Financial Instruments
 
 We enter into derivative instruments for risk management purposes only. We operate internationally and, in the normal course of business, are exposed to fluctuations in interest rates, foreign exchange rates and commodity prices. These fluctuations can increase the costs of financing, investing and operating the business. We use forward contracts, a type of derivative instrument, to manage certain foreign currency exposures.
 
By nature, all financial instruments involve market and credit risks. We enter into forward contracts with major investment grade financial institutions and have policies to monitor the credit risk of those counterparties. While there can be no assurance, we do not anticipate any material non-performance by any of these counterparties.
 
Foreign Currency Forward Contracts. We hedge forecasted intercompany sales denominated in foreign currencies through the use of forward contracts.  We account for these forward contracts as cash flow hedges.  To the extent these forward contracts meet hedge accounting criteria, changes in their fair value are not included in current earnings but are included in accumulated other comprehensive loss.  These changes in fair value will be recognized into earnings as a component of sales or cost of sales when the forecasted transaction occurs.  

We also enter into forward contracts to exchange foreign currencies for United States dollars in order to hedge our currency transaction exposures on intercompany receivables designated in foreign currencies.  These forward contracts settle each month at month-end, at which time we enter into new forward contracts.  We have not designated these forward contracts as hedges and have not applied hedge accounting to them.  

The following table presents the notional contract amounts for forward contracts outstanding:

As ofAs of
FASB ASC Topic 815 DesignationSeptember 30, 2020December 31, 2019FASB ASC Topic 815 DesignationJune 30, 2021December 31, 2020
Forward exchange contractsForward exchange contractsCash flow hedge$141,376 $156,818 Forward exchange contractsCash flow hedge$172,705 $154,504 
Forward exchange contractsForward exchange contractsNon-designated41,074 33,867 Forward exchange contractsNon-designated39,270 42,380 

The remaining time to maturity as of SeptemberJune 30, 20202021 is within two years for hedge designated foreign exchange contracts and approximately one month for non-hedge designated forward exchange contracts.

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Statement of comprehensive income (loss) presentation

Derivatives designated as cash flow hedges

Foreign exchange contracts designated as cash flow hedges had the following effects on accumulated other comprehensive income (loss) and net earnings on our consolidated condensed statements of comprehensive income (loss) and our consolidated condensed balance sheets:
Amount of Gain (Loss) Recognized in AOCIConsolidated Condensed Statements of Comprehensive Income (Loss)Amount of Gain (Loss) Reclassified from AOCI
Three Months Ended September 30,
Total Amount of Line Item Presented
Derivative Instrument20202019Location of amount reclassified2020201920202019
Foreign exchange contracts$(3,542)$4,887 Net Sales$237,835 $233,590 $663 $2,241 
 Cost of Sales104,137 103,479 (215)120 
Pre-tax gain (loss)$(3,542)$4,887 $448 $2,361 
Tax expense (benefit)(856)1,181 108 570 
Net gain (loss)$(2,686)$3,706 $340 $1,791 

Amount of Gain (Loss) Recognized in AOCIConsolidated Condensed Statements of Comprehensive Income (Loss)Amount of Gain (Loss) Reclassified from AOCI
Three Months Ended June 30,
Total Amount of Line Item Presented
Derivative Instrument20212020Location of amount reclassified2021202020212020
Foreign exchange contracts$(3)$(3,279)Net Sales$255,161 $157,785 $(2,022)$342 
 Cost of Sales113,737 85,856 410 (418)
Pre-tax loss$(3)$(3,279)$(1,612)$(76)
Tax benefit(1)(792)(389)(18)
Net loss$(2)$(2,487)$(1,223)$(58)

Amount of Gain (Loss) Recognized in AOCIConsolidated Condensed Statements of Comprehensive Income (Loss)Amount of Gain (Loss) Reclassified from AOCIAmount of Gain (Loss) Recognized in AOCIConsolidated Condensed Statements of Comprehensive Income (Loss)Amount of Gain (Loss) Reclassified from AOCI
Nine Months Ended September 30,Six Months Ended June 30,
Total Amount of Line Item PresentedTotal Amount of Line Item Presented
Derivative InstrumentDerivative Instrument20202019Location of amount reclassified2020201920202019Derivative Instrument20212020Location of amount reclassified2021202020212020
Foreign exchange contractsForeign exchange contracts$(2,526)$6,751 Net Sales$609,631 $690,232 $2,206 $5,834 Foreign exchange contracts$3,590 $1,015 Net Sales$487,837 $371,796 $(3,871)$1,543 
Cost of Sales284,845 307,492 (710)359 Cost of Sales217,964 180,707 675 (495)
Pre-tax gain (loss)Pre-tax gain (loss)$(2,526)$6,751 $1,496 $6,193 Pre-tax gain (loss)$3,590 $1,015 $(3,196)$1,048 
Tax expense (benefit)Tax expense (benefit)(610)1,631 362 1,496 Tax expense (benefit)867 245 (772)254 
Net gain (loss)Net gain (loss)$(1,916)$5,120 $1,134 $4,697 Net gain (loss)$2,723 $770 $(2,424)$794 


At SeptemberJune 30, 2020, $1.92021, $1.2 million of net unrealized losses on forward contracts accounted for as cash flow hedges, and included in accumulated other comprehensive loss, are expected to be recognized in earnings in the next twelve months.

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Derivatives not designated as cash flow hedges

Net gains and losses from derivative instruments not accounted for as hedges and gains and losses on our intercompany receivables on our consolidated condensed statements of comprehensive income (loss) were:

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
Derivative InstrumentDerivative InstrumentLocation on Consolidated Condensed Statements of Comprehensive Income (Loss)2020201920202019Derivative InstrumentLocation on Consolidated Condensed Statements of Comprehensive Income (Loss)2021202020212020
    
Net gain (loss) on currency forward contractsSelling and administrative expense$(682)$138 $(1,224)$(355)
Net loss on currency forward contractsNet loss on currency forward contractsSelling and administrative expense$(809)$(302)$(350)$(547)
Net gain (loss) on currency transaction exposuresNet gain (loss) on currency transaction exposuresSelling and administrative expense$312 $(368)$143 $(530)Net gain (loss) on currency transaction exposuresSelling and administrative expense$243 $22 $(879)$(169)

Balance sheet presentation

We record these forward foreign exchange contracts at fair value. The following tables summarize the fair value for forward foreign exchange contracts outstanding at SeptemberJune 30, 20202021 and December 31, 2019:2020:

September 30, 2020Location on Consolidated Condensed Balance SheetAsset Fair ValueLiabilities Fair ValueNet
Fair
Value
June 30, 2021June 30, 2021Location on Consolidated Condensed Balance SheetAsset Fair ValueLiabilities Fair ValueNet
Fair
Value
Derivatives designated as hedged instruments:Derivatives designated as hedged instruments:   Derivatives designated as hedged instruments:   
Foreign exchange contractsForeign exchange contractsOther current liabilities$529 $(3,338)$(2,809)Foreign exchange contractsOther current liabilities$1,885 $(3,411)$(1,526)
Foreign exchange contractsForeign exchange contractsOther long-term liabilities103 (948)(845)Foreign exchange contractsOther long-term assets745 (271)474 
$632 $(4,286)$(3,654)$2,630 $(3,682)$(1,052)
Derivatives not designated as hedging instruments:Derivatives not designated as hedging instruments:   Derivatives not designated as hedging instruments:   
Foreign exchange contractsForeign exchange contractsOther current liabilities(158)(149)Foreign exchange contractsOther current liabilities40 (71)(31)
Total derivativesTotal derivatives$641 $(4,444)$(3,803)Total derivatives$2,670 $(3,753)$(1,083)

December 31, 2019Location on Consolidated Condensed Balance SheetAsset Fair ValueLiabilities Fair ValueNet
Fair
Value
December 31, 2020December 31, 2020Location on Consolidated Condensed Balance SheetAsset Fair ValueLiabilities Fair ValueNet
Fair
Value
Derivatives designated as hedged instruments:Derivatives designated as hedged instruments:  Derivatives designated as hedged instruments:  
Foreign exchange contractsForeign exchange contractsPrepaids and other current assets$2,307 $(1,341)$966 Foreign exchange contractsOther current liabilities$1,500 $(8,826)$(7,326)
Foreign exchange contractsForeign exchange contractsOther long-term liabilities38 (353)(315)Foreign exchange contractsOther long-term liabilities23 (535)(512)
$2,345 $(1,694)$651 $1,523 $(9,361)$(7,838)
Derivatives not designated as hedging instruments:Derivatives not designated as hedging instruments:  Derivatives not designated as hedging instruments:  
Foreign exchange contractsForeign exchange contractsOther current liabilities22 (159)(137)Foreign exchange contractsOther current liabilities25 (150)(125)
Total derivativesTotal derivatives$2,367 $(1,853)$514 Total derivatives$1,548 $(9,511)$(7,963)

Our forward foreign exchange contracts are subject to a master netting agreement and qualify for netting in the consolidated condensed balance sheets.
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Fair Value Disclosure. FASB guidance defines fair value and establishes a framework for measuring fair value and related disclosure requirements. This guidance applies when fair value measurements are required or permitted. The guidance indicates, among other things, that a fair value measurement assumes that the transaction to sell an asset or transfer a liability occurs in the principal market for the asset or liability or, in the absence of a principal market, the most advantageous market for the asset or liability. Fair value is defined based upon an exit price model.

Valuation Hierarchy. A valuation hierarchy was established for disclosure of the inputs to the valuations used to measure fair value. This hierarchy prioritizes the inputs into three broad levels as follows. Level 1 inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets in markets that are not active, inputs other than quoted prices that are observable for the asset or liability, including interest rates, yield curves and credit risks, or inputs that are derived principally from or corroborated by observable market data through correlation. Level 3 inputs are unobservable inputs based on our own assumptions used to measure assets and liabilities at fair value. A financial asset or liability’s classification within the hierarchy is determined based on the lowest level input that is significant to the fair value measurement. There have been no significant changes in the assumptions.
 
Valuation Techniques. Assets and liabilities carried at fair value and measured on a recurring basis as of SeptemberJune 30, 20202021 consist of forward foreign exchange contracts. The Company values its forward foreign exchange contracts using quoted prices for similar assets. The most significant assumption is quoted currency rates. The value of the forward foreign exchange contract assets and liabilities were valued using Level 2 inputs and are listed in the table above.  
    
The carrying amounts reported in our consolidated condensed balance sheets for cash and cash equivalents, accounts receivable, accounts payable and long-term debt approximate fair value.  

Note 76 - Inventories

Inventories consist of the following:

September 30,
2020
December 31,
2019
June 30,
2021
December 31,
2020
Raw materialsRaw materials$62,604 $51,103 Raw materials$72,090 $71,807 
Work-in-processWork-in-process18,944 15,142 Work-in-process17,828 15,864 
Finished goodsFinished goods101,120 98,371 Finished goods121,405 107,197 
TotalTotal$182,668 $164,616 Total$211,323 $194,868 
 
Note 87 – Earnings (Loss) Per Share

Basic earnings (loss) per share (“basic EPS”) is computed by dividing net income (loss) by the weighted average number of common shares outstanding for the reporting period. Diluted earnings (loss) per share (“diluted EPS”) gives effect to all dilutive potential shares outstanding resulting from employee stock options, restricted stock units, performance share units and stock appreciation rights ("SARs") as well as the Notes and related hedge transactions during the period.

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The following table sets forth the computation of basic and diluted earnings (loss) per share for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Net income (loss)Net income (loss)$6,850 $6,970 $(14,623)$13,686 Net income (loss)$13,290 $(27,400)$23,150 $(21,473)
Basic – weighted average shares outstandingBasic – weighted average shares outstanding28,583 28,353 28,529 28,280 Basic – weighted average shares outstanding29,125 28,542 29,052 28,506 
Effect of dilutive potential securitiesEffect of dilutive potential securities843 1,439 1,074 Effect of dilutive potential securities3,339 2,912 
Diluted – weighted average shares outstandingDiluted – weighted average shares outstanding29,426 29,792 28,529 29,354 Diluted – weighted average shares outstanding32,464 28,542 31,964 28,506 
Net income (loss) (per share)Net income (loss) (per share)    Net income (loss) (per share)    
BasicBasic$0.24 $0.25 $(0.51)$0.48 Basic$0.46 $(0.96)$0.80 $(0.75)
DilutedDiluted0.23 0.23 (0.51)0.47 Diluted0.41 (0.96)0.72 (0.75)
 
The shares used in the calculation of diluted EPS exclude options and SARs to purchase shares where the exercise price was greater than the average market price of common shares for the period and the effect of the inclusion would be anti-dilutive. Such shares aggregated approximately 1.6 million for the three months ended September 30, 2020 and 0.80.7 million and 0.70.5 million for the three and ninesix months ended SeptemberJune 30, 2019,2021, respectively. As the Company was in a net loss position for the ninethree and six months ended SeptemberJune 30, 2020, there were 0no anti-dilutive shares. Our 2.625% convertible notes due in 2024 (the “Notes”) are convertible under certain circumstances, as defined in the indenture, into a combination of cash and CONMED common stock. 

The following is intended to describe the impact of the Notes and related hedge transactions on the calculation of diluted EPS. Additional shares to be issued pursuant to the terms of the Notes and related hedge transactions, if any, would occur at maturity.

The calculation of diluted EPS would includeincludes potential diluted shares upon conversion of the Notes when the average market price per share of our common stock for the period is greater than the conversion price of the Notes of $88.80. We intend to settle in cash the principal outstanding and use the treasury stock method when calculating their potential dilutive effect, if any.

During the three and ninesix months ended SeptemberJune 30, 20202021, our average share price exceeded the conversion price of the Notes and ninewe included in our diluted share count 1.4 million and 1.2 million shares, respectively, assumed to be issued if the Notes were converted. During the three and six months ended SeptemberJune 30, 2019,2020, our average share price had not exceeded the conversion price of the Notes; therefore, under the net share settlement method, there were no potential shares issuable under the Notes to be used in the calculation of diluted EPS. During the three months ended September 30, 2019, our average share price exceeded the conversion price of the Notes and we included 0.2 million shares assumed to be issued if the Notes were converted in our diluted share count.

We intend to settle in cash the principal outstanding and use the treasury stock method when calculating their potential dilutive effect, if any. We havepreviously entered into convertible notes hedge transactions to increase the effective conversion price of the Notes to $114.92.  However, our convertible notes hedges are not included when calculating potential dilutive shares since their effect is always anti-dilutive.

Concurrently with entering into the hedge transactions, we also previously entered into warrant transactions under which we agreed to sell shares of our common stock at $114.92.

The calculation of diluted EPS also includespotential diluted shares to be issued under the warrants when the average market price per share of our common stock for the period is greater than $114.92. During the three and six months ended June 30, 2021, our average share price exceeded $114.92 and we therefore included in our diluted share count an additional 0.6 million and 0.4 million shares, respectively, assumed to be issued under the warrants.





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Note 98 – Goodwill and Other Intangible Assets

The changes in the net carrying amount of goodwill for the ninesix months ended SeptemberJune 30, 20202021 are as follows:

Balance as of December 31, 20192020$618,042618,440 
Goodwill adjustment resulting from business acquisition(1,009)
Foreign currency translation360 (160)
Balance as of SeptemberJune 30, 20202021$617,393618,280 
Assets and liabilities of acquired businesses are recorded at their estimated fair values as of the date of acquisition.  Goodwill represents costs in excess of fair values assigned to the underlying net assets of acquired businesses. During the nine months ended September 30, 2020, the Company recorded a measurement period adjustment related to a prior business combination.
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Other intangible assets consist of the following:

September 30, 2020December 31, 2019 June 30, 2021December 31, 2020
Weighted Average Amortization Period (Years)Gross
Carrying
Amount
Accumulated
Amortization
Gross
Carrying
Amount
Accumulated
Amortization
Weighted Average Amortization Period (Years)Gross
Carrying
Amount
Accumulated
Amortization
Gross
Carrying
Amount
Accumulated
Amortization
Intangible assets with definite lives:Intangible assets with definite lives:Intangible assets with definite lives:
Customer and distributor relationshipsCustomer and distributor relationships24$342,523 $(129,706)$342,568 $(115,311)Customer and distributor relationships24$342,575 $(143,738)$342,639 $(134,555)
Sales representation, marketing and promotional rightsSales representation, marketing and promotional rights25149,376 (52,500)149,376 (48,000)Sales representation, marketing and promotional rights25149,376 (57,000)149,376 (54,000)
Developed technologyDeveloped technology16106,604 (18,071)106,604 (13,171)Developed technology16106,604 (23,112)106,604 (19,705)
Patents and other intangible assetsPatents and other intangible assets1573,181 (48,267)70,646 (46,456)Patents and other intangible assets1675,235 (49,861)73,516 (48,882)
Intangible assets with indefinite lives:Intangible assets with indefinite lives:    Intangible assets with indefinite lives:    
Trademarks and tradenamesTrademarks and tradenames86,544 — 86,544 — Trademarks and tradenames86,544 — 86,544 — 
22$758,228 $(248,544)$755,738 $(222,938)22$760,334 $(273,711)$758,679 $(257,142)

Customer and distributor relationships, trademarks and tradenames, developed technology and patents and other intangible assets primarily represent allocations of purchase price to identifiable intangible assets of acquired businesses. Sales representation, marketing and promotional rights represent intangible assets created under our agreement with Musculoskeletal Transplant Foundation (“MTF”).

Amortization expense related to intangible assets which are subject to amortization totaled $8.6$8.2 million and $8.4$8.5 million in the three months ended SeptemberJune 30, 20202021 and 2019,2020, respectively, and $25.6$16.6 million and $24.1$17.0 million in the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, respectively, and is included as a reduction of revenue (for amortization related to our sales representation, marketing and promotional rights) and in selling and administrative expense (for all other intangible assets) in the consolidated condensed statements of comprehensive income (loss). Included in developed technology is $6.0 million of earn-out consideration that is considered probable as of SeptemberJune 30, 20202021 associated with a prior asset acquisition. This is recorded in other current liabilities at SeptemberJune 30, 2020.2021.
 
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The estimated intangible asset amortization expense remaining for the year ending December 31, 20202021 and for each of the five succeeding years is as follows:
 
Amortization included in expenseAmortization recorded as a reduction of revenueTotalAmortization included in expenseAmortization recorded as a reduction of revenueTotal
Remaining, 2020$6,970 $1,500 $8,470 
202127,523 6,000 33,523 
Remaining, 2021Remaining, 2021$13,909 $3,000 $16,909 
2022202226,369 6,000 32,369 202226,474 6,000 32,474 
2023202325,588 6,000 31,588 202325,609 6,000 31,609 
2024202424,777 6,000 30,777 202424,884 6,000 30,884 
2025202525,023 6,000 31,023 202525,105 6,000 31,105 
2026202624,576 6,000 30,576 

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Note 109 - Long-Term Debt

Long-term debt consists of the following:

September 30, 2020December 31, 2019 June 30, 2021December 31, 2020
Revolving line of creditRevolving line of credit$230,000 $220,000 Revolving line of credit$185,000 $207,000 
Term loan, net of deferred debt issuance costs of $1,562 and $1,528 in 2020 and 2019, respectively243,563 253,535 
2.625% convertible notes, net of deferred debt issuance costs of $5,920 and $7,252 in 2020 and 2019, respectively, and unamortized discount of $36,073 and $43,312 in 2020 and 2019, respectively303,007 294,436 
Term loan, net of deferred debt issuance costs of $1,373 and $1,668 in 2021 and 2020, respectivelyTerm loan, net of deferred debt issuance costs of $1,373 and $1,668 in 2021 and 2020, respectively232,158 240,145 
2.625% convertible notes, net of deferred debt issuance costs of $4,588 and $5,475 in 2021 and 2020, respectively, and unamortized discount of $28,589 and $33,620 in 2021 and 2020, respectively2.625% convertible notes, net of deferred debt issuance costs of $4,588 and $5,475 in 2021 and 2020, respectively, and unamortized discount of $28,589 and $33,620 in 2021 and 2020, respectively311,823 305,904 
Financing leasesFinancing leases686 836 Financing leases695 587 
Total debtTotal debt777,256 768,807 Total debt729,676 753,636 
Less: Current portionLess: Current portion16,805 13,596 Less: Current portion21,868 18,415 
Total long-term debtTotal long-term debt$760,451 $755,211 Total long-term debt$707,808 $735,221 

On February 7, 2019 we entered into a sixth amended and restated senior credit agreement consisting of: (a) a $265.0 million term loan facility and (b) a $585.0 million revolving credit facility. The revolving credit facility willthen in effect was due to terminate and the loans outstanding under the term loan facility will expirethen in effect were scheduled to mature on the earlier of (i) February 7, 2024 or (ii) 91 days prior to the earliest scheduled maturity date of the 2.625% convertible notes due in 2024 described below, (if, as of such date, more than $150.0 million in aggregate principal amount of such convertible notes (or any refinancing thereof) remainsremained outstanding). The term loan facility iswas payable in quarterly installments increasing over the term of the facility. Proceeds from the term loan facility and borrowings under the revolving credit facility were used to repay the then existing senior credit agreement and in part to finance the acquisition of Buffalo Filter. On April 17, 2020, we amended our sixth amended and restated senior credit agreement to suspend our required leverage ratios for up to four quarters as a result of the potential impact from the COVID-19 pandemic (as further described in Note 17). Under the terms of thepandemic. On November 20, 2020, we entered into a third amendment there are certain minimum liquidity and fixed charge coverage ratio requirements. Interest rates are also adjusted so thatunder our senior credit agreement to lower the applicable margin for base rateon the loans is 2.50% per annum and forlower the interest floor on Eurocurrency rate loans is 3.50% per annum, and the applicable commitment fee rate for the revolving credit facility is 0.50%. Followingagreed upon in April 2020. On April 15, 2021, we terminated the suspension period, thethus reinstating our required leverage ratios. The applicable margin will dependdepended upon CONMED’s consolidated senior secured leverage ratio, using the pricing grid set forth in the November 2020 amendment. Interest rates were at LIBOR (subject to 1.00%0.125% floor) plus an interest rate margin of 3.50% (4.50%2.50% (2.625% at SeptemberJune 30, 2020)2021).

There were $245.1$233.5 million in borrowings outstanding on the term loan facility as of SeptemberJune 30, 2020.2021. There were $230.0$185.0 million in borrowings outstanding under the revolving credit facility as of SeptemberJune 30, 2020.2021. Our available borrowings on the revolving credit facility at SeptemberJune 30, 20202021 were $352.5$397.4 million with approximately $2.5$2.6 million of the facility set aside for outstanding letters of credit.
    
The sixth amended and restated senior credit agreement iswas collateralized by substantially all of our personal property and assets. The sixth amended and restated senior credit agreement contained covenants and restrictions which, among other things, required the maintenance of certain financial ratios and restricted dividend payments and the incurrence of certain indebtedness and other activities, including acquisitions and dispositions. We were in full compliance with these covenants and
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restrictions as of June 30, 2021. We were also required, under certain circumstances, to make mandatory prepayments from net cash proceeds from any issuance of equity and asset sales.

On July 16, 2021, we entered into a seventh amended and restated senior credit agreement consisting of: (a) a $233.5 million term loan facility and (b) a $585.0 million revolving credit facility. The revolving credit facility will terminate and the loans outstanding under the term loan facility will expire on the fifth anniversary of the closing date. The term loan is payable in quarterly installments increasing over the term of the facility. Initial interest rates are at LIBOR plus an interest rate margin of 1.75%. For those borrowings where we elect to use the alternate base rate, the initial base rate will be the greatest of (i) the Prime Rate, (ii) the Federal Funds Rate plus 0.50% or (iii) the one-month Adjusted LIBOR plus 1.00%, plus, in each case, an interest rate margin. The seventh amended and restated senior credit agreement contains covenants and restrictions which, among other things, require the maintenance of certain financial ratios and restrict dividend payments and the incurrence of certain indebtedness and other activities, including acquisitions and dispositions. We were in full compliance with these covenants and restrictions as of September 30, 2020. We are also required, under certain circumstances, to make mandatory prepayments from net cash proceeds from any issuance of equity and asset sales.

On January 29, 2019, we issued $345.0 million in 2.625% convertible notes due in 2024 (the "Notes"). Interest is payable semi-annually in arrears on February 1 and August 1 of each year, commencing August 1, 2019. The Notes will mature on February 1, 2024, unless earlier repurchased or converted. The Notes represent subordinated unsecured obligations and are convertible under certain circumstances, as defined in the indenture, into a combination of cash and CONMED common stock.  The Notes may be converted at an initial conversion rate of 11.2608 shares of our common stock per $1,000 principal amount of Notes (equivalent to an initial conversion price of approximately $88.80 per share of common stock). Holders of the Notes may convert the Notes at their option at any time on or after November 1, 2023 through the second scheduled trading day preceding the maturity date. Holders of the Notes will also have the right to convert the Notes prior to November 1, 2023, but only upon the occurrence of specified events. The conversion rate is subject to anti-dilution adjustments if certain events occur. A portion of the net proceeds from the offering of the Notes were used as part of the financing for the Buffalo Filter acquisition and $21.0 million were used to pay the cost of certain convertible notes hedge transactions as further described below.

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Our effective borrowing rate for nonconvertible debt at the time of issuance of the Notes was estimated to be 6.14%, which resulted in $51.6 million of the $345.0 million aggregate principal amount of Notes issued, or $39.1 million after taxes, being attributable to equity.  For both the three months ended SeptemberJune 30, 20202021 and 2019,2020, we have recorded interest expense related to the amortization of debt discount on the Notes of $2.4$2.5 million and $2.3 million, respectively, and for the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, we have recorded interest expense related to the amortization of debt discount on the Notes of $7.2$5.0 million and $6.0$4.8 million, respectively, at the effective interest rate of 6.14%.  The debt discount on the Notes is being amortized through February 2024.  For both the three months ended SeptemberJune 30, 20202021 and 2019,2020, we have recorded interest expense on the Notes of $2.3 million and for both the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, we have recorded interest expense on the Notes of $6.8$4.5 million and $6.0 million, respectively, at the contractual coupon rate of 2.625%.

In connection with the offering of the Notes, we entered into convertible note hedge transactions with a number of financial institutions (each, an “option counterparty”). The convertible note hedge transactions cover, subject to anti-dilution adjustments substantially similar to those applicable to the Notes, the number of shares of our common stock underlying the Notes. Concurrently with entering into the convertible note hedge transactions, we also entered into separate warrant transactions with each option counterparty whereby we sold to such option counterparty warrants to purchase, subject to customary anti-dilution adjustments, the same number of shares of our common stock.

The convertible note hedge transactions are expected generally to reduce the potential dilution upon conversion of the Notes and/or offset any cash payments we are required to make in excess of the principal amount of converted Notes, as the case may be, in the event that the market price per share of our common stock, as measured under the terms of the convertible note hedge transactions, is greater than the strike price ($114.92) of the convertible note hedge transactions, which initially corresponds to the conversion price of the Notes and is subject to anti-dilution adjustments substantially similar to those applicable to the conversion rate of the Notes. If, however, the market price per share of our common stock, as measured under the terms of the warrant transactions, exceeds the strike price ($114.92) of the warrants, there would nevertheless be dilution to the extent that such market price exceeds the strike price of the warrants.warrants as noted in Note 7, unless we elect to settle the warrants in cash.

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The scheduled maturities of long-term debt outstanding at SeptemberJune 30, 20202021 are as follows:

Remaining 2020$3,312 
202118,219 
Remaining 2021Remaining 2021$9,937 
2022202224,844 202224,844 
20232023428,750 2023383,750 
20242024345,000 2024345,000 
20252025
The above amounts exclude debt discount, deferred debt issuance costs and financing leases.

Note 1110 – Guarantees

We provide warranties on certain of our products at the time of sale and sell extended warranties. The standard warranty period for our capital equipment is generally one year and our extended warranties typically vary from one to three years. Liability under warranty policies is based upon a review of historical claim experience. Adjustments are made to accruals as claim data and historical experience warrant.

Changes in the liability for standard warranties for the ninesix months ended SeptemberJune 30, are as follows:

20202019 20212020
Balance as of January 1,Balance as of January 1,$2,186 $1,585 Balance as of January 1,$1,826 $2,186 
Provision for warrantiesProvision for warranties616 1,495 Provision for warranties864 427 
Claims madeClaims made(932)(821)Claims made(440)(584)
Balance as of September 30,$1,870 $2,259 
Balance as of June 30,Balance as of June 30,$2,250 $2,029 
 
Costs associated with extended warranty repairs are recorded as incurred and amounted to $4.4$3.4 million and $4.0$3.0 million for the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, respectively.

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Note 1211 – Pension Plan

Net periodic pension cost consists of the following: 

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Service costService cost$179 $253 $537 $759 Service cost$248 $179 $496 $358 
Interest cost on projected benefit obligationInterest cost on projected benefit obligation639 782 1,917 2,346 Interest cost on projected benefit obligation451 639 902 1,278 
Expected return on plan assetsExpected return on plan assets(1,255)(1,181)(3,765)(3,543)Expected return on plan assets(1,289)(1,255)(2,578)(2,510)
Net amortization and deferralNet amortization and deferral705 720 2,115 2,160 Net amortization and deferral832 705 1,664 1,410 
Net periodic pension costNet periodic pension cost$268 $574 $804 $1,722 Net periodic pension cost$242 $268 $484 $536 
 
We do not expect to make any pension contributions during 2020.2021. Non-service cost of $0.1 million and $0.3$0.2 million for the three and six months ended SeptemberJune 30, 2020, and 2019, respectively, and $0.3 million and $1.0 million for the nine months ended September 30, 2020 and 2019, respectively, areis included in other expense in the consolidated condensed statements of comprehensive income (loss). Non-service pension cost was immaterial for the three and six months ended June 30, 2021.

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Note 1312 – Acquisition and Other Expense

Acquisition and other expense consist of the following, which are included in cost of sales or selling and administrative expense or other expense depending on the nature of the charge:

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Plant underutilization costsPlant underutilization costs$$$6,586 $Plant underutilization costs$$6,586 $$6,586 
Product rationalization costs - inventoryProduct rationalization costs - inventory2,169 Product rationalization costs - inventory2,169 2,169 
Restructuring costsRestructuring costs1,087 Restructuring costs1,087 1,087 
Manufacturing consolidation costsManufacturing consolidation costs606 1,430 3,993 1,430 Manufacturing consolidation costs1,602 3,387 
Acquisition and integration costsAcquisition and integration costs796 171 2,253 1,335 Acquisition and integration costs652 1,457 
Acquisition and other expense included in cost of salesAcquisition and other expense included in cost of sales$1,402 $1,601 $16,088 $2,765 Acquisition and other expense included in cost of sales$$12,096 $$14,686 
Restructuring and related costsRestructuring and related costs$1,009 $$3,133 $Restructuring and related costs$$2,124 $414 $2,124 
Product rationalization costs - field inventoryProduct rationalization costs - field inventory2,095 Product rationalization costs - field inventory2,095 2,095 
Acquisition and integration costsAcquisition and integration costs1,490 1,192 11,196 Acquisition and integration costs439 1,192 
Acquisition and other expense included in selling and administrative expenseAcquisition and other expense included in selling and administrative expense$1,009 $1,490 $6,420 $11,196 Acquisition and other expense included in selling and administrative expense$$4,658 $414 $5,411 
Debt refinancing costs included in other expense$$$$3,904 

During the nine months ended September 30,second quarter of 2020, we recorded a $6.6 million charge to cost of sales related to plant underutilization due to abnormally low production as a result of decreased sales caused by the COVID-19 pandemic.

During nine months ended September 30,the second quarter of 2020, we performed an analysis of our product lines and determined certain catalog numbers, principally related to capital equipment, would be discontinued and consolidated into existing product offerings. We consequently recorded a $2.2 million charge to cost of sales to write-off inventory of the discontinued products.
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In addition, we incurred $2.1 million in costs related to the write-off of field inventory used for customer demonstration and evaluation of the discontinued products which we charged to selling and administrative expense.

During the nine months ended September 30,second quarter of 2020, we incurred $1.1 million in restructuring costs related to a voluntary separation arrangement with employees as a result of the COVID-19 pandemic whichthat were charged to cost of sales based on the job function of the affected employees. Substantially allWe additionally recorded a charge of $2.1 million primarily related to the restructuring of our Orthopedic sales force and a voluntary separation arrangement with employees as a result of the COVID-19 pandemic that was charged to selling and administrative expenses based on the nature of the costs associated withand function of the voluntary separation arrangement were paid duringaffected employees. During the third quarter.six months ended June 30, 2021, we recorded a charge of $0.4 million related to the restructuring of our sales force which consisted primarily of termination payments to Orthopedic distributors made in exchange for ongoing assistance to transition to employee-based sales representatives and severance that was charged to selling and administrative expenses.

During the three and ninesix months ended SeptemberJune 30, 2020, we incurred $0.6$1.6 million and $4.0$3.4 million, respectively, in costs related to the consolidation of certain manufacturing operations which were charged to cost of sales. These costs related to winding down operations at certain locations and moving production lines to other facilities.

During the three and ninesix months ended SeptemberJune 30, 2019,2020, we incurred $1.4costs for inventory step-up adjustments and other costs of $0.7 million in costsand $1.5 million, respectively, related to the consolidation of certain manufacturing operations. These costs mainly related to severance anda previous acquisition, which were charged to cost of sales.

During the three and ninesix months ended September 30, 2020, we recognized costs for inventory step-up adjustments and other costs related to a previous acquisition of $0.8 million and $2.3 million, respectively. During the three and nine months ended September 30, 2019, we incurred costs of $0.2 million and $1.3 million, respectively, for inventory adjustments associated with the acquisition of Buffalo Filter as further described in Note 3. These costs were charged to cost of sales.

During the three and nine months ended September 30, 2020, we recorded charges of $1.0 million and $2.3 million respectively, related to the restructuring of our Orthopedic sales force which was charged to selling and administrative expense. The charges for Orthopedic sales force restructuring consist primarily of termination payments to distributors made in exchange for ongoing assistance to transition to employee-based sales representatives.

During the nine months ended September 30, 2020, we recorded $0.8 million in restructuring charges principally related to a voluntary separation arrangement with employees as a result of the COVID-19 pandemic which were charged to selling and administrative expense based on the nature of the costs and function of the affected employees. Substantially all of the costs associated with the voluntary separation arrangement were paid during the third quarter.

During the nine months ended SeptemberJune 30, 2020, we incurred $0.4 million and $1.2 million, respectively, in severance and integration costs mainly related to the Buffalo Filter acquisition. During the three and nine months ended September 30, 2019, we incurred $1.5 million and $11.2 million, respectively, in costs associated with the acquisition of Buffalo Filter as further described in Note 3. These costs include investment banking fees in the first quarter of 2019, and, consulting fees, legal fees, severance and integration related costs in the three and nine months ended September 30, 2019. These costswhich were included in selling and administrative expense.

During the nine months ended September 30, 2019, we incurred a $3.6 million charge related to commitment fees paid to certain of our lenders, which provided a financing commitment for the Buffalo Filter acquisition and recorded a loss on the early extinguishment of debt of $0.3 million in conjunction with the sixth amended and restated senior credit agreement.

During the third quarter of 2020, we sold a vacant facility for $3.2 million that was classified as an asset held for sale at the end of the second quarter of 2020.

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Note 1413 — Business Segment
We are accounting and reporting for our business as a single operating segment entity engaged in the development, manufacturing and sale on a global basis of surgical devices and related equipment. Our chief operating decision maker (the CEO) evaluates the various global product portfolios on a net sales basis and evaluates profitability, investment, cash flow metrics and allocates resources on a consolidated worldwide basis due to shared infrastructure and resources. Our product lines consist of orthopedic surgery and general surgery. Orthopedic surgery consists of sports medicine instrumentation and small bone, large bone and specialty powered surgical instruments as well as imaging systems for use in minimally invasive surgery procedures including 2DHD and 3DHD vision technologies and fees related to the sales representation, promotion and marketing of sports medicine allograft tissue. General surgery consists of a complete line of endo-mechanical instrumentation for minimally invasive laparoscopic and gastrointestinal procedures, smoke evacuation devices, a line of cardiac monitoring products as well as electrosurgical generators and related instruments. These product lines' net sales are as follows:

Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Orthopedic surgeryOrthopedic surgery$102,187 $110,328 $261,954 $339,522 Orthopedic surgery$107,893 $60,483 $215,058 $159,766 
General surgeryGeneral surgery135,648 123,262 347,677 350,710 General surgery147,268 97,302 272,779 212,030 
Consolidated net salesConsolidated net sales$237,835 $233,590 $609,631 $690,232 Consolidated net sales$255,161 $157,785 $487,837 $371,796 

Note 1514 – Legal Proceedings

From time to time, the Company may receive an information request, subpoena or warrant from a government agency such as the Securities and Exchange Commission, Department of Justice, Equal Employment Opportunity Commission, the Occupational Safety and Health Administration, the United States Food and Drug Administration, the Department of Labor, the Treasury Department or other federal and state agencies or foreign governments or government agencies. These information requests, subpoenas or warrants may or may not be routine inquiries, or may begin as routine inquiries and over time develop into enforcement actions of various types. Likewise, if we receive reports of alleged misconduct from employees and third parties, we investigate as appropriate.

Manufacturers of medical devices have been the subject of various enforcement actions relating to interactions with health care providers domestically or internationally whereby companies are claimed to have provided health care providers with inappropriate incentives to purchase their products. Similarly, the Foreign Corrupt Practices Act ("FCPA") imposes obligations on manufacturers with respect to interactions with health care providers who may be considered government officials based on their affiliation with public hospitals. The FCPA also requires publicly listed manufacturers to maintain accurate books and records, and maintain internal accounting controls sufficient to provide assurance that transactions are accurately recorded, lawful and in accordance with management's authorization. The FCPA poses unique challenges both because manufacturers operate in foreign cultures in which conduct illegal under the FCPA may not be illegal in local jurisdictions, and because, in some cases, a United States manufacturer may face risks under the FCPA based on the conduct of third parties over whom the manufacturer may not have complete control. While CONMED has not experienced any material enforcement action to date, there can be no assurance that the Company will not be subject to a material enforcement action in the future, or that the Company will not incur costs including, in the form of fees for lawyers and other consultants, that are material to the Company’s results of operations in the course of responding to a future inquiry or investigation.

Manufacturers of medical products may face exposure to significant product liability claims, as well as patent infringement and other claims incurred in the ordinary course of business. To date, we have not experienced any claims that have been material to our financial statements or financial condition, but any such claims arising in the future could have a material adverse effect on our business, results of operations or cash flows. We currently maintain commercial product liability insurance of $30 million per incident and $30 million in the aggregate annually, which we believe is adequate. This coverage is on a claims-made basis. There can be no assurance that claims will not exceed insurance coverage, that the carriers will be solvent or that such insurance will be available to us in the future at a reasonable cost.

Our operations are subject, and in the past have been subject, to a number of environmental laws and regulations governing, among other things, air emissions; wastewater discharges; the use, handling and disposal of hazardous substances and wastes; soil and groundwater remediation and employee health and safety. Likewise, the operations of our suppliers and sterilizers are subject to similar environmental laws and regulations. In some jurisdictions, environmental requirements may be
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expected to become more stringent in the future. In the United States, certain environmental laws can impose liability for the
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entire cost of site restoration upon each of the parties that may have contributed to conditions at the site regardless of fault or the lawfulness of the party’s activities. While we do not believe that the present costs of environmental compliance and remediation are material, there can be no assurance that future compliance or remedial obligations would not have a material adverse effect on our financial condition, results of operations or cash flows.

In 2014, the Company acquired EndoDynamix, Inc. The agreement governing the terms of the acquisition provides that, if various conditions are met, certain contingent payments relating to the first commercial sale of the products (the milestone payment), as well as royalties based on sales (the revenue based payments), are due to the seller. In 2016, we notified the seller that there was a need to redesign the product, and that, as a consequence, the first commercial sale had been delayed. Consequently, the payment of contingent milestone and revenue-based payments were delayed. On January 18, 2017, the seller provided notice ("the Notice") seeking $12.7 million under a liquidated damages clause, which essentially represents the seller's view as to the sum of the projected contingent milestone and revenue-based payments on an accelerated basis. CONMED responded to the Notice denying that there was any basis for acceleration of the payments due under the acquisition agreement. On February 22, 2017, the representative of the former shareholders of EndoDynamix filed a complaint in Delaware Chancery Court claiming breach of contract with respect to the duty to commercialize the product and seeking the contingent payments on an accelerated basis. We believe that there was a substantive contractual basis to support the Company's decision to redesign the product, such that there was no legitimate basis for seeking the acceleration of the contingent payments at that time.liquidated damages. In the third quarter of 2018, the Company decided to halt the development of the EndoDynamix clip applier. We previously recorded a charge to write off assets and released a previously accrued contingent consideration liability. In a pre-trial filing the Plaintiffs claim to seek liquidated damages, as well as additional damages up to $24.8 million. A non-jury trial is now scheduled to take place in the Delaware Chancery Court in December 2020.commenced on March 18, 2021, and testimony concluded on April 7, 2021. The parties have submitted post-trial briefs, and the Court will hear oral arguments at a hearing scheduled for September 2021, with the Court to issue a ruling at some point thereafter. The Company has not recorded any expense related to potential damages in connection with this matter because the Company does not believe any potential loss is probable. We expect to defend the claims asserted by the sellers of EndoDynamix, although there can be no assurance that we will prevail in the trial and/or any resulting appeals.

On June 17, 2020, our Seoul, South Korea Office was served with a search warrant by the Incheon Customs Office ("ICO") as part of what we believe to be an industry-wide criminal investigation concerning alleged manipulation of transfer pricing and maximum reimbursement pricing. We understand that the period under investigation with respect to CONMED currently relates to 2016-2019, although this could change as the investigation develops over time. CONMED is cooperatingdefending two Georgia State Court actions. The first was filed by various employees, former employees, contract workers and others against CONMED, and against a contract sterilizer. The second action is against CONMED’s landlord and other related entities. Plaintiffs in the lawsuits allege personal injury and related claims purportedly arising from or relating to exposure to Ethylene Oxide, a chemical used to sterilize certain products. CONMED is defending the claims asserted directly against it and is providing indemnification for certain other defendants based on contractual provisions. CONMED has submitted all of the claims for insurance coverage. One insurer is providing coverage for certain of the claims asserted directly against the Company. CONMED is currently in litigation with one of the investigation, which weother insurers regarding coverage for one of the indemnification claims and is waiting for the carrier to make a coverage determination for the other indemnification claim. The Company is unable to estimate any range of possible loss at this time, and has not recorded any expense related to potential damages in connection with this matter because the Company does not believe any potential loss is probable.

Both actions are in itstheir early stages. The ICOstages and discovery has previously audited the transfer pricing appliednot yet started. CONMED believes it has strong defenses to the majority of our imports into Korea, without any resulting material adjustments. We believe our transfer pricing was appropriate, on an aggregate basis,claims and we intend towill vigorously defend our position initself and all parties it is indemnifying. As with any litigation, there are risks, including the investigation, although there can be no assurancerisk that CONMED may not prevail with respect to the outcomedefense of the investigation,underlying claims, or with respect to securing adequate insurance coverage for the related costs, given that the investigation is in a relatively early stage.indemnification claims.

We record reserves sufficient to cover probable and estimable losses associated with any such pending claims. We do not expect that the resolution of any pending claims, investigations or reports of alleged misconduct will have a material adverse effect on our financial condition, results of operations or cash flows. There can be no assurance, however, that future claims or investigations, or the costs associated with responding to such claims, investigations or reports of misconduct, especially claims and investigations not covered by insurance, will not have a material adverse effect on our financial condition, results of operations or cash flows.

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Note 1615 – New Accounting Pronouncements
Recently Adopted Accounting Standards
In June 2016, the FASB issued ASU No. 2016-13 Financial Instruments-Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, along with subsequent amendments issued in 2019. This ASU requires instruments measured at amortized cost, including accounts receivable, to be presented at the net amount expected to be collected. The new model requires an entity to estimate credit losses based on historical information, current information, and reasonable and supportable forecasts, including estimates of prepayments. This ASU is effective for fiscal years beginning after December 31, 2019 and the Company adopted the new standard on January 1, 2020. We adopted this ASU by applying historical loss rates to our accounts receivable aging schedule to estimate expected credit losses. We further adjusted expected credit losses for specifically identified and forecasted credit losses. This update did not have a material impact on our net income (loss), earnings (loss) per share or cash flows.

In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework-Changes to the Disclosure Requirements for Fair Value Measurement, which modifies the disclosure requirements on fair value measurements. This ASU is effective for fiscal years beginning after December 15, 2019 and early adoption is permitted. We
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adopted this update as of January 1, 2020 and it did not have a material impact on our net income (loss), earnings (loss) per share or cash flows.

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which results in the removal of certain exceptions to the general principles of ASC 740 and simplifies other aspects of the accounting for income taxes. This ASU is effective for fiscal years beginning after December 15, 2020 and early adoption is permitted in any interim period. We early adopted this new guidance effective April 1, 2020 and it did not have a material impact on the consolidated financial statements.
    
Recently Issued Accounting Standards, Not Yet Adopted
    
In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Topic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans, which modifies the disclosure requirements for defined benefit pension plans and other postretirement plans. This ASU is effective for fiscal years ending after December 15, 2020 and early adoption is permitted. The Company will include the required disclosures in the 2020 year-end consolidated financial statements.

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional guidance if certain criteria are met for entities that have contracts, hedging relationships, and other transactions that reference LIBOR or other reference rates expected to be discontinued as a result of reference rate reform. This ASU is effective as of March 12, 2020 through December 31, 2022. The Company has not adopted thethis ASU as of SeptemberJune 30, 2020,2021, however will continue to monitor the impact of reference rates and will elect to apply this guidance in our consolidated financial statements in the event that we are impacted by reference rate reform.

In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which simplifies the accounting for convertible instruments by removing certain separation models requiring separate accounting for embedded conversion features which will result in more convertible debt instruments accounted for as a single liability. The ASU eliminates certain settlement conditions that are required for equity classification to qualify for the derivative scope exception. The ASU addresses how convertible instruments are accounted for in the calculation of diluted earnings per share by using the if-converted method. The ASU is effective for fiscal years beginning after December 15, 2021, with early adoption permitted no earlier than fiscal years beginning after December 15, 2020. The Company is currently assessing the impact of this guidance on our consolidated financial statements.

Note 17 - COVID-1916 – Subsequent Events

We experienced lower sales in the first and second quarters of 2020 compared to 2019 asOn July 16, 2021, we entered into a result of the emergence of the COVID-19 virus, which was first identified in Wuhan, China in December 2019 and then spread throughout Asia before emerging and becoming a pandemic in the United States, Europe and elsewhere. Our sales were negatively impacted first in the Asia Pacific geography and later in the United States, and the rest of the world as temporary closures occurred and hospitals and surgery centers postponed many non-urgent surgical procedures in order to minimize the risk of infection with COVID-19.
In compliance with various governmental orders, beginning in March we restricted access to our main facilities to only essential personnel required to be onsite (primarily manufacturing and distribution) with substantially all other personnel working remotely. As a medical device manufacturer, we were designated as an “essential business” by the relevant authorities in New York, Florida, Georgia and Mexico and have maintained production or distribution at our facilities in these locations. We returned to year over year sales growth in the third quarter of 2020 as temporary closures were lifted in jurisdictions in the United States and around the world and hospitals and surgery centers resumed many surgical procedures.
Because of the ongoing uncertainty of the prevalence and impact of COVID-19 on our business, on April 17, 2020, we amended our sixthseventh amended and restated senior credit agreement to suspend our required leverage ratios for up to four quarters. Under the terms of the amendment, we have certain minimum liquidityconsisting of: (a) a $233.5 million term loan facility and fixed charge coverage ratio requirements with which we were in full compliance as of September 30, 2020. We are forecasting that sales and earnings will be sufficient to remain in compliance with the liquidity and fixed charge coverage ratio requirements under the terms of the amendment and we will have sufficient availability under our(b) a $585.0 million revolving credit facility. The revolving credit facility to meet our liquidity needs. We have undertaken steps to reduce our spendingwill terminate and expenses in lightthe loans outstanding under the term loan facility will expire on the fifth anniversary of the impactclosing date. The term loan is payable in quarterly installments increasing over the term of COVID-19 on revenuethe facility. Proceeds from the term loan facility and earnings. Whileborrowings under the revolving credit facility were used to repay the then existing senior credit agreement. Initial interest rates are at LIBOR plus an interest rate margin of 1.75%. For those borrowings where we expect that weelect to use the alternate base rate, the initial base rate will be well positioned when surgeries begin to return to their pre-pandemic levels, we are unable to predict with certainty how long the COVID-19 pandemic will last,greatest of (i) the Prime Rate, (ii) the Federal Funds Rate plus 0.50% or resurgence thereof, or how severe its economic impact will be. Even after(iii) the COVID-19
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pandemiccertain financial ratios and government responses thereto have subsided, residual economicrestrict dividend payments and the incurrence of certain indebtedness and other effects may have an impact on the demand for post-pandemic surgery levels that are difficult to predict. If the downturn is more severeactivities, including acquisitions and prolonged than we currently expect, we may need to take further steps to reduce our costs, or to refinance our debt.

Additionally, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27, 2020 to provide economic relief in the early wake of the COVID-19 pandemic.  The CARES Act includes many measures to assist companies, including temporary changes to income and non-income-based tax laws.  Income tax relief includes temporary favorable changes to net operating loss and interest expense annual deduction limitations.  These provisions are not expected to result in any material impact to our financial results. 



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Item 2.MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION
 AND RESULTS OF OPERATIONS
 
Forward-Looking Statements
 
In this Report on Form 10-Q, we make forward-looking statements about our financial condition, results of operations and business. Forward-looking statements are statements made by us concerning events that may or may not occur in the future. These statements may be made directly in this document or may be “incorporated by reference” from other documents. Such statements may be identified by the use of words such as “anticipates”, “expects”, “estimates”, “intends” and “believes” and variations thereof and other terms of similar meaning.

Forward-Looking Statements are not Guarantees of Future Performance
 
Forward-looking statements involve known and unknown risks, uncertainties and other factors, including those that may cause our actual results, performance or achievements or industry results, to be materially different from any future results, performance or achievements expressed or implied by such forward-looking statements. Such factors include those identified under “Risk Factors” in our Annual Report on Form 10-K for the year-ended December 31, 20192020 and the following, among others:

general economic and business conditions;
compliance with and changes in regulatory requirements;
COVID-19 global pandemic poses significant risks to our business, financial condition and results of operations, which may be heightened if the pandemic, and various government responses to it, continue for an extended period of time;
environmental compliance risks, including lack of availability of sterilization with Ethylene Oxide (“EtO”) or other compliance costs associated with the use of EtO;
the possibility that United States or foreign regulatory and/or administrative agencies may initiate enforcement actions against us or our distributors;
competition;
changes in customer preferences;
changes in technology;
the introduction and acceptance of new products;
the availability and cost of materials;
the risk of an information security breach, including a cybersecurity breach;
cyclical customer purchasing patterns due to budgetary and other constraints;
the quality of our management and business abilities and the judgment of our personnel;
the availability, terms and deployment of capital;
future levels of indebtedness and capital spending;
changes in foreign exchange and interest rates;
the ability to evaluate, finance and integrate acquired businesses, products and companies;
changes in business strategy;
the risk of an information security breach, including a cybersecurity breach;
the risk of a lack of allograft tissues due to reduced donations of such tissues or due to tissues not meeting the appropriate high standards for screening and/or processing of such tissues;
the ability to defend and enforce intellectual property, including the risks related to theft or compromise of intellectual property in connection with our international operations;
the risk of patent, product and other litigation, as well as the cost associated with such litigation; and
trade protection measures, tariffs and other border taxes, and import or export licensing requirements.

See “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and "Risk Factors" below and “Risk Factors” and “Business” in our Annual Report on Form 10-K for the year-ended December 31, 20192020 for a further discussion of these factors. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. We do not undertake any obligation to publicly release any revisions to these forward-looking statements to reflect events or circumstances after the date of this Quarterly Report on Form 10-Q or to reflect the occurrence of unanticipated events.



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Overview

CONMED Corporation (“CONMED”, the “Company”, “we” or “us”) is a medical technology company that provides surgical devices and equipment for minimally invasive procedures. The Company’s products are used by surgeons and physiciansother healthcare professionals in a variety of specialties including orthopedics, general surgery, gynecology, neurosurgery, thoracic surgery and gastroenterology.

Our product lines consist of orthopedic surgery and general surgery. Orthopedic surgery consists of sports medicine instrumentation and small bone, large bone and specialty powered surgical instruments as well as, imaging systems for use in minimally invasive surgery procedures including 2DHD and 3DHD vision technologies and service fees related to the promotion and marketing of sports medicine allograft tissue. General surgery consists of a complete line of endo-mechanical instrumentation for minimally invasive laparoscopic and gastrointestinal procedures, smoke evacuation devices, a line of cardiac monitoring products as well as electrosurgical generators and related instruments. These product lines as a percentage of consolidated net sales are as follows:
 
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended June 30,Six Months Ended June 30,
2020201920202019 2021202020212020
Orthopedic surgeryOrthopedic surgery43 %47 %43 %49 %Orthopedic surgery42 %38 %44 %43 %
General surgeryGeneral surgery57 %53 %57 %51 %General surgery58 %62 %56 %57 %
Consolidated net salesConsolidated net sales100 %100 %100 %100 %Consolidated net sales100 %100 %100 %100 %

A significant amount of our products are used in surgical procedures with approximately 82%81% of our revenues derived from the sale of single-use products. Our capital equipment offerings also facilitate the ongoing sale of related single-use products and accessories, thus providing us with a recurring revenue stream. We manufacture substantially all of our products in facilities located in the United States and Mexico. We market our products both domestically and internationally directly to customers and through distributors. International sales approximated 44% and 46%45% during both the ninesix months ended SeptemberJune 30, 20202021 and 2019, respectively.2020.

Business Environment
    
Our business has beenwas, and to a lesser extent continues today to be, significantly impacted by the emergence of the COVID-19 virus, with the Company experiencing lower sales in the first and second quarters of 2020 compared to 2019,pandemic, first in the Asia Pacific geography and later in the United States, Europe and elsewhere as temporary closures occurred and hospitals and surgery centers postponed many non-urgent surgical procedures in order to minimize the risk of infection.  In compliance with various governmental orders, beginning in March 2020 we restricted access to our main facilities to only essential personnel required to be onsite while maintaining production and distribution. WeAlthough such restrictions continued to be in place as of June 30, 2021, we are uncertaindeveloping plans in certain of our facilities to ease such restrictions as the number of COVID-19 cases decline and vaccination rates increase.  During the first six months of 2021, revenues increased compared to the outlook forfirst six months of 2020. We have seen and believe we will continue to experience market variability that could influence sales, growth forsuppliers, patients and customers. We also have seen and continue to expect general surgery to rebound faster than orthopedic surgery due to the remaindernature of the yearproducts. However, there remains uncertainty related to the COVID-19 pandemic, including the duration and 2021 until such time as an effective vaccine is generally available.severity of future impacts to the business. See additional discussion in Note 10 and Note 17 to the consolidated condensed financial statements, as well as in Liquidity and Capital Resources below. 

Critical Accounting Policies

Preparation of our financial statements requires us to make estimates and assumptions which affect the reported amounts of assets, liabilities, revenues and expenses. Note 1 to the Consolidated Financial Statements in our Annual Report on Form 10-K for the year-ended December 31, 20192020 describes the significant accounting policies used in preparation of the Consolidated Financial Statements. On an ongoing basis, we evaluate the critical accounting policies used to prepare our consolidated financial statements, including, but not limited to, those related to goodwill and intangible assets.assets and our pension benefit obligation.







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Consolidated Results of Operations

The following table presents, as a percentage of net sales, certain categories included in our consolidated condensed statements of income (loss) for the periods indicated:

 Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Net sales100.0 %100.0 %100.0 %100.0 %
Cost of sales43.8 44.3 46.7 44.5 
Gross profit56.2 55.7 53.3 55.5 
Selling and administrative expense39.7 42.0 45.1 43.2 
Research and development expense4.2 4.7 4.7 4.8 
Income from operations12.4 9.0 3.5 7.4 
Interest expense5.0 4.8 5.4 4.7 
Other expense— 0.1 — 0.7 
Income (loss) before income taxes7.3 4.0 (2.0)2.0 
Income tax expense4.4 1.1 0.4 — 
Net income (loss)2.9 %3.0 %(2.4)%2.0 %
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 Three Months Ended June 30,Six Months Ended June 30,
 2021202020212020
Net sales100.0 %100.0 %100.0 %100.0 %
Cost of sales44.6 54.4 44.7 48.6 
Gross profit55.4 45.6 55.3 51.4 
Selling and administrative expense40.9 53.5 41.6 48.5 
Research and development expense4.4 5.5 4.4 5.1 
Income (loss) from operations10.1 (13.5)9.4 (2.2)
Interest expense3.7 7.2 4.1 5.6 
Other expense— 0.1 — — 
Income (loss) before income taxes6.4 (20.7)5.3 (7.9)
Provision (benefit) for income taxes1.2 (3.4)0.6 (2.1)
Net income (loss)5.2 %(17.4)%4.7 %(5.8)%

Net Sales

The following table presents net sales by product line for the three and ninesix months ended SeptemberJune 30, 20202021 and 2019:2020:

Three Months EndedThree Months Ended
% Change% Change
20202019As ReportedImpact of Foreign CurrencyConstant Currency20212020As ReportedImpact of Foreign CurrencyConstant Currency
Orthopedic surgeryOrthopedic surgery$102.2 $110.3 -7.4 %0.3 %-7.1 %Orthopedic surgery$107.9 $60.5 78.4 %-5.5 %72.9 %
General surgeryGeneral surgery135.6 123.3 10.0 %-0.2 %9.8 %General surgery147.3 97.3 51.4 %-2.3 %49.1 %
Net sales Net sales$237.8 $233.6 1.8 %— %1.8 % Net sales$255.2 $157.8 61.7 %-3.5 %58.2 %
Single-use productsSingle-use products$190.9 $184.4 3.6 %— %3.6 %Single-use products$208.9 $128.5 62.6 %-3.6 %59.0 %
Capital productsCapital products46.9 49.2 -4.7 %-0.2 %-4.9 %Capital products46.3 29.3 58.0 %-3.4 %54.6 %
Net sales Net sales$237.8 $233.6 1.8 %— %1.8 % Net sales$255.2 $157.8 61.7 %-3.5 %58.2 %
Nine Months EndedSix Months Ended
% Change% Change
20202019As ReportedImpact of Foreign CurrencyConstant Currency20212020As ReportedImpact of Foreign CurrencyConstant Currency
Orthopedic surgeryOrthopedic surgery$261.9 $339.5 -22.8 %1.2 %-21.6 %Orthopedic surgery$215.0 $159.8 34.6 %-3.3 %31.3 %
General surgeryGeneral surgery347.7 350.7 -0.9 %0.4 %-0.5 %General surgery272.8 212.0 28.7 %-1.7 %27.0 %
Net sales Net sales$609.6 $690.2 -11.7 %0.9 %-10.8 % Net sales$487.8 $371.8 31.2 %-2.3 %28.9 %
Single-use productsSingle-use products$497.1 $547.0 -9.1 %0.9 %-8.2 %Single-use products$396.3 $306.2 29.4 %-2.2 %27.2 %
Capital productsCapital products112.5 143.2 -21.5 %0.7 %-20.8 %Capital products91.5 65.6 39.6 %-2.8 %36.8 %
Net sales Net sales$609.6 $690.2 -11.7 %0.9 %-10.8 % Net sales$487.8 $371.8 31.2 %-2.3 %28.9 %

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Net sales increased 1.8%61.7% and decreased 11.7%31.2% in the three and ninesix months ended SeptemberJune 30, 2020, respectively. The increase during the three months ended September 30, 20202021, respectively, compared to the same periodperiods a year ago was driven by strong general surgery sales. Net sales decreasedincreases across all product lines as the COVID-19 pandemic had a significant impact on sales during the nine months ended September 30, 2020 as a resultsecond quarter of the COVID-19 pandemic.2020.

Orthopedic surgery sales decreased 7.4%increased 78.4% and 22.8%34.6% in the three and ninesix months ended SeptemberJune 30, 2021, respectively. 2020 respectively, primarily drivenwas significantly impacted by continued deferral of non-urgent surgeries as a result of the COVID-19 pandemic. A significant portion of this decline was driven by a reduction in capital equipment purchasespandemic as hospitals and surgery centers conserve cashdeferred non-urgent surgeries and defercustomers also deferred capital outlays.equipment purchases. Sales have increased since the first quarter of 2021 with growth in single-use products as non-urgent surgeries continue to increase.

General surgery sales increased 10.0%51.4% and decreased 0.9%28.7% in the three and ninesix months ended SeptemberJune 30, 2021, respectively. 2020 respectively.was significantly impacted by the COVID-19 pandemic as hospitals and surgery centers deferred non-urgent surgeries. General surgery sales increased from the first quarter of 2021 mainly driven by continued growth in our advanced surgical products, including in our Buffalo Filter and AirSeal products, as well as growth in our advanced endoscopic technologies products. We believe the deferral of non-urgent procedures has had a lesser impact on our general surgery linesproducts as a result of the nature of the products and procedures in which they are used and this belief was borne out in the third quarter by a resumption in growth in these lines, including continued growth in our Buffalo Filter and AirSeal products. The decrease during the nine months ended September 30, 2020 was a result of the deferral of non-urgent surgeries during the first half of the year as a result of the COVID-19 pandemic.used.

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Cost of Sales

Cost of sales increased to $104.1$113.7 million in the three months ended SeptemberJune 30, 20202021 as compared to $103.5$85.9 million in the three months ended SeptemberJune 30, 20192020 and decreasedincreased to $284.8$218.0 million in the ninesix months ended SeptemberJune 30, 20202021 as compared to $307.5$180.7 million in the ninesix months ended SeptemberJune 30, 2019.2020. Gross profit margins increased 50980 basis points to 56.2%55.4% in the three months ended SeptemberJune 30, 20202021 as compared to 55.7%45.6% in the three months ended SeptemberJune 30, 20192020 and decreased 220increased 390 basis points to 53.3%55.3% in the ninesix months ended SeptemberJune 30, 20202021 as compared to 55.5%51.4% in the ninesix months ended SeptemberJune 30, 2019.2020.

The increase in gross profit margin of 50980 basis points in the three months ended SeptemberJune 30, 20202021 and 390 basis points in the six months ended June 30, 2021 was primarily due to lower production costsdriven by an increase in sales as well as favorable product and channel mix.

The decreasethe absence in 2021 of 220 basis pointscertain costs incurred in gross margin in the nine months ended September 30, 2020 compared to the same period a year ago was primarily driven by a decline in net sales as well asincluding the following:

$6.6 million in costs related to plant underutilization due to abnormally low production as a result of decreased sales caused by the COVID-19 pandemic;pandemic in the second quarter of 2020;
$2.2 million in costs related to product rationalization;rationalization in the second quarter of 2020;
$1.1 million in restructuring costs related to a voluntary separation arrangement as a result of the COVID-19 pandemic; andpandemic in the second quarter of 2020;
$4.01.6 million and $3.4 million for the three and six months ended June 30, 2020, respectively, in costs related to the consolidation of certain manufacturing operations related to winding down operations at certain locations and moving production lines to other facilities.facilities; and
$0.7 million and $1.5 million for the three and six months ended June 30, 2020, respectively, related inventory step-up adjustments from a previous acquisition.

Refer to Note 1312 for further details on the above items.

Selling and Administrative Expense

Selling and administrative expense decreasedincreased to $94.4$104.4 million in the three months ended SeptemberJune 30, 20202021 as compared to $98.2$84.5 million in the three months ended SeptemberJune 30, 20192020 and decreasedincreased to $274.7$202.7 million in the ninesix months ended SeptemberJune 30, 20202021 as compared to $298.1$180.3 million in the ninesix months ended SeptemberJune 30, 2019.2020. Selling and administrative expense as a percentage of net sales decreased to 39.7%40.9% in the three months ended SeptemberJune 30, 20202021 as compared to 42.0%53.5% in the three months ended SeptemberJune 30, 20192020 and increaseddecreased to 45.1%41.6% in the ninesix months ended SeptemberJune 30, 20202021 as compared to 43.2%48.5% in the ninesix months ended SeptemberJune 30, 2019.2020.

The decrease in selling and administrative expense as a percentage of net sales for the three and ninesix months ended SeptemberJune 30, 20202021 was mainly driven mainly by actions takenhigher sales in 2021 while continuing to reducemonitor our expenses in response to the COVID-19 pandemic. We experienced reduced travel due to safety measures put in place and reduced trade show costs as shows were cancelled during the year. We also had lower commission costs during the nine months ended September 30, 2020 as sales declined compared to the same period a year ago. In addition, during2020 included the nine months ended September 30, 2019, we incurred $11.2 million in acquisition and integration costs relating to the Buffalo Filter acquisition compared to $3.1following expenses:

$2.1 million in severance costs related to a voluntary termination program and costs associated with the restructuring of our Orthopedic sales force and in the second quarter of 2020;
a $2.1 million write-off of field inventory used for customer demonstration and evaluation of products resulting from the product rationalization initiative discussed above duringin the ninesecond quarter of 2020; and
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$0.4 million and $1.2 million, respectively, in severance and integration costs mainly related to the Buffalo Filter acquisition in the three and six months ended SeptemberJune 30, 2020. Refer to Note 13 for further details.

Research and Development Expense

Research and development expense decreasedincreased to $9.9$11.3 million in the three months ended SeptemberJune 30, 20202021 as compared to $11.0$8.7 million in the three months ended SeptemberJune 30, 2019.2020. Research and development expense increased to $21.3 million in the six months ended June 30, 2021 as compared to $18.8 million in the six months ended June 30, 2020. As a percentage of net sales, research and development expense decreased 50110 basis points to 4.2%4.4% in the three months ended SeptemberJune 30, 20202021 as compared to 4.7%5.5% in the three months ended SeptemberJune 30, 2019. Research2020 and developmentdecreased 70 basis points to 4.4% in the six months ended June 30, 2021 as compared to 5.1% in the six months ended June 30, 2020. The lower spend as a percentage of sales is driven by higher sales in 2021.

Interest Expense

Interest expense decreased to $28.8$9.4 million in the ninethree months ended SeptemberJune 30, 2021 from $11.4 million in the three months ended June 30, 2020 and decreased to $19.8 million in the six months ended June 30, 2021 from $21.0 million in the six months ended June 30, 2020. The weighted average interest rates on our borrowings decreased to 2.97% in the three months ended June 30, 2021 as compared to $33.4 million3.75% in the ninethree months ended SeptemberJune 30, 2019. As a percentage of net sales, research2020 and development expense decreased 10 basis points to 4.7%3.17% in the ninesix months ended SeptemberJune 30, 20202021 as compared to 4.8%3.44% in the ninesix months ended SeptemberJune 30, 2019.2020. The decrease in interest expense is primarily due to lower spend is driven by cost cutting measuresborrowings and decreases in light ofour weighted average interest rates compared to the COVID-19 pandemic while still investing in key projects.same periods a year ago.

Other Expense

Other expense in the three and six months ended SeptemberJune 30, 2020 and 2019is related to non-service pension costs as further described in Note 12.
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11.

Other expense in the nine months ended September 30, 2020 related to non-service pension costs as further described in Note 12 andProvision (Benefit) for the nine months ended September 30, 2019 it mainly related to non-service pension costs and costs associated with our sixth amended and restated senior credit agreement entered into on February 7, 2019. These costs include a $3.6 million charge related to commitment fees paid to certain of our lenders, which provided a financing commitment for the Buffalo Filter acquisition, and a loss on the early extinguishment of debt of $0.3 million.

Interest Expense

Interest expense increased to $11.9 million in the three months ended September 30, 2020 from $11.2 million in the three months ended September 30, 2019 and increased to $32.9 million in the nine months ended September 30, 2020 from $32.4 million in the nine months ended September 30, 2019. The weighted average interest rates on our borrowings increased to 4.01% in the three months ended September 30, 2020 as compared to 3.66% in the three months ended September 30, 2019 and decreased to 3.63% in the nine months ended September 30, 2020 as compared to 3.83% in the nine months ended September 30, 2019.

The increase in interest expense during the three months ended September 30, 2020 was due to higher interest rates as compared to the prior period resulting from the amendment to our senior credit facility as more fully described in Note 10 and an increase in non-cash interest expense. The increase in interest expense during the nine months ended September 30, 2020 as compared to the prior period is primarily due to an increase in non-cash interest expense offset by a decrease in interest rates.

Income Tax ExpenseTaxes

Income tax expense has been recorded at an effective tax rate of 60.5%18.4% for the three months ended SeptemberJune 30, 20202021 compared to 26.2%income tax benefit at an effective tax rate of 16.3% for the three months ended SeptemberJune 30, 2019.2020. Income tax expense has been recorded at an effective tax rate of (22.9)%11.0% for the ninesix months ended SeptemberJune 30, 20202021 compared to 2.1%income tax benefit at an effective tax rate of 26.6% for the ninesix months ended SeptemberJune 30, 2019.2020. We calculate our estimated tax liability each quarter based on the level of income and tax liability on a year-to-date basis. AtThe tax rates for the endthree months and six months ended June 30, 2020 were primarily the result of theour second quarter ofloss position. The three months ended June 30, 2020 our loss position resulted in anincluded a discrete income tax benefit associated with stock options which increased the effective tax rate of 26.6% through the firstby 1.2%. The six months ofended June 30, 2020 included discrete income tax benefit associated with stock options and other federal income tax items which increased the year. Given the increase in income in the third quarter of 2020, the year-to-date income level changed and drove a higher level of tax liability in the third quarter on a year-to-date basis. This resulted in aeffective tax rate by 10.9%. Our income position for the third quarter of 2020 of 60.5%three and six months ended June 30, 2021 generated tax expense which included awas offset by discrete income tax benefit from federal tax deductions relating to stock option exercises that decreased the final issuance ofeffective tax regulations regarding US tax on foreign earnings at different rates.rate by 9.8% and 15.1%, respectively. A reconciliation of the United States statutory income tax rate to our effective tax rate is included in our Annual Report on Form 10-K for the year ended December 31, 2019,2020, under Note 8 to the consolidated financial statements.

Non-GAAP Financial Measures

Net sales on a "constant currency" basis is a non-GAAP measure. The Company analyzes net sales on a constant currency basis to better measure the comparability of results between periods. To measure percentage sales growth in constant currency, the Company removes the impact of changes in foreign currency exchange rates that affect the comparability and trend of net sales.

Because non-GAAP financial measures are not standardized, it may not be possible to compare this financial measure with other companies' non-GAAP financial measures having the same or similar names. This adjusted financial measure should not be considered in isolation or as a substitute for reported net sales growth, the most directly comparable GAAP financial measure. This non-GAAP financial measure is an additional way of viewing net sales that, when viewed with our GAAP results, provides a more complete understanding of our business. The Company strongly encourages investors and shareholders to review our financial statements and publicly-filed reports in their entirety and not to rely on any single financial measure.

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Liquidity and Capital Resources

Our liquidity needs arise primarily from capital investments, working capital requirements and payments on indebtedness under the sixth amended and restated senior credit agreement, described below. We have historically met these liquidity requirements with funds generated from operations and borrowings under our revolving credit facility. In addition, we have historically used term borrowings, including borrowings under the sixth amended and restated senior credit agreement, and borrowings under separate loan facilities, in the case of real property purchases, to finance our acquisitions. We also have the ability to raise funds through the sale of stock or we may issue debt through a private placement or public offering.

As a result of the COVID-19 pandemic, we experienced lower sales in the first and second quarters of 2020 and although we returned to sales growth in the third quarter of 2020, we are uncertain as to the outlook for sales growth for the
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remainder of the year and 2021 until such time as an effective vaccine is generally available. Due to the decrease in sales, we incurred a net loss in the nine months ended September 30, 2020. On April 17, 2020 we amended our senior credit agreement to suspend our required leverage ratios for up to four quarters. Under the terms of the amendment, weWe continued to have certain minimum liquidity and fixed charge coverage ratio requirements with whichrequirements. On November 20, 2020, we wereentered into a third amendment under our senior credit agreement to lower the applicable margin on loans and lower the interest floor on Eurocurrency loans agreed upon in full compliance with as of September 30,April 2020. We are forecasting that sales and earnings will be sufficient to remain in compliance withOn April 15, 2021, we terminated the liquidity and fixed charge coverage ratio requirements under the terms of the amendment.suspension period, thus reinstating our required leverage ratios. Management believes that cash flow from operations, including cash and cash equivalents on hand and available borrowing capacity under our revolving credit facility, will be adequate to meet our liquidity needs for the foreseeable future. We have undertaken stepscontinue to reducemonitor our spending and expenses in light of our expectation that our revenues will continue to be depressed overimpacted by the next several months.pandemic. While we expect that we will be well positioned when surgeries beginthe results of operations support continued recovery, there remains uncertainty in the financial markets related to return to their pre-pandemic levels, we are unable to predict with certainty how long the COVID-19 pandemic will last, or how severe its economic impact will be. Even after the COVID-19 pandemic and government responses thereto have subsided, residual economic and other effectswhich may have an impact on the demand for post-pandemic surgery levels that are difficult to predict. If the downturn is more severe and prolonged than we currently expect, we may need to take further steps to reduce our costs, or to refinance our debt.

Operating cash flows

Our net working capital position was $225.2$244.7 million at SeptemberJune 30, 2020.2021.  Net cash provided by operating activities was $44.4$56.6 million and $54.3$9.3 million in the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, respectively, generated on net income (loss) of $(14.6)$23.2 million and $13.7$(21.5) million for the ninesix months ended SeptemberJune 30, 20202021 and 2019,2020, respectively. The decreaseincrease in cash provided by operating activities in 20202021 as compared to 20192020 was mainly driven by lower sales andhigher net lossincome in 2020 resulting from the COVID-19 pandemic. Significant impacts to operating cash flows in 2020 includes increases from accounts receivable as amounts owed by customers as of December 31, 2019 were collected during the nine months ended September 30, 2020. These increases to operating cash flow from accounts receivable were largely offset by decreases in operating cash flow caused by higher inventories on lower sales2021 compared to the same period a year ago.

Investing cash flows

Net cash used in investing activities in the ninesix months ended SeptemberJune 30, 20202021 decreased $368.3$4.3 million from the same period a year ago mainly due to the $364.9 million payment for the Buffalo Filter Acquisition in 2019 and $3.2$3.9 million in cash received frompayments mainly related to the saleacquisition of a facility during the third quarter ofdistributor in 2020. Capital expenditures were also lower during$6.1 million in the ninesix months ended SeptemberJune 30, 2020 at $9.9 million2021 compared to $13.9$6.6 million in the same period a year ago.

Financing cash flows

Net cash used in financing activities in the ninesix months ended SeptemberJune 30, 20202021 was $24.9$31.0 million compared to cash provided by financing activities of $337.9$10.8 million during 2019.2020. Below is a summary of the significant financing activities impacting the change during the ninesix months ended SeptemberJune 30, 20202021 compared to 2019:2020:

We received proceeds of $345.0 million during the nine months ended September 30, 2019 related to the issuance of 2.625% convertible notes as further described below.
We entered into a $265.0 million term loan during the nine months ended September 30, 2019 in conjunction with the refinancing of our senior credit agreement. This new term loan replaced the previous term loan and resulted in net proceeds of $114.0 million during the nine months ended September 30, 2019 compared to $9.9 million in payments in the current year.
We had net proceedspayments on our revolving line of credit of $10.0$22.0 million compared to $65.0$38.0 million in paymentsnet borrowings during the ninesix months ended SeptemberJune 30, 2019.2020.
DuringWe had net cash proceeds of $13.1 million related to stock issued under employee plans for the ninesix months ended SeptemberJune 30, 2019, we paid $51.2 million2021 compared to purchase hedges related to our convertible notes. Partially offsetting this, were proceeds of $30.6 million from the issuance of warrants as further described below.
During the nine months ended September 30, 2019, we paid $16.2$2.2 million in debt issuance costs associated with the 2.625% convertible notes and the sixth amended and restated senior credit agreement compared to $2.1 million in debt issuance costs during the nine months ended September 30, 2020 in connection with the April 17, 2020 amendment of our sixth amended and restated senior credit agreement as further described below.same period a year ago.
We paid $2.1 million in contingent consideration related to a prior acquisitionsacquisition during the ninesix months ended SeptemberJune 30, 2020.
We paid $2.1 million in debt issuance costs related to the April 2020 as comparedamendment to $5.7 millionour sixth amended and restated senior credit agreement during the ninesix months ended SeptemberJune 30, 2019.2020.

On February 7, 2019 we entered into a sixth amended and restated senior credit agreement consisting of: (a) a $265.0 million term loan facility and (b) a $585.0 million revolving credit facility. The revolving credit facility willthen in effect was due to terminate and the
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loans outstanding under the term loan facility will expirethen in effect were scheduled to mature on the earlier of (i) February 7, 2024 or (ii) 91 days prior to the earliest scheduled maturity date of the $345.0 million in 2.625% convertible notes due in 2024 described below, (if, as of such date, more than $150.0 million in aggregate principal amount of such convertible notes (or any refinancing thereof) remainsremained outstanding). The term loan facility iswas payable in quarterly installments increasing over the term of the facility. Proceeds from the term loan facility and borrowings under the revolving credit facility were used to repay the then existing senior credit agreement and in part to finance the acquisition of Buffalo Filter. As noted above, on April 17, 2020 we amended our sixth amended and restated senior credit agreement to suspend our required leverage ratios for up to four
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quarters. Under the terms of the amendment, there areWe continued to have certain minimum liquidity and fixed charge coverage ratio requirements. Interest rates are also adjusted so thatOn November 20, 2020, we entered into a third amendment under our senior credit agreement to lower the applicable margin for base rateon the loans is 2.50% per annum and forlower the interest floor on Eurocurrency rate loans is 3.50% per annum, and the applicable commitment fee rate for the revolving credit facility is 0.50%. Followingagreed upon in April 2020. On April 15, 2021, we terminated the suspension period, thethus reinstating our required leverage ratios. The applicable margin will dependdepended upon CONMED’s consolidated senior secured leverage ratio, using the pricing grid set forth in the November 2020 amendment.  Interest rates were at LIBOR (subject to 1.00%0.125% floor) plus an interest rate margin of 3.50% (4.50%2.50% (2.625% at SeptemberJune 30, 2020)2021).

There were $245.1$233.5 million in borrowings outstanding on the term loan facility as of SeptemberJune 30, 2020.2021. There were $230.0$185.0 million in borrowings outstanding under the revolving credit facility as of SeptemberJune 30, 2020.2021. Our available borrowings on the revolving credit facility at SeptemberJune 30, 20202021 were $352.5$397.4 million with approximately $2.5$2.6 million of the facility set aside for outstanding letters of credit.

The sixth amended and restated senior credit agreement iswas collateralized by substantially all of our personal property and assets. The sixth amended and restated senior credit agreement contained covenants and restrictions which, among other things, required the maintenance of certain financial ratios and restricted dividend payments and the incurrence of certain indebtedness and other activities, including acquisitions and dispositions. We were in full compliance with these covenants and restrictions as of June 30, 2021. We were also required, under certain circumstances, to make mandatory prepayments from net cash proceeds from any issuance of equity and asset sales.

On July 16, 2021, we entered into a seventh amended and restated senior credit agreement consisting of: (a) a $233.5 million term loan facility and (b) a $585.0 million revolving credit facility. The revolving credit facility will terminate and the loans outstanding under the term loan facility will expire on the fifth anniversary of the closing date. The term loan is payable in quarterly installments increasing over the term of the facility. Proceeds from the term loan facility and borrowings under the revolving credit facility were used to repay the then existing senior credit agreement. Initial interest rates are at LIBOR plus an interest rate margin of 1.75%. For those borrowings where we elect to use the alternate base rate, the initial base rate will be the greatest of (i) the Prime Rate, (ii) the Federal Funds Rate plus 0.50% or (iii) the one-month Adjusted LIBOR plus 1.00%, plus, in each case, an interest rate margin. The seventh amended and restated senior credit agreement contains covenants and restrictions which, among other things, require the maintenance of certain financial ratios and restrict dividend payments and the incurrence of certain indebtedness and other activities, including acquisitions and dispositions. We were in full compliance with these covenants and restrictions as of September 30, 2020. We are also required, under certain circumstances, to make mandatory prepayments from net cash proceeds from any issuance of equity and asset sales.

On January 29, 2019, we issued $345.0 million in 2.625% convertible notes due in 2024 (the "Notes"). Interest is payable semi-annually in arrears on February 1 and August 1 of each year, commencing August 1, 2019. The Notes will mature on February 1, 2024, unless earlier repurchased or converted. The Notes represent subordinated unsecured obligations and are convertible under certain circumstances, as defined in the indenture, into a combination of cash and CONMED common stock.  The Notes may be converted at an initial conversion rate of 11.2608 shares of our common stock per $1,000 principal amount of Notes (equivalent to an initial conversion price of approximately $88.80 per share of common stock). Holders of the Notes may convert the Notes at their option at any time on or after November 1, 2023 through the second scheduled trading day preceding the maturity date. Holders of the Notes will also have the right to convert the Notes prior to November 1, 2023, but only upon the occurrence of specified events. The conversion rate is subject to anti-dilution adjustments if certain events occur. A portion of the net proceeds from the offering of the Notes were used as part of the financing for the Buffalo Filter acquisition and $21.0 million were used to pay the cost of certain convertible notes hedge transactions as further described below.

In connection with the offering of the Notes, we entered into convertible note hedge transactions with a number of financial institutions (each, an “option counterparty”). The convertible note hedge transactions cover, subject to anti-dilution adjustments substantially similar to those applicable to the Notes, the number of shares of our common stock underlying the Notes. Concurrently with entering into the convertible note hedge transactions, we also entered into separate warrant transactions with each option counterparty whereby we sold to such option counterparty warrants to purchase, subject to customary anti-dilution adjustments, the same number of shares of our common stock.

The convertible note hedge transactions are expected generally to reduce the potential dilution upon conversion of the Notes and/or offset any cash payments we are required to make in excess of the principal amount of converted Notes, as the case may be, in the event that the market price per share of our common stock, as measured under the terms of the convertible note hedge transactions, is greater than the strike price ($114.92) of the convertible note hedge transactions, which initially corresponds to the conversion price of the Notes and is subject to anti-dilution adjustments substantially similar to those applicable to the conversion rate of the Notes. If, however, the market price per share of our common stock, as measured under the terms of the warrant transactions, exceeds the strike price ($114.92) of the warrants, there would nevertheless be dilution to the extent that such market price exceeds the strike price of the warrants as noted in Note 7, unless we elect to settle the warrants in cash.

Our Board of Directors has authorized a $200.0 million share repurchase program. Through SeptemberJune 30, 2020,2021, we have repurchased a total of 6.1 million shares of common stock aggregating $162.6 million under this authorization and have $37.4
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million remaining available for share repurchases. The repurchase program calls for shares to be purchased in the open market or in private transactions from time to time. We may suspend or discontinue the share repurchase program at any time. We have not purchased any shares of common stock under the share repurchase program during 2020.2021. We have financed the
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repurchases and may finance additional repurchases through operating cash flow and from available borrowings under our revolving credit facility.

Management believes that cash flow from operations, including cash and cash equivalents on hand and available borrowing capacity under our sixthseventh amended and restated senior credit agreement, will be adequate to meet our anticipated operating working capital requirements, debt service, funding of capital expenditures, dividend payments and common stock repurchases in the foreseeable future.

New accounting pronouncements

See Note 1615 to the consolidated condensed financial statements for a discussion of new accounting pronouncements.


Item 3. Quantitative and Qualitative Disclosures About Market Risk

There have been no significant changes in our primary market risk exposures or in how these exposures are managed during the ninesix months ended SeptemberJune 30, 2020.2021.  Reference is made to Item 7A. of our Annual Report on Form 10-K for the year ended December 31, 20192020 for a description of Qualitative and Quantitative Disclosures About Market Risk.
 
Item 4.  Controls and Procedures
 
As of the end of the period covered by this report, an evaluation was carried out by CONMED Corporation’s management, with the participation of our Chief Executive Officer and Chief Financial Officer, of the effectiveness of our disclosure controls and procedures (as defined in Rule 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934).  Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that these disclosure controls and procedures were effective as of the end of the period covered by this report.  In addition, no change in our internal control over financial reporting (as defined in Rule 13a-15(f) and 15d-15(f) under the Securities Exchange Act of 1934) occurred during the quarter ended SeptemberJune 30, 20202021 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.


PART II OTHER INFORMATION


Item 1. Legal Proceedings

Reference is made to Item 3 of the Company’s Annual Report on Form 10-K for the year-ended December 31, 20192020 and to Note 1514 of the Notes to Consolidated Condensed Financial Statements included in Part I of this Report for a description of certain legal matters.

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Item 1A. Risk Factors

This Form 10-Q should be read in conjunction with the risk factors and information disclosed in our Annual Report on Form 10-K under Part I, Item 1A for the year ended December 31, 2019. There have been no material changes in the risk factors described in our Annual Report on Form 10-K under Part I, Item 1A for the year ended December 31, 2019, except for the risk factor below.

The COVID-19 global pandemic may pose significant risks to our business if the pandemic, and various government responses to it, continue for an extended period of time.

The public health actions being undertaken to reduce the spread of the virus are and may continue to create significant disruptions with respect to the demand for non-urgent surgeries, hospital and ambulatory surgery center operating volumes, and potentially to our ability to adequately rely on our supply chain.

As of the date of this report:

1.In some geographies or territories, our field-based sales representatives may be limited in their ability to travel to service or call on customers, with in-person visits in many cases dependent on requests by physicians to cover surgeries, the policies of individual hospitals, surgery centers or other institutions, and the availability of appropriate personal protective equipment; 

2.Our office-based employees continue to work remotely, and

3.Our manufacturing facilities and warehouses continue to operate with precautions including, increased hygiene and cleaning within facilities, social distancing and monitoring of temperatures.

As such, the COVID-19 pandemic has directly and indirectly adversely impacted the Company’s business, financial condition and operating results. The extent to which this will continue will depend on numerous evolving factors that are highly uncertain, rapidly changing and cannot be predicted with precision or certainty at this time, including:

the duration and scope of the COVID-19 pandemic, including any resurgence of the pandemic in some areas;

governmental, business and individual actions that have been, continue to be, or may in the future be taken in response to the COVID-19 pandemic including, for example, business and travel restrictions, “stay-at-home” and “shelter-in-place” directives, quarantines, and slowdowns, suspensions or delays of commercial activity;

the effect of the COVID-19 pandemic on our partners and customers, including their ability to conduct surgeries, to continue to purchase our products, to pay for the products purchased from us and/or to collect reimbursement, or their ability to do so in the volumes that existed prior to the pandemic;

the effect of the COVID-19 pandemic and the governmental response on the budgets of our partners and customers;

our ability during the COVID-19 pandemic to continue operations and/or adjust our production schedules in an efficient manner, as a result of current and anticipated weakened demand and/or production delays, if any, from our suppliers;

significant reductions or volatility in demand for certain surgeries or for certain of our products;  

the effect of the COVID-19 pandemic on our supply chain’s reliability and costs;  

costs incurred as a result of actions intended to protect the health and safety of our employees and continued operations, including enhanced cleaning processes, protocols designed to implement appropriate social distancing practices, and/or adoption of additional wage and benefit programs to assist employees;  

potential future restructuring, impairment and other charges;

the impact of the COVID-19 pandemic on the financial and credit markets and economic activity generally;  
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our ability to access lending, capital markets, and other sources of liquidity when needed on reasonable terms or at all; 

our ability to comply with the financial covenants in our debt agreements if a material economic downturn as a result of the COVID-19 pandemic results in substantially increased indebtedness and/or lower earnings; and  

the exacerbation of negative impacts resulting from the occurrence of a global or national recession, depression or other sustained adverse market event as a result of the COVID-19 pandemic.

We have undertaken steps to reduce our spending and expenses in light of the uncertainty concerning forecasting demand, and consequently revenues. While we expect that we will be well positioned if and/or when surgeries begin to return to their pre-pandemic levels, we are unable to predict with certainty how long the COVID-19 pandemic will last, or how severe its economic impact will be. Even after the COVID-19 pandemic and government responses thereto have subsided, residual economic and other effects may have an impact on the demand for post-pandemic surgery levels that are difficult to predict. If the downturn is more severe and prolonged than we currently expect, we may need to take further steps to reduce our costs, or to refinance our debt.

In addition to the other information set forth in this report, you should carefully consider the factors discussed under “Risk Factors” in our annual report on Form 10-K for the 2019 fiscal year. These risks may be heightened by the COVID-19 pandemic and could materially and adversely affect our business. The risks and uncertainties presented in this report and in our annual report on Form 10-K are not the only ones facing us. Additional risks and uncertainties not presently known to us, or that we currently believe to be immaterial, may also adversely affect our business.



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Item 6. Exhibits

Exhibit Index
Exhibit No.Description of Exhibit
31.1
  
31.2
  
32.1
101.INSXBRL 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.SCHXBRL Taxonomy Extension Schema Document
101.CALXBRL Taxonomy Extension Calculation Linkbase Document
101.DEFXBRL Taxonomy Extension Definition Linkbase Document
101.LABXBRL Taxonomy Extension Label Linkbase Document
101.PREXBRL Taxonomy Extension Presentation Linkbase Document
104Cover Page - Interactive Data File - the cover page XBRL tags are embedded within the Inline XBRL document (included in Exhibit 101)
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SIGNATURES

Pursuant to the requirements of Section 13 or 15(d) 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 on the date indicated below.

 CONMED CORPORATION
 
  
 
By: /s/ Todd W. Garner
 Todd W. Garner
 Executive Vice President and
 Chief Financial Officer
 
 Date:  
 OctoberJuly 29, 20202021
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