COVID-19

9 Months Ended

Sep. 30, 2020

Risks and Uncertainties [Abstract]

COVID-19

COVID-19

We experienced lower sales in the first and second quarters of 2020 compared to 2019 as 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 sixth 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 liquidity 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 revolving credit facility to meet our liquidity needs. We have undertaken steps to reduce our spending and expenses in light of the impact of COVID-19 on revenue and earnings. While we expect that we 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, or resurgence thereof, 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.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.