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Acquisition and Other Expense
9 Months Ended
Sep. 30, 2021
Acquisition and Other Expense [Abstract]  
Acquisition and Other Expense Acquisition and Other Expense
Acquisition and other expense consist of the following, which are included in cost of sales, selling and administrative expense or other expense depending on the nature of the charge:

Three Months Ended September 30,Nine Months Ended September 30,
 2021202020212020
Plant underutilization costs$— $— $— $6,586 
Product rationalization costs - inventory— — — 2,169 
Restructuring costs— — — 1,087 
Manufacturing consolidation costs— 606 — 3,993 
Acquisition and integration costs— 796 — 2,253 
Acquisition and other expense included in cost of sales$— $1,402 $— $16,088 
Restructuring and related costs$— $1,009 $414 $3,133 
Product rationalization costs - field inventory— — — 2,095 
Acquisition and integration costs — — — 1,192 
Acquisition and other expense included in selling and administrative expense$— $1,009 $414 $6,420 
Debt refinancing costs included in other expense$1,127 $— $1,127 $— 

During the nine months ended September 30, 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 the nine months ended September 30, 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. 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, 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 that were charged to cost of sales based on the job function of the affected employees.

During the three and nine months ended September 30, 2020, we incurred $0.6 million and $4.0 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 nine months ended September 30, 2020, we incurred costs for inventory step-up adjustments and other costs of $0.8 million and $2.3 million, respectively, related to a previous acquisition, which 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, primarily related to the restructuring of our Orthopedic sales force that was charged to selling and administrative expenses based on the nature of the costs and function of the affected employees. During the nine months ended September 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 nine months ended September 30, 2020, we incurred $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.
During the nine months ended September 30, 2020, we incurred $1.2 million in severance and integration costs mainly related to the Buffalo Filter acquisition which were included in selling and administrative expense.

During the three and nine months ended September 30, 2021, we recorded $1.1 million related to a loss on early extinguishment and third party fees associated with the seventh amended and restated senior credit agreement as further described in Note 9. These costs were included in other expense.