0001376339-23-000003 | 10-K | XBRL Viewer

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Cover Page - USD ($) $ in Millions	12 Months Ended
Cover Page - USD ($) $ in Millions	Dec. 31, 2022	Feb. 24, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-35887
Entity Registrant Name	MIMEDX GROUP, INC.
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-2792552
Entity Address, Address Line One	1775 West Oak Commons Court, NE
Entity Address, City or Town	Marietta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30062
City Area Code	770
Local Phone Number	651-9100
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	MDXG
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 388.1
Entity Common Stock, Shares Outstanding		114,083,096
Documents Incorporated by Reference	Documents Incorporated By Reference Portions of the proxy statement relating to the 2023 Annual Meeting of Shareholders, to be filed within 120 days after the end of the fiscal year to which this report relates, are incorporated by reference in Part III of this Report.
Entity Central Index Key	0001376339
Document Fiscal Year Focus	2022
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	FY
Amendment Flag	false
Entity Filer Category	Accelerated Filer

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Auditor Information [Abstract]
Auditor Firm ID	34	34	243
Auditor Name	Deloitte & Touche LLP	Deloitte & Touche LLP	BDO USA, LLP
Auditor Location	Atlanta, Georgia	Atlanta, Georgia	Atlanta, Georgia

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 65,950	$ 87,083
Accounts receivable, net	43,084	40,353
Inventory	13,183	11,389
Prepaid expenses	8,646	6,146
Income tax receivable	704	743
Other current assets	2,631	2,809
Total current assets	134,198	148,523
Property and equipment, net	7,856	9,165
Right of use asset	3,400	4,696
Goodwill	19,976	19,976
Intangible assets, net	5,852	5,383
Other assets	148	186
Total assets	171,430	187,929
Current liabilities:
Accounts payable	8,847	7,385
Accrued compensation	21,852	23,595
Accrued expenses	11,024	9,812
Other current liabilities	1,834	1,565
Total current liabilities	43,557	42,357
Long term debt, net	48,594	48,127
Other liabilities	4,773	4,869
Total liabilities	96,924	95,353
Commitments and contingencies (Note 16)
Convertible preferred stock Series B; $.001 par value; 100,000 shares authorized, issued and outstanding at December 31, 2022 and December 31, 2021	92,494	92,494
Stockholders’ (deficit) equity:
Preferred stock Series A; $.001 par value; 5,000,000 shares authorized; 0 issued and outstanding at December 31, 2022 and 0 issued and outstanding at December 31, 2021	0	0
Common stock; $.001 par value; 187,500,000 shares authorized, 113,705,447 issued and outstanding at December 31, 2022 and 112,703,926 issued and 111,925,216 outstanding at December 31, 2021	114	113
Additional paid-in capital	173,804	165,695
Treasury stock at cost; 0 shares at December 31, 2022 and 778,710 shares at December 31, 2021	0	(4,017)
Accumulated deficit	(191,906)	(161,709)
Total stockholders’ (deficit) equity	(17,988)	82
Total liabilities, convertible preferred stock, and stockholders’ (deficit) equity	$ 171,430	$ 187,929

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2022	Dec. 31, 2021
LIABILITIES, CONVERTIBLE PREFERRED STOCK, AND STOCKHOLDERS’ (DEFICIT) EQUITY
Series B convertible preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Series B convertible preferred stock, shares authorized	100,000	100,000
Series B convertible preferred stock, shares issued	100,000	100,000
Series B convertible preferred stock, shares outstanding	100,000	100,000
Stockholders’ (deficit) equity:
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized	187,500,000	187,500,000
Common stock, shares issued	113,705,447	112,703,926
Common stock, shares outstanding	113,705,447	111,925,216
Treasury stock, shares	0	778,710

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Net sales	$ 267,841	$ 258,615	$ 248,234
Cost of sales	48,316	43,283	39,330
Gross profit	219,525	215,332	208,904
Operating expenses:
Selling, general and administrative	208,789	198,359	181,022
Research and development	22,829	17,344	11,715
Investigation, restatement and related	12,177	3,791	59,465
Amortization of intangible assets	701	820	1,073
Impairment of intangible assets	0	53	1,027
Operating loss	(24,971)	(5,035)	(45,398)
Other expense, net
Interest expense, net	(5,016)	(4,980)	(7,941)
Other expense, net	(4)	(23)	(3)
Loss on extinguishment of debt	0	0	(8,201)
Loss before income tax provision	(29,991)	(10,038)	(61,543)
Income tax provision (expense) benefit	(206)	(247)	12,259
Net loss	(30,197)	(10,285)	(49,284)
Net loss available to common stockholders (Note 10)	(36,777)	(16,421)	(83,328)
Net loss available to common stockholders (Note 10)	$ (36,777)	$ (16,421)	$ (83,328)
Net loss per common share - basic (in dollars per share)	$ (0.33)	$ (0.15)	$ (0.77)
Net loss per common share - diluted (in dollars per share)	$ (0.33)	$ (0.15)	$ (0.77)
Weighted average shares outstanding - basic (in shares)	112,909,266	110,353,406	108,257,112
Weighted average shares outstanding - diluted (in shares)	112,909,266	110,353,406	108,257,112

CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (DEFICIT) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Accumulated Deficit
Balance beginning of period (in shares) at Dec. 31, 2019		112,703,926
Balance, beginning of period at Dec. 31, 2019	$ 34,398	$ 113	$ 147,231	$ (10,806)	$ (102,140)
Treasury stock, beginning balance (in shares) at Dec. 31, 2019				1,885,277
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of Series B Convertible Preferred Stock	32,954		32,954
Deemed dividends	(32,028)		(32,028)
Shares repurchased for tax withholding (in shares)				435,492
Shares repurchased for tax withholding	(2,334)			$ (2,334)
Share-based compensation expense	15,733		15,733
Exercise of stock options (in shares)				(359,328)
Exercise of stock options	411		(3,180)	$ 3,591
Issuance of restricted stock (in shares)				613,146
Issuance of restricted stock	0		(5,463)	$ 5,463
Restricted stock shares canceled/forfeited	0		3,363	$ (3,363)
Restricted stock cancellation/forfeited (in shares)				425,388
Net loss	(49,284)				(49,284)
Balance end of period (in shares) at Dec. 31, 2020		112,703,926
Balance, end of period at Dec. 31, 2020	(150)	$ 113	158,610	$ (7,449)	(151,424)
Treasury stock, ending balance (in shares) at Dec. 31, 2020				1,773,683
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Deemed dividends	(926)		(926)
Shares repurchased for tax withholding (in shares)				469,239
Shares repurchased for tax withholding	(4,751)			$ (4,751)
Share-based compensation expense	14,757		14,757
Exercise of stock options (in shares)				(487,361)
Exercise of stock options	1,437		(1,199)	$ 2,636
Issuance of restricted stock (in shares)				810,405
Issuance of restricted stock	0		(4,053)	$ 4,053
Restricted stock shares canceled/forfeited	0		515	$ (515)
Restricted stock cancellation/forfeited (in shares)				73,056
Other	0		(2,009)	$ 2,009
Other (in shares)				(239,502)
Net loss	$ (10,285)				(10,285)
Balance end of period (in shares) at Dec. 31, 2021	112,703,926	112,703,926
Balance, end of period at Dec. 31, 2021	$ 82	$ 113	165,695	$ (4,017)	(161,709)
Treasury stock, ending balance (in shares) at Dec. 31, 2021	778,710			778,710
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Shares repurchased for tax withholding (in shares)				249,442
Shares repurchased for tax withholding	$ (1,190)			$ (1,190)
Share-based compensation expense	$ 12,666		12,666
Exercise of stock options (in shares)	(312,001)	(160,762)		(151,239)
Exercise of stock options	$ 651		(618)	$ 1,269
Issuance of restricted stock (in shares)		840,759		882,251
Issuance of restricted stock	0	$ 1	(3,969)	$ 3,968
Restricted stock shares canceled/forfeited	0		30	$ (30)
Restricted stock cancellation/forfeited (in shares)				5,338
Net loss	$ (30,197)				(30,197)
Balance end of period (in shares) at Dec. 31, 2022	113,705,447	113,705,447
Balance, end of period at Dec. 31, 2022	$ (17,988)	$ 114	$ 173,804	$ 0	$ (191,906)
Treasury stock, ending balance (in shares) at Dec. 31, 2022	0			0

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net loss	$ (30,197)	$ (10,285)	$ (49,284)
Adjustments to reconcile net loss to net cash used in operating activities:
Share-based compensation	12,666	14,757	15,357
Depreciation	3,345	4,363	5,782
Bad debt expense	2,820	0	0
Non cash lease expenses	1,259	989	983
Amortization of intangible assets	701	820	1,073
Amortization of deferred financing costs and debt discount	467	1,055	2,276
Accretion of asset retirement obligation	92	81	10
(Gain) loss on fixed asset disposal	(17)	262	1
Impairment of intangible assets	0	53	1,027
Loss on extinguishment of debt	0	0	8,201
Increase (decrease) in cash resulting from changes in:
Accounts receivable	(5,550)	(4,930)	(3,096)
Inventory	(1,794)	(1,028)	(1,257)
Prepaid expenses	(2,500)	(542)	1,064
Other assets	(333)	675	(119)
Accounts payable	1,053	(326)	177
Accrued compensation	(1,744)	5,128	(2,459)
Accrued expenses	1,762	(21,197)	1,746
Income taxes	39	9,302	(10,027)
Other liabilities	38	(1,159)	(1,718)
Net cash flows used in operating activities	(17,893)	(1,982)	(30,263)
Cash flows from investing activities:
Purchases of property and equipment	(1,514)	(3,218)	(4,228)
Principal payments from note receivable	0	75	0
Proceeds from property and equipment sale	24	0	0
Net cash flows used in investing activities	(2,660)	(3,395)	(4,555)
Cash flows from financing activities:
Stock repurchased for tax withholdings on vesting of restricted stock	(1,190)	(4,751)	(2,334)
Proceeds from exercise of stock options	651	1,437	411
Payments under finance lease obligations	(41)	(38)	0
Proceeds from sale of Series B convertible preferred stock	0	0	100,000
Stock issuance costs	0	0	(7,470)
Proceeds from term loans	0	0	59,500
Deferred financing costs	0	0	(3,235)
Repayment of term loans	0	0	(83,872)
Prepayment premium on early repayment of term loan	0	0	(1,439)
Net cash flows (used in) provided by financing activities	(580)	(3,352)	61,561
Net change in cash	(21,133)	(8,729)	26,743
Cash and cash equivalents, beginning of year	87,083	95,812	69,069
Cash and cash equivalents, end of year	65,950	87,083	95,812
Licenses
Cash flows from investing activities:
Payments to acquire intangible assets	(1,000)	0	0
Patents and know-how
Cash flows from investing activities:
Payments to acquire intangible assets	$ (170)	$ (252)	$ (327)

Nature of Business	12 Months Ended
Nature of Business	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Business	Nature of Business MiMedx Group, Inc. (together with its subsidiaries, except where the context otherwise requires, “MIMEDX,” or the “Company”) is a is a pioneer and leader in placental biologics focused on addressing the needs of patients with acute and chronic non-healing wounds. The Company is also advancing a promising late-stage biologics pipeline targeted at decreasing pain and improving function for patients with knee osteoarthritis (“KOA”). To accomplish these goals, the Company operates as two defined, internal business units: Wound & Surgical and Regenerative Medicine. All of our products sold in the United States are regulated by the United States Food and Drug Administration (“FDA”). The Wound & Surgical business focuses on the Advanced Wound Care and Surgical Recovery markets through sales of the Company’s existing product portfolio and product development to serve these end markets. This business unit is responsible for substantially all sales of the Company’s Advanced Wound Care products, as well as the sale of the Company’s micronized and certain particulate products (collectively, the “Section 351 products”) internationally. The Regenerative Medicine business focuses on progressing the Company’s placental biologics platform towards registration as a FDA-approved biological drug. Micronized dehydrated human amnion chorion membrane (“mDHACM”) is an injectable placental biologic product candidate in its late-stage pipeline targeted at achieving FDA approval for an indication to help decrease pain and improve function in patients suffering from KOA. Prior to May 31, 2021, this business unit was responsible for domestic sales of the Company’s Section 351 products. Regenerative Medicine does not currently generate revenue. Additional information regarding the principal operations and results of these business units can be found in Note 13, Segment Information. The Company’s business is focused primarily on the United States of America but the Company is pursuing opportunities for international expansion, with specific focus on the sale of its placental tissue products in Japan.

Significant Accounting Policies

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Significant Accounting Policies

Principles of Consolidation

The consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.

Use of Estimates

The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”). 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 financial statements and the reported consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment, goodwill and intangible assets, estimates of loss for contingent liabilities, estimate of allowance for doubtful accounts, management’s assessment of the Company’s ability to continue as a going concern, estimate of fair value of share-based payments, estimates of returns and allowances, and valuation of deferred tax assets.

Segment Reporting

The application of GAAP requires the use of the “management approach” model for segment reporting. The management approach model is based on the way a company’s chief operating decision maker (“CODM”) organizes segments within the Company for which separate financial information is available regarding resource allocation and assessing performance. The Company has concluded that its Chief Executive Officer (“CEO”) is its CODM. Prior to June 30, 2022, the Company assessed that it operated as one operating and reportable segment. The Company reassesses the existence of operating segments when facts and circumstances suggest that there may have been a change in the way that the Company is managed.

On September 30, 2022, the Company reassessed its operating segments, concluding that the CODM assesses performance and allocates resources between two, distinct reportable segments: Wound & Surgical and Regenerative Medicine. Information regarding the principal operations and results of these segments can be found in Note 13, Segment Information.

Cash and Cash Equivalents

Cash and cash equivalents include cash held at various banks. The Company considers all highly-liquid investments purchased with an original maturity of three months or less at the date of purchase and money market mutual funds to be cash equivalents.

Market Concentrations and Credit Risk

The Company places its cash and cash equivalents on deposit with U.S.-based financial institutions. The U.S. Federal Deposit Insurance Corporation (“FDIC”) provides insurance coverage for deposits up to $250,000 for substantially all depository accounts. As of December 31, 2022 and 2021, the Company had cash and cash equivalents of approximately $65.2 million and $86.4 million, respectively, in excess of the insured amounts in four depository institutions.

Accounts Receivable

Accounts receivable represent amounts due from customers for which revenue has been recognized. Generally, the Company does not require collateral or any other security to support its receivables.

Bad debt expense and the allowance for doubtful accounts are based on historical trends and current expectations for credit losses. The Company’s policy to reserve for potential bad debts is based on the aging of the individual receivables as well as customer-specific qualitative factors, such as bankruptcy proceedings. The Company manages credit risk by routinely performing credit checks on customers prior to sales. Individual receivables are written-off after all reasonable efforts to collect the funds have been made. Actual write-offs may differ from the amounts reserved.

Inventory

Inventory is valued at the lower of cost or net realizable value. Costs of inventory sold are recognized using the first–in, first-out (“FIFO”) method. Inventory is tracked through raw material, work-in-process, and finished goods stages as the product progresses through various production steps and stocking locations. Labor and overhead costs are absorbed through the various production processes up to when the work order closes. Historical yields and normal capacities are utilized in the calculation of production overhead rates. Write-downs are utilized to account for slow-moving inventory as well as inventory no longer needed due to diminished demand or regulatory action.

Property and Equipment, Net

Property and equipment are recorded at cost and depreciated on a straight-line method over their estimated useful lives, principally three to seven years. Leasehold improvements are depreciated on a straight-line method over the shorter of the estimated useful lives and the remaining lease term.

Asset Retirement Obligations

The Company records obligations associated with the legal requirement to retire long-lived assets at the sooner of the imposition of the legal requirement and when an estimate for the cost of retirement can reasonably be made. The Company reviews legal obligations associated with the retirement of long-lived assets that result from contractual obligations or the acquisition, construction, development and/or normal use of the assets. If it is determined that a legal obligation exists, regardless of whether the obligation is conditional on a future event, the fair value of the liability for an asset retirement obligation is recognized in the period in which it is incurred, if a reasonable estimate of fair value can be made. The fair value is calculated as the estimate of the expected cash outflow to satisfy the legal obligation discounted to present value using the Company’s incremental borrowing rate. At such point in time, an asset and liability are recorded for the amount of the expected liability. The asset amount is depreciated, straight-line, over the life of the underlying asset, while the liability is accreted to the amount of the expected outflow through selling, general and administrative expense using the effective interest method. Subsequent revisions to estimates for future cash flows related to the asset retirement obligations are recorded as equal increases or decreases to the retirement asset and liability.

Impairment of Long-lived Assets

The Company evaluates the recoverability of its long-lived assets (property, equipment, right of use, and intangible assets with finite lives) whenever adverse events or changes in business climate indicate that the expected undiscounted future cash flows from the related assets may be less than their carrying amounts. When a situation arises which results in a conclusion that it is more likely than not that an asset is not recoverable, the Company estimates cash flows expected to be derived from the continuing use and eventual disposition of the asset. If the sum of those cash flows, not discounted to present value, does not exceed the net book value of the asset, the Company estimates the fair value of the asset. Impairment loss is recorded to the extent that the net book value exceeds the fair value of the asset.

Impairment reviews are based on an estimated future cash flow approach that requires significant judgment with respect to future revenue and expense growth rates, selection of appropriate discount rate (as applicable), asset groupings, and other assumptions and estimates. The Company uses estimates that are consistent with its business plans and a market participant view of the assets being evaluated. Actual results may differ from these estimates.

The Company recorded impairment losses on amortizable intangible assets of $0, $0.1 million, and $1.0 million in in 2022, 2021, and 2020, respectively. The Company recorded no impairment losses with respect to any other classes of long-lived assets in those periods.

Goodwill and Indefinite-lived Intangible Assets

The Company assesses goodwill for impairment at least annually on October 1 and more frequently whenever events or substantive changes in circumstances indicate that it is more likely than not that goodwill is impaired. In performing the goodwill impairment test, the Company first assesses qualitative factors to determine the existence of impairment. If the qualitative factors indicate that the carrying value of a reporting unit exceeds its fair value, the Company proceeds to a quantitative test to measure the existence and amount, if any, of goodwill impairment. The Company may also choose to bypass the qualitative assessment and proceed directly to the quantitative test.

In performing the quantitative test, impairment loss is recorded to the extent that the carrying value of the reporting unit exceeds its assessed fair value.

If the Company concludes that the way in which it is being managed has changed and results in a change to its concluded reporting units, the goodwill assigned to the original reporting unit is allocated to the new reporting units based on the relative fair value of the new reporting units.

The Company determines the fair value of reporting units using the income and market approaches, as applicable. Under the income approach, the fair value of a reporting unit is the present value of its future cash flows as viewed from the lens of a hypothetical market participant in an orderly transaction. These future cash flows are derived from expectations of revenue, expenses, tax deductions and credits, working capital flows, capital expenditures, and other projected sources and uses of cash, as applicable. Value indications are developed by discounting expected cash flows to their present value using a discount rate commensurate with the risks associated with the reporting unit subject to testing. Under the market approach, the Company uses market multiples derived from various comparable companies based on measures salient to investors in those companies.

As indicated above, on September 30, 2022, the Company changed its operating segments, determining that it operates as two reportable segments. In concert with this re-evaluation, the Company concluded that it has two reporting units for goodwill impairment testing purposes. Management performed a goodwill impairment test as of September 30, 2022 on its previous reporting unit, concluding that goodwill was not impaired as of that date. Management subsequently allocated the goodwill assigned to its previous reporting unit to its new reporting units. Refer to Note 7, Goodwill and Intangible Assets, Net, for information regarding the reallocation of goodwill to the reporting units.

As part of the goodwill impairment test performed on October 1, 2022, the Company performed a quantitative assessment, concluding that goodwill was not impaired for any of its reporting units.

There were no recorded impairment losses related to goodwill in 2022, 2021, or 2020. The Company recorded no impairment losses related to any of our other indefinite-lived intangible assets during 2022, 2021, or 2020.

Patent Costs

The Company incurs certain legal and related costs in connection with patent applications. The Company capitalizes such costs to be amortized over the expected life of the patent to the extent that an economic benefit is anticipated from the resulting patent

or an alternative future use is available to the Company. The Company capitalized $0.2 million, $0.3 million, and $0.3 million of patent costs for the years ended December 31, 2022, 2021, and 2020, respectively.

Leases

The Company determines if a contract is, or contains, a lease at inception. Leases provide the Company with the right to control an underlying asset for a contractual term, subject to certain renewal and other rights, in exchange for a series of stipulated cash flows. Right of use (“ROU”) assets represent the Company's right to use an underlying asset for the lease term and lease liabilities represent the Company's obligation to make lease payments arising from the lease.

Lease assets and liabilities are recognized at the lease commencement date based on the estimated present value of lease payments over the lease term. The Company calculates the present value of lease payments by discounting the lease payments using the Company’s incremental borrowing rate for a collateralized or secured borrowing over a term equivalent to that of the lease. Lease payments that vary according to an index or rate are measured using the index or rate at lease inception. The lease term and applicable payments include options to extend or terminate the lease when it is reasonably certain that the Company will exercise such options. Options to renew or terminate a lease are included in the lease term to the extent that such provisions are reasonably certain to be exercised. This determination is reassessed as new information arises and is accounted for prospectively. As an accounting policy election, the Company does not capitalize leases having initial terms of 12 months or fewer. The Company has made an accounting policy election not to separate lease components from non-lease components in the event that the agreement contains both.

Operating lease right of use assets and the related liabilities are included in right of use asset, other current liabilities, and other liabilities, respectively, in the consolidated balance sheets. Lease expense associated with operating leases is recognized, straight-line, over the lease term. The Company does not recognize interest expense as part of operating lease liabilities.

Finance lease right of use assets and the related liabilities are included in property and equipment, net, other current liabilities, and other liabilities, respectively, in the consolidated balance sheets. Finance lease right of use assets are amortized, straight-line, over the lease term as depreciation expense. Interest expense is recognized using the effective interest method on finance lease liabilities as part of interest expense, net.

Treasury Stock

Shares repurchased by the Company are recorded as treasury stock at the cost to acquire such shares. Subsequent issuances of shares held in treasury are assumed to be released on a FIFO basis.

Contingencies

The Company is or has been subject to various patent challenges, product liability claims, government investigations, former employee matters, and other legal proceedings, see Note 16, Commitments and Contingencies. Legal fees and other expenses related to litigation are expensed as incurred and included in selling, general and administrative expenses in the consolidated statements of operations. The Company records an accrual for resolution costs and other contingencies in the consolidated financial statements when the Company determines that a loss is both probable and reasonably estimable. Subsequent revisions to the Company’s accrual are made as new information emerges and are accounted for prospectively. The Company discloses all ongoing legal matters for which a loss is reasonably possible, regardless of whether an estimate can be reasonably determined.

Due to the fact that legal proceedings and other contingencies are inherently unpredictable, the Company’s estimates of the probability and amount of any such liabilities involve significant judgment regarding future events. The actual costs of resolving a claim may be substantially different from the amount of reserve the Company recorded. The Company records a receivable from its insurance carriers only when the resolution of any dispute has been reached and realization of the amounts equal to the potential claim for recovery is considered probable. Any recovery of an amount in excess of the related recorded contingent loss will be recognized only when all contingencies relating to recovery have been resolved.

Revenue Recognition

Current Policy

The Company sells its products primarily to individual customers and independent distributors (collectively referred to as “customers”). Customers obtain and use products either through ship and bill sales or consignment arrangements. Under ship and bill arrangements, the Company retains possession of the product until the customer submits an order. Upon approval of the sales order, the Company ships product to the customer and invoices them for the product sold. Under consignment

arrangements, the customer takes possession of the product, but the Company retains title until the implantation or application of the Company’s product to the end user.

The Company recognizes revenue as performance obligations are fulfilled, which generally occurs upon the shipment of product to the customers for ship and bill orders or upon implantation for consignment sales.

Revenue is recognized based on the consideration the Company expects to receive from the sale. This consists of the gross selling price of the product, less any discounts, rebates or other amounts paid to customers, fees paid to Group Purchasing Organizations (“GPOs”), and returns (collectively, “deductions” or “sales deductions”). Gross selling price is a standard set by the Company for all customers unless a contract governing the sale provides for a specified price. Sales deductions are specified in individual contracts with customers. The Company estimates the total sales deductions which a specific customer will achieve over the relevant term and applies the reduction to sales as they are made throughout the period.

Sales deductions owed to customers and other parties are accrued and recorded in accrued expenses on the consolidated balance sheets.

The Company acts as the principal in all of its customer arrangements and records revenue on a gross basis. Shipping is considered immaterial in the context of the overall customer arrangement, and damages or loss of goods in transit are rare. Therefore, shipping is not deemed a separately recognized performance obligation and the Company has elected to treat shipping costs as activities to fulfill the promise to transfer the product. The Company maintains a returns policy that allows its customers to return product that is damaged or non-conforming, ordered in error, or due to a recall. The estimate of the provision for returns is based upon historical experience with actual returns. The Company’s payment terms for customers are typically 30 to 60 days from receipt of title of the goods.

Remaining Contracts

Prior to 2020, the Company’s control environment was such that it created uncertainty surrounding all of its customer arrangements, which required consideration related to the proper revenue recognition under the applicable literature. The control environment allowed for the existence of extra-contractual or undocumented terms or arrangement initiated by or agreed to by the company and former members of Company management at the outset of the transactions (side agreements). Concessions were also agreed to subsequent to the initial sale (e.g. sales above established customer credit limits extended and unusually long payment terms, return or exchange rights, and contingent payment obligations) that precluded the Company from recognizing revenue at the time that product was shipped to a customer.

Because of the prevalence of these arrangements, the Company’s sales arrangements did not qualify as contracts under Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, until consideration was collected from customers. This determination precluded the recognition of revenue at the time of shipment. Instead, recognition of revenue was deferred until: (1) the customer returned the product prior to payment; or (2) the Company received payment from the customer. Cost of sales associated with product shipped was deferred until collection was received.

The Company implemented changes and remediated weaknesses, which gave rise to the above conclusion beginning in mid-2018. Management concluded that these efforts had been sufficiently implemented such that customers were aware of the Company’s sales policies and procedures and that a contract existed prior to the transfer of title or the implantation of product for ship-and-bill and consignment sales, respectively, by the third quarter of 2019. Accordingly, the Company changed its pattern of revenue recognition effective October 1, 2019 to the policy described under the section titled “Current Policy” above.

The Company also reassessed whether the revenue recognition criteria had been met for all shipments of products where payment had not been received as of September 30, 2019. While the measures summarized above provided significant evidence necessary to understand the terms of the Company’s contractual arrangements with its customers, certain of these customers continued to exhibit behaviors that resulted in extended periods until cash collection. Such delays in collection suggested that uncertainty regarding extra-contractual arrangements may continue, particularly as it relates to payment terms. As a result, the Company concluded the following for any existing arrangements, which remained unpaid at September 30, 2019:

•For customer arrangements where collection was considered probable within 90 days from the date of original shipment or implantation of the products, the Company concluded the revenue recognition criteria were met. The revenue associated with this event was recognized prior to 2020.

•For the remaining customer arrangements (the “Remaining Contracts”), the Company concluded that, due to the uncertainty that extra-contractual arrangements may continue, the revenue recognition criteria would not be satisfied until the Company received payment from the customer. At that point, the Company determined that an accounting

contract would exist and the performance obligations for the Company to deliver product and the customer to pay for the product would be satisfied. The Company continued to reassess the Remaining Contracts for settlement of the revenue recognition criteria prior to payment, concluding that the revenue recognition criteria continued to not be met due to the same circumstances described above.

The effect of the cash collections on the Remaining Contracts on net sales and cost of sales for each of the years ended December 31, 2022, 2021, and 2020 were as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Net sales	$	259	$	1,038	$	7,767
Cost of sales	—		174		1,087
Gross profit	$	259	$	864	$	6,680

Group Purchasing Organization Fees

The Company sells to GPO members who transact directly with the Company at GPO-agreed pricing. Group Purchasing Organizations are funded by administrative fees that are paid by the Company. These fees are set as a percentage of the purchase volume, which is typically 3% of sales made to the GPO members. Fees paid to GPOs are presented as a reduction to net sales.

Cost of Sales

Cost of sales includes all costs directly related to bringing the Company’s products to their final selling destination. Amounts include direct and indirect costs to manufacture products including raw materials, personnel costs and direct overhead expenses necessary to convert collected tissues into finished goods, product testing costs, quality assurance costs, facility costs associated with the Company’s manufacturing and warehouse facilities, including depreciation, freight charges, costs to operate equipment and other shipping and handling costs for products shipped to customers.

The Company obtains raw material in the form of human placenta donations from participating mothers who give birth via scheduled Caesarean section.

Research and Development Costs

Research and development costs consist of direct and indirect costs associated with the development of the Company’s technologies. These costs are expensed as incurred.

Advertising expense

Advertising expense consists primarily of print media promotional materials. Advertising costs are expensed as incurred. Advertising expense for the year ended December 31, 2022, 2021, and 2020 was $0.2 million, $0.1 million, and $0.1 million respectively.

Income Taxes

Income tax provision (expense) benefit, deferred tax assets and liabilities, and liabilities for unrecognized tax benefits reflect management’s best assessment of estimated current and future taxes to be paid. The Company is subject to income taxes in the United States and numerous states.

Deferred income taxes arise from temporary differences between the tax basis of assets and liabilities and their reported amounts in the financial statements, which will result in taxable or deductible amounts in the future. The Company recognizes deferred tax assets to the extent that it believes these assets are more likely than not to be realized. If the Company determines that it would be able to realize its deferred tax assets in the future in excess of their net recorded amount, the Company would make an adjustment to the deferred tax asset valuation allowance.

In evaluating the Company’s ability to recover its deferred tax assets within the jurisdiction from which they arise, management considers all available positive and negative evidence, including scheduled reversals of deferred tax liabilities, projected future taxable income, tax-planning strategies, results of recent operations, and changes in tax laws. In projecting future taxable income, the Company begins with historical results and incorporates assumptions about the amount of future state and federal

pretax operating income adjusted for items that do not have tax consequences. The assumptions about future taxable income require significant judgment and are consistent with the plans and estimates the Company uses to manage the underlying businesses. In evaluating the objective evidence that historical results provide, management considers three years of cumulative income (loss). The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in the tax provision (benefit) in the period that includes the enactment date.

The calculation of income tax liabilities involves dealing with uncertainties in the application of complex tax laws and regulations both for U.S. federal income tax purposes and across numerous state jurisdictions. ASC Topic 740, Income Taxes, states that a tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, on the basis of the technical merits. The Company (1) records unrecognized tax benefits as liabilities in accordance with ASC Topic 740 included within other liabilities on the consolidated balance sheets, and (2) adjusts these liabilities when management’s judgment changes as a result of the evaluation of new information not previously available. Because of the complexity of some of these uncertainties, the ultimate resolution may result in a payment that is materially different from management’s current estimate of the unrecognized tax benefit liabilities. These differences will be reflected as increases or decreases to the deferred tax asset or income tax expense in the period in which new information is available.

The Company records uncertain tax positions in accordance with ASC Topic 740 on the basis of a two-step process whereby (1) it determines whether it is more likely than not that the tax positions will be sustained on the basis of the technical merits of the position, and (2) for those tax positions that meet the more-likely-than-not recognition threshold, it recognizes the largest amount of tax benefit that is more than 50 percent likely to be realized upon ultimate settlement with the related tax authority.

The Company recognizes interest and penalties related to unrecognized tax benefits within the income tax expense line in the consolidated statements of operations. Accrued interest and penalties, if any, are included within the related deferred tax liability line in the consolidated balance sheets and recorded as a component of income tax expense.

Share-based Compensation

The Company grants share-based awards to employees and members of the Company’s Board of Directors (the “Board”). Awards to employees and the Board are generally made annually. Grants are issued outside of the annual cadence for certain new hires, promotions, and other events.

The amount of expense to be recognized is determined by the fair value of the award using inputs available as of the grant date. The fair value of equity incentive awards that are not subject to a market condition is the value of common stock on the grant date. For equity incentive awards that are subject to a market condition, the fair value of common stock on the grant date is adjusted to reflect the value of the market condition, generally using a path-dependent pricing model, such as a Monte Carlo simulation.

For awards with service-based vesting conditions only, the Company recognizes share-based compensation expense on a straight-line basis through the vesting date of the last tranche of the award. For awards with service- and performance-based vesting conditions, the Company recognizes stock-based compensation expense using the graded-vesting method, treating each tranche as if it were a separately-granted award and recognizing expense through the vesting date of each individual tranche. In each scenario, the Company recognizes share-based compensation expense based upon the probability that the award will ultimately vest. The Company recognizes the cumulative effect of changes in the probability outcomes in the period in which the changes occur.

For awards subject to a market condition, the resolution of the market condition is not subsequently considered in expense recognition. Consequently, the Company could recognize expense for awards that do not ultimately vest.

Basic and Diluted Net Loss per Common Share

Basic net loss per common share is calculated as net loss available to common stockholders divided by weighted average common shares outstanding for the applicable period. Net loss available to common stockholders is calculated by adjusting net loss for periodic preferred accrued or deemed dividends. These amounts include (i) dividends accumulated on the Company’s Series B Convertible Preferred Stock (“Series B Preferred Stock”) during the period, (ii) periodic amortization of the beneficial conversion feature, and (iii) periodic accretion of the increasing-rate dividend feature.

This amount is divided by the weighted average common shares outstanding during the period. Weighted average common shares outstanding is calculated as shares of the Company outstanding adjusted for the portion of the period for which they are outstanding. Unvested restricted stock awards are excluded from the calculation of weighted average common shares outstanding until they have vested.

Diluted net loss per common share adjusts basic net loss per common share for convertible securities, options, equity incentive awards, and other share-based payment awards which have yet to vest, to the extent such adjustments reduce basic net loss per common share.

The Company uses the if-converted method to calculate the dilutive effect of the Series B Preferred Stock and other convertible securities to the extent they are outstanding. The if-converted method assumes that convertible securities are converted at the later of the issuance date or the beginning of the period. If the hypothetical conversion of convertible securities, and the consequential avoidance of any deemed or accumulated preferred dividends, would decrease basic net loss per common share, these effects are incorporated in the calculation of diluted net loss per common share, adjusted for the proportion of the period the securities were outstanding.

The Company uses the treasury stock method to calculate the dilutive effect of outstanding options, restricted stock awards, and other share-based payments. The treasury stock method assumes that the proceeds from exercise are used to repurchase common shares at the weighted average market price during the period, increasing the denominator for the net effect of shares issued upon exercise less hypothetical shares repurchased.

If the dilutive effects noted above would cause diluted net loss per common share to exceed basic net loss per common share, such effects are not incorporated into the calculation, as they are deemed antidilutive. For all periods with a net loss available to common stockholders, any adjustment for potential common shares would be naturally anti-dilutive. Therefore, the weighted average shares outstanding used to calculate both basic and diluted net loss per common share are the same for periods with a net loss.

Fair Value of Financial Instruments and Fair Value Measurements

The respective carrying value of certain on-balance sheet financial instruments approximated their fair values due to the short-term nature and type of these instruments. These financial instruments include cash and cash equivalents, accounts receivable, notes receivable, and certain other financial assets and liabilities.

The Company measures certain non-financial assets at fair value on a non-recurring basis. These non-recurring valuations include evaluating assets such as long-lived assets, and non-amortizing intangible assets for impairment, allocating value to assets in an acquired asset group, and accounting for business combinations. The Company uses the fair value measurement framework to value these assets and reports these fair values in the periods in which they are recorded or written down.

Fair value financial instruments are recorded in accordance with the fair value measurement framework. The fair value measurement framework includes a fair value hierarchy that prioritizes observable and unobservable inputs used to measure fair values in their broad levels. These levels from highest to lowest priority are as follows:

•Level 1: Quoted prices (unadjusted) in active markets that are accessible at the measurement date for identical assets or liabilities;

•Level 2: Quoted prices in active markets for similar assets or liabilities or observable prices that are based on inputs not quoted on active markets, but corroborated by market data.

•Level 3: Unobservable inputs or valuation techniques that are used when little or no market data is available.

The determination of fair value and the assessment of a measurement’s placement within the hierarchy require judgment. Level 3 valuations often involve a higher degree of judgment and complexity. Level 3 valuations may require the use of various valuation methodologies which incorporate unobservable inputs, management estimates, and assumptions. Management’s assumptions could vary depending on the asset or liability valued and the valuation method used. Such assumptions could include: estimates of prices, earnings, costs, actions of market participants, market factors, or the weighting of various valuation methods. The Company may also engage external advisors to assist it in determining fair value, as appropriate.

Although the Company believes that the recorded fair value of its financial instruments is appropriate, these fair values may not be indicative of net realizable value or reflective of future fair values.

Government Assistance

The Company receives benefits from various government entities for various purposes from time to time. With respect to any benefits that are not dependent on income (which are subject to the policy described under Income Taxes, above), the Company recognizes such benefits at the point in time in which all barriers to receive the assistance have been overcome in an amount equal to the expected benefit. Benefits are reflected in the consolidated statements of operations in the line item to which the associated benefit relates.

Recently Adopted Accounting Pronouncements

In November 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)”, which provides disclosure requirements regarding government grants and contributions. The ASU requires disclosure of the nature of transactions and related accounting policies used to account for transactions, the effect, including amounts, of government assistance on individual line items on the financial statements, and significant terms and conditions of the transactions, including commitments and contingencies. This ASU is effective for fiscal years beginning after December 15, 2021. The Company adopted the provisions of this ASU effective January 1, 2022. There was no impact upon adoption. Refer to Note 20, Government Assistance, for the disclosures required by this ASU.

Recently Issued Accounting Pronouncements Not Yet Adopted

In March 2020, the FASB issued ASU 2020-04, “Reference Rate Reform (Topic 848)”, which provides temporary, optional expedients and exceptions to accounting guidance for certain contract modifications and hedging arrangements to ease financial reporting burdens as a result of market transitions from the London Interbank Offered Rate (“LIBOR”) to alternative reference rates. The guidance is available for prospective application and can generally be applied to contract modifications and hedging relationships entered into beginning March 12, 2020 through December 31, 2022. In December 2022, following the issuance of ASU 2022-06, “Reference Rate Reform (Topic 848) — Deferral of the Sunset Date of Topic 848”, the end date was extended to December 31, 2024.

As of December 31, 2022, the Company has long-term debt outstanding which carries an interest rate tied to LIBOR, the agreement for which contemplates an interest rate alternative in the event that LIBOR is unavailable. The LIBOR tenor which underlies the Company’s term loan is expected to sunset effective June 30, 2023.

The Company is evaluating the possibility of adoption and the related impact on its financial statements. If adopted, the Company does not expect the provisions of this ASU to have a material impact on its consolidated financial statements.

All other ASUs issued and not yet effective as of December 31, 2022, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s current or future financial position or results of operations.

Accounts Receivable, Net

12 Months Ended

Dec. 31, 2022

Receivables [Abstract]

Accounts Receivable, Net

Accounts receivable, net, consists of the following (in thousands):


	December 31,
	2022		2021
Accounts receivable, gross	$	46,867	$	41,540
Allowance for doubtful accounts	(3,783)		(1,187)
Accounts receivable, net	$	43,084	$	40,353

Activity related to the Company’s allowance for doubtful accounts during the year ended December 31, 2022 was as follows (in thousands):


	Allowance for Doubtful Accounts
Balance at December 31, 2021	$	1,187
Bad debt expense	2,820
Write-offs	(224)
Balance at December 31, 2022	$	3,783

Bad debt expense and write-offs were not material for the year ended December 31, 2021.

Inventory

12 Months Ended

Dec. 31, 2022

Inventory Disclosure [Abstract]

Inventory

Inventory consists of the following (in thousands):


	December 31,
	2022		2021
Raw materials	$	810	$	364
Work in process	6,855		6,112
Finished goods	5,518		4,913
Inventory	$	13,183	$	11,389

As a result of the conclusion of the FDA’s period of enforcement discretion on May 31, 2021, the Company wrote down $1.0 million of its Section 351 product inventory and $0.7 million related to discontinued product during the year ended December 31, 2021. There were no significant, unusual write-downs of inventory during the year ended December 31, 2022.

Consignment inventory, included as a component of finished goods in the table above, was $3.4 million and $2.6 million as of December 31, 2022 and 2021, respectively.

Property and Equipment, Net

12 Months Ended

Dec. 31, 2022

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

Property and equipment, net, consists of the following (in thousands):


	December 31,
	2022		2021
Lab and clean room equipment	$	16,422	$	16,567
Furniture and office equipment	15,016		14,975
Leasehold improvements	9,190		9,052
Construction in progress	1,983		397
Asset retirement cost	983		863
Finance lease assets	189		189
Property and equipment, gross	43,783		42,043
Less: accumulated depreciation and amortization	(35,927)		(32,878)
Property and equipment, net of accumulated depreciation and amortization	$	7,856	$	9,165

Depreciation expense for each of the years ended December 31, 2022, 2021, and 2020 was recorded in certain captions of the consolidated statements of operations for those periods in the amounts shown in the table below (in thousands):


	Year Ended December 31,
	2022		2021		2020
Cost of sales	$	1,816	$	1,787	$	2,022
Selling, general, and administrative expense	1,243		2,278		3,416
Research and development expense	286		298		344
Total	$	3,345	$	4,363	$	5,782

Leases

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Leases

The Company has leases for corporate offices, manufacturing facilities, vehicles, and certain equipment. Such leases do not require any contingent rental payments, impose any financial restrictions, or contain any residual value guarantees.

Supplemental balance sheet information related to the Company’s leases, including the financial statement caption in which the amounts are presented, is as follows (amounts in thousands, except lease term and discount rate):


	Operating Leases						Finance Leases
	December 31,						December 31,
	2022			2021			2022			2021
Assets
Right of use asset	$	3,400		$	4,696		$	—		$	—
Property and equipment, net	—			—			98			145
Total assets	$	3,400		$	4,696		$	98		$	145

Liabilities
Other current liabilities	$	1,391		$	1,203		$	49		$	45
Other liabilities	2,381			3,812			57			106
Total liabilities	$	3,772		$	5,015		$	106		$	151

Weighted-average remaining lease term (years)	2.8			4.0			2.1			3.1
Weighted-average discount rate	8.3		%	8.4		%	8.3		%	8.3		%

Information related to lease costs are as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Operating lease cost	$	1,620	$	1,327	$	1,392

Amortization of finance lease ROU assets	47		43		—
Interest expense on finance lease liabilities	10		13		—

Maturities of lease liabilities are as follows (amounts in thousands):


Year Ending December 31,	Operating Leases		Finance Leases		Total
2023	$	1,638	$	55	$	1,693
2024	1,618		55		1,673
2025	506		5		511
2026	419		—		419
2027	35		—		35
Thereafter	—		—		—
Total lease payments	4,216		115		4,331
Less: imputed interest	(444)		(9)		(453)
Lease liability	$	3,772	$	106	$	3,878

Asset Retirement Obligations

Certain lease agreements require the Company to return designated areas of leased space to its original condition upon termination of the lease agreement, for which the Company records an asset retirement obligation and a corresponding capital asset in an amount equal to the estimated fair value of the obligation. In subsequent periods, the asset retirement obligation is accreted for the change in its present value and the capitalized asset is depreciated, both over the term of the associated lease

agreement. Asset retirement obligations of $1.2 million and $1.0 million are included in other liabilities in the consolidated balance sheets as of December 31, 2022 and 2021, respectively.

Sublease

The Company subleases one of its leased industrial warehouse spaces. The sublease income from the facility offsets the lease expense associated with the facility. Sublease income for the facility was $0.1 million for each of the years ended December 31, 2022, 2021, and 2020, respectively, and is presented as a reduction to selling, general, and administrative expense on the consolidated statements of operations in those periods.

Leases


	Operating Leases						Finance Leases
	December 31,						December 31,
	2022			2021			2022			2021
Assets
Right of use asset	$	3,400		$	4,696		$	—		$	—
Property and equipment, net	—			—			98			145
Total assets	$	3,400		$	4,696		$	98		$	145

Liabilities
Other current liabilities	$	1,391		$	1,203		$	49		$	45
Other liabilities	2,381			3,812			57			106
Total liabilities	$	3,772		$	5,015		$	106		$	151

Weighted-average remaining lease term (years)	2.8			4.0			2.1			3.1
Weighted-average discount rate	8.3		%	8.4		%	8.3		%	8.3		%

Information related to lease costs are as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Operating lease cost	$	1,620	$	1,327	$	1,392

Amortization of finance lease ROU assets	47		43		—
Interest expense on finance lease liabilities	10		13		—

Maturities of lease liabilities are as follows (amounts in thousands):


Year Ending December 31,	Operating Leases		Finance Leases		Total
2023	$	1,638	$	55	$	1,693
2024	1,618		55		1,673
2025	506		5		511
2026	419		—		419
2027	35		—		35
Thereafter	—		—		—
Total lease payments	4,216		115		4,331
Less: imputed interest	(444)		(9)		(453)
Lease liability	$	3,772	$	106	$	3,878

Asset Retirement Obligations

agreement. Asset retirement obligations of $1.2 million and $1.0 million are included in other liabilities in the consolidated balance sheets as of December 31, 2022 and 2021, respectively.

Sublease

Goodwill and Intangible Assets, Net

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets, Net

Goodwill

Historically, the Company had concluded that it operated as a single operating segment and single reporting unit. For the year ended December 31, 2022, as a result of changes in the management of the Company’s business, management concluded that the Company operates as three operating segments, including two distinct reportable segments: Wound & Surgical and Regenerative Medicine. See Note 13, Segment Information, for a description of the Company’s operating segments. Management further concluded that these two reportable segments reflected its reporting units for goodwill impairment testing purposes.

The Company allocated $20.0 million of consolidated goodwill, which was entirely allocated to its previous reporting unit, to each of its Wound & Surgical and Regenerative Medicine segments based on their relative fair values from a market participant standpoint. The result was $19.4 million and $0.5 million allocated to Wound & Surgical and Regenerative Medicine, respectively. A third reporting unit associated with the Company’s third operating segment was deemed immaterial and no goodwill was assigned to it.

The Company performed goodwill impairment tests using the Company’s single reporting unit and the new reporting units on September 30, 2022. In all cases, the Company concluded that the estimated fair values of each reporting unit exceeded its respective carrying values. Therefore, the Company did not record impairment for goodwill on September 30, 2022.

For the annual impairment test performed October 1, 2022, the Company performed a quantitative assessment to determine the existence of impairment. The quantitative assessment concluded that it was more likely than not that goodwill was not impaired. No impairment was recorded for the year ended December 31, 2022.

For the annual impairment test performed on October 1, 2021, the Company performed a qualitative assessment to determine the existence of impairment. The qualitative assessment concluded that it was more likely than not that goodwill was not impaired. The Company did not proceed to the quantitative assessment, and no impairment was recorded for the year ended December 31, 2021.

The following table indicates the changes in the carrying amount of goodwill for 2022 and 2021 (in thousands):



	Previous Reporting Unit		Wound & Surgical		Regenerative Medicine		Total Company
Balance as of January 1, 2021	$	19,976	$	—	$	—	$	19,976
Activity	—		—		—		—
Balance as of December 31, 2021	$	19,976	$	—	$	—	$	19,976
Reallocation	(19,976)		19,441		535		—
Balance as of December 31, 2022	$	—	$	19,441	$	535	$	19,976

Intangible Assets, Net

Intangible assets, net, are summarized as follows (in thousands):


	December 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,923	$	(7,106)	$	2,817	$	9,578	$	(6,408)	$	3,170
Licenses	1,000		(4)		996		—		—		—


Total amortized intangible assets	$	10,923	$	(7,110)	$	3,813	$	9,578	$	(6,408)	$	3,170

Unamortized intangible assets
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in process	1,031				1,031		1,205				1,205
Total intangible assets	$	12,962			$	5,852	$	11,791			$	5,383

Amortization expense and impairment expense for the years ended December 31, 2022, 2021, and 2020, is summarized in the table below (amounts in thousands):


	Year ended December 31,
	2022		2021		2020
Amortization of intangible assets	$	701	$	820	$	1,073
Impairment of intangible assets	—		53		1,027

Impairment of intangible assets in 2021 related to supplier relationship assets that were determined to be unrecoverable due to attrition. Impairment of intangible assets in 2020 related to customer relationship assets that were determined to be unrecoverable due to lower than expected margins.

Expected future amortization of intangible assets as of December 31, 2022, is as follows (in thousands):


	Estimated
	Amortization
Year Ending December 31,	Expense
2023	$	756
2024	756
2025	361
2026	207
2027	206
Thereafter	1,527
Total amortization expense	$	3,813

Accrued Expenses

12 Months Ended

Dec. 31, 2022

Payables and Accruals [Abstract]

Accrued Expenses

Accrued expenses consist of the following (in thousands):


	December 31,
	2022		2021
Legal costs	$	4,447	$	2,806

External commissions	2,941		2,630
Accrued rebates	707		1,343
Estimated returns	659		788
Accrued GPO Fees	638		559
Accrued travel	566		385
Accrued clinical trials	90		694
Other	976		607
Total	$	11,024	$	9,812

Long Term Debt

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Long Term Debt

Hayfin Loan Agreement

On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services, LLP, (“Hayfin”) an affiliate of Hayfin Capital Management LLP (the “Hayfin Loan Agreement”), which was funded on July 2, 2020 and provided the Company with a senior secured term loan in an aggregate amount of $50.0 million (the “Term Loan”). The Term Loan matures on June 30, 2025 (the “Maturity Date”). Interest is payable quarterly on the Term Loan for the principal balance outstanding through the Maturity Date. No principal payments are due and payable until the Maturity Date.

The Hayfin Loan Agreement also provided the Company with an option to draw on an additional delayed draw term loan (the “DD TL”, collectively with the Term Loan, the “Credit Facilities”) in the form of a committed but undrawn $25.0 million facility until June 30, 2021. The Company did not exercise the option.

On February 28, 2022, the Company executed an Amendment to the Hayfin Loan Agreement (as amended, the “Amended Hayfin Loan Agreement”). The amendment was accounted for as a modification. No gain or loss was recognized nor was there a change to the carrying amount of the debt as a result of the amendment.

Interest on any borrowings under the Amended Hayfin Loan Agreement is equal to the London Interbank Offered Rate (“LIBOR”) (subject to a floor of 1.5%) plus a margin of 6.75% per annum. If LIBOR is unavailable, the Term Loan will carry interest at the 6.75% margin plus the greatest of the Prime Rate, the Federal Funds Rate plus 0.5% per annum, and 2.5%.

An additional 3.0% margin is applied to the interest rate in the event of default as defined by the Amended Hayfin Loan Agreement. The Term Loan carried an interest rate of 8.3% at issuance and 11.5% as of December 31, 2022.

The Amended Hayfin Loan Agreement contains financial covenants requiring the Company, on a consolidated basis, to maintain the following:

•Minimum Consolidated Total Net Sales (as defined in the Amended Hayfin Loan Agreement) of varying amounts, required to be calculated on a quarterly basis, and

•Minimum Liquidity (as defined in the Amended Hayfin Loan Agreement) of $20 million, an at-all-times financial covenant tested monthly.

As of December 31, 2022, the Company is in compliance with all applicable financial covenants under the Amended Hayfin Loan Agreement.

The Amended Hayfin Loan Agreement also includes certain negative covenants and events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, the Term Loan may be accelerated or the lenders’ commitments terminated. Mandatory prepayments are also required in the event of a change in control, incurring other indebtedness, certain proceeds from disposal of assets and insured casualty event (as defined in the Amended Hayfin Loan Agreement). Annually, beginning with the fiscal year ended December 31, 2021, the Company is required to prepay the outstanding loans based on a percentage of Excess Cash Flow (as defined in the Amended Hayfin Loan Agreement), if such is generated. No such prepayments have been required as of December 31, 2022.

The Amended Hayfin Loan Agreement, as amended, also specifies that any prepayment of the loan, voluntary or mandatory, will subject the Company to a prepayment premium applicable as of the date of the prepayment:

•On or before July 2, 2023: 2% of the principal balance repaid.

•After July 2, 2023, but on or before July 2, 2024: 1% of the principal balance repaid.

•After July 2, 2024: no premium.

Hayfin maintains a first-priority security interest in substantially all of the Company’s assets.

A breach of a financial covenant in the Amended Hayfin Loan Agreement, if uncured or unable to be cured, would likely result in an event of default that could trigger the lender’s remedies, including acceleration of the entire principal balance of the loan as well as any applicable prepayment premiums. Future compliance with the financial covenants, as amended, requires continuing growth in net sales consistent with the Company’s business strategy and plans. The Company is subject to inherent uncertainties that could impact the Company’s net sales growth, including, but not limited to, the regulatory pathway of the Company’s EPICORD® and AMNIOCORD®. If the FDA were to determine that these products do not meet the requirements for regulation solely under Section 361, the Company would be required to obtain the appropriate FDA clearance or approval to continue marketing these products. The loss of the Company’s ability to market and sell its umbilical cord-derived products would have an adverse effect on the Company’s revenue, business, financial condition, and results of operations, including its ability to comply with the financial covenants set forth pursuant to the Amended Hayfin Loan Agreement. Refer to Note 12, Revenue, for net sales derived from the Company’s cord products.

Original issue discount and deferred financing costs were allocated between the sale of the Series B Preferred Stock (which occurred simultaneously with the funding of the Hayfin Loan Agreement, collectively the “Financing Transactions”) and the Term Loan on the basis of the relative fair values of the transactions. The costs allocated to the Hayfin Loan Agreement were further allocated between the Term Loan and the DD TL on the basis of the maximum potential principal outstanding between the Credit Facilities. The allocation of the deferred financing costs and original issue discount between Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands):


	July 2, 2020
	Term Loan		DD TL		Total
Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

Deferred financing costs and original issue discount allocated to the Term Loan are amortized using the effective interest method through the Maturity Date. The amortization of such amounts is presented as part of interest expense, net on the consolidated statement of operations for the years ended December 31, 2022, 2021, and 2020.

Deferred financing costs and original issue discount associated with the DD TL were amortized using the straight-line method through the expiration of the DD TL commitment term on June 30, 2021. Amortization of these amounts are presented as part of interest expense, net on the consolidated statements of operations for the years ended December 31, 2021 and 2020.

The balances of the Term Loan as of December 31, 2022 and 2021 were as follows (amounts in thousands):


	December 31,
	2022		2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,219)		(1,624)
Original issue discount	(187)		(249)
Long term debt, net	$	48,594	$	48,127

Interest expense related to the Term Loan, included in interest expense, net in the consolidated statements of operations, was as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Stated interest	$	4,559	$	4,182	$	2,085
Amortization of deferred financing costs	405		372		173
Accretion of original issue discount	62		58		26
Interest expense	$	5,026	$	4,612	$	2,284

Interest expense related to the DD TL, included in interest expense, net in the consolidated statements of operations, was as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Commitment fee	$	—	$	126	$	128
Amortization of deferred financing costs	—		542		542
Accretion of original issue discount	—		83		83
Interest expense	$	—	$	751	$	753

Scheduled principal payments on the Term Loan as of December 31, 2022 are as follows:


Year ending December 31,	Principal
2023	$	—
2024	—
2025	50,000
2026	—
2027	—
Thereafter	—
Outstanding principal	$	50,000

As of December 31, 2022, the fair value of the Term Loan was $46.7 million. This valuation was calculated based on a series of Level 2 and Level 3 inputs, including a discount rate based on the credit risk spread of debt instruments of similar risk character in reference to U.S. Treasury instruments with similar maturities, with an incremental risk premium for risk factors specific to the Company. The remaining cash flows associated with the Term Loan were discounted to December 31, 2022 using this discount rate to derive the fair value.

BT Term Loan

On June 10, 2019, the Company entered into a loan agreement (the “BT Loan Agreement”) with Blue Torch Finance LLC (“Blue Torch”), as administrative agent and collateral agent, to borrow funds with a face value of $75.0 million (the “BT Term Loan”), of which the full amount was borrowed and funded. The proceeds from the BT Term Loan were used (i) for working capital and general corporate purposes and (ii) to pay transaction fees, costs and expenses incurred in connection with the BT Term Loan and the related transactions. The BT Term Loan would have matured on June 20, 2022 and was repayable in quarterly installments of $0.9 million, with the balance due on June 20, 2022. Blue Torch maintained a first-priority security interest in substantially all the Company’s assets. The BT Term Loan was issued net of the original issue discount of $2.3 million. The Company incurred $6.7 million of deferred financing costs.

On April 22, 2020, the Company amended the BT Loan Agreement with Blue Torch. The amendment provided for an increase in the maximum Total Leverage Ratio, which was a quarterly test, for the remainder of 2020, and also provided for a reduction in the minimum Liquidity requirement from April 2020 through November 2020. In connection with the amendment, the Company agreed to pay a one-time fee of approximately $0.7 million, added to the principal balance, and a 1 percentage point increase in the interest rate to LIBOR plus 9%.

On July 2, 2020, a portion of the proceeds from the Financing Transactions was used to repay the outstanding balance of principal, accrued but unpaid interest, and prepayment premium under the BT Loan Agreement. In connection with the repayment of the BT Term Loan, the Company terminated the BT Loan Agreement. The Company has no continuing obligations related to the BT Term Loan as of December 31, 2021.

The Company recorded a loss on extinguishment of debt of $8.2 million during the year ended December 31, 2020. The composition of the loss on extinguishment of debt was as follows (amounts in thousands):


	July 2, 2020
Unamortized deferred financing costs	$	4,528
Unamortized original issue discount	1,538
Unamortized amendment fee	671
Prepayment premium	1,439
Other fees	25
Loss on extinguishment of debt	$	8,201

Interest expense related to the BT Term Loan, included in interest expense, net in the consolidated statements of operations was as follows (amounts in thousands):


	Year ended December 31, 2020

Interest on principal balance	$	3,773
Accretion of original issue discount	354
Accretion of amendment fee	53
Amortization of deferred financing costs	1,051
Total BT Term Loan interest expense	$	5,231

Paycheck Protection Program Loan

The Company applied for and, on April 24, 2020, received proceeds of $10.0 million in the form of a loan under the Paycheck Protection Program (the “PPP Loan”). On May 11, 2020, the Company repaid the PPP Loan in full. There are no continuing obligations under the PPP Loan as of December 31, 2022.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI https://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1I
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Basic and Diluted Net Loss Per Common Share

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

Basic and Diluted Net Loss Per Common Share

Net loss per common share is calculated using two methods: basic and diluted.

Basic Net Loss Per Common Share

The following table provides a reconciliation of net loss to net loss available to common shareholders and calculation of basic net loss per common share for each of the years ended December 31, 2022, 2021, and 2020 (amounts in thousands, except share and per-share amounts):


	Year ended December 31,
	2022		2021		2020
Net loss	$	(30,197)	$	(10,285)	$	(49,284)
Adjustments to reconcile to net loss available to common stockholders:
Accumulated dividend on Series B Preferred Stock	6,580		5,210		2,016
Amortization of beneficial conversion feature	—		—		31,110
Accretion of increasing-rate dividend feature	—		926		918
Total adjustments	6,580		6,136		34,044
Net loss available to common stockholders	$	(36,777)	$	(16,421)	$	(83,328)
Weighted average common shares outstanding	112,909,266		110,353,406		108,257,112
Basic net loss per common share	$	(0.33)	$	(0.15)	$	(0.77)

Diluted Net Loss Per Common Share

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per-share amounts):


	Year ended December 31,
	2022		2021		2020
Net loss available to common stockholders	$	(36,777)	$	(16,421)	$	(83,328)
Adjustments:
Dividends on Series B Preferred Stock	6,580		6,136		34,044
Less: antidilutive adjustments	(6,580)		(6,136)		(34,044)
Total adjustments	—		—		—
Numerator	$	(36,777)	$	(16,421)	$	(83,328)
Weighted average common shares outstanding	112,909,266		110,353,406		108,257,112
Adjustments:
Potential common shares	28,705,593		29,801,836		15,687,044
Less: antidilutive potential common shares (a)	(28,705,593)		(29,801,836)		(15,687,044)
Total adjustments	—		—		—
Weighted average common shares outstanding adjusted for potential common shares	112,909,266		110,353,406		108,257,112
Diluted net loss per common share	$	(0.33)	$	(0.15)	$	(0.77)

(a)Weighted average common shares outstanding for the calculation of diluted net loss per common share does not include the following adjustments for potential common shares below because their effects were determined to be anti-dilutive for the periods presented:


	Year ended December 31,
	2022	2021	2020
Series B Preferred Stock	27,850,916	26,497,570	12,987,013
Restricted stock unit awards	546,883	1,393,910	616,141
Restricted stock awards	217,971	1,121,019	1,299,770
Outstanding stock options	65,720	771,409	752,499
Performance stock unit awards	5,251	17,928	31,621
Employee stock purchase plan	18,852	—	—
Potential common shares	28,705,593	29,801,836	15,687,044

Equity

12 Months Ended

Dec. 31, 2022

Equity [Abstract]

Equity

Series B Convertible Preferred Stock

The Series B Preferred Stock are convertible, cumulative securities which rank senior to the Company’s Series A Junior Participating Preferred Stock and the Company’s common stock. The Series B Preferred Stock accumulated dividends at a rate of 4.0% per annum through June 30, 2021, and 6.0% per annum thereafter. Dividends are declared at the sole discretion of the Board. Dividends are paid at the end of each quarter based on the dividend amounts that accumulate beginning of the last payment date through the day prior to the end of each quarter. In lieu of paying a dividend, the Company may elect to accrue the dividend owed to the holders of the Series B Preferred Stock. Accrued dividend balances accumulate dividends at the prevailing dividend rate for each dividend period for which they are outstanding.

Each share of Series B Preferred Stock is convertible into Company’s common stock at any time at the option of the Holder. Shares are converted based on the liquidation preference of $1,000 per share (the “Liquidation Preference”) plus any accrued or accumulated dividends through the date of the conversion at a conversion price of $3.85 per common share. The Series B Preferred Stock, including any accumulated and unpaid dividends, automatically converts into common stock at any time after July 2, 2023, provided that the common stock has traded at $7.70 per common share or more (i) for 20 out of 30 consecutive trading days and (ii) on such date of conversion.

The holders of the Series B Preferred Stock, voting as a class, are entitled to appoint two members to the board of directors. The holders of the Series B Preferred Stock are entitled to vote on all matters to be voted on by the Company’s shareholders on an as-converted basis as a single class with the common stock; provided that the votes represented by a single holder of Series B Preferred Stock cannot exceed 19.9% of the total voting stock of the Company and no share of Series B Preferred Stock held can entitle the holder to a number of votes that exceeds the quotient of the Liquidation Preference divided by $5.25 per share.

Holders of the Series B Preferred Stock are also entitled to the Liquidation Preference and all accumulated and unpaid dividends in the event of a liquidation, dissolution, or winding-up of the Company.

If the Company undergoes a change of control (as defined), the Company will have the option to repurchase some or all of the then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus any accumulated and unpaid dividends, subject to the rights of the holders of the Series B Preferred Stock in connection with such change in control. If the Company does not exercise such repurchase right, holders of the Series B Preferred Stock will have the option to (1) require the Company to repurchase any or all of their then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus accumulated and unpaid dividends or (2) convert the Series B Preferred Stock into common stock and receive their pro rata consideration thereunder. Since the contingent redemption of the Series B Preferred Stock by the holders in the event of a change in control is outside the Company’s control, the Series B Preferred Stock is classified as temporary equity.

At the time of the issuance of the Series B Preferred Stock, the Company’s common stock, into which the Company’s Series B Preferred Stock is convertible, had an estimated fair value exceeding the effective conversion price of the Series B Preferred Stock, giving rise to a beneficial conversion feature in the amount of $31.1 million. This amount was immediately recognized as a deemed dividend on the commitment date since there is no stated redemption date and the Series B Preferred Stock is immediately convertible.

The Series B Preferred Stock instrument contains an increasing-rate cumulative dividend feature. The Company determined the present value of the difference between the (1) dividends that will be payable in the period preceding commencement of the perpetual dividend and (2) the perpetual dividend amount for a corresponding number of periods in order to ascribe a fair value to this feature. These amounts were discounted to present value using a market rate for dividend yield as of the date on which the Series B Preferred Stock was issued. The Company calculated the amount of the increasing-rate dividend feature as $1.8 million. This amount was amortized as a deemed dividend to preferred shareholders using the effective interest method through June 30, 2021. During each of the years ended December 31, 2021 and 2020, the Company recognized $0.9 million of deemed dividends related to the amortization of the increasing-rate dividend feature.

The below table illustrates changes in the Company’s balance of the Series B Preferred Stock for the years ended December 31, 2022, 2021, and 2020 (in thousands, except per share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2019	—	$	—
Issuance of Series B Preferred Stock	100,000	59,540
Deemed dividends	—	32,028
Balance at December 31, 2020	100,000	$	91,568
Deemed dividends	—	926
Balance at December 31, 2021	100,000	$	92,494
Activity	—	—
Balance at December 31, 2022	100,000	$	92,494

The Company has not declared or paid any dividends on the Series B Preferred Stock since issuance. Dividends in arrears as of December 31, 2022 were $13.8 million. As this amount has not been declared, the Company has not recorded this amount on its consolidated balance sheet as of December 31, 2022.

As of December 31, 2022, based on accumulated dividends as of that date, the Series B Preferred Stock was convertible into an aggregate of 29,559,946 shares of the Company’s common stock.

Stock Incentive Plans

The Company has two share-based compensation plans which provide for the granting of equity awards, including qualified incentive and non-qualified stock options and restricted stock awards: the MiMedx Group, Inc. 2016 Equity and Cash Incentive Plan Amended and Restated through October 2, 2020 (the “2016 Plan”), which was approved by shareholders on May 18, 2016, and the MiMedx Group, Inc. Assumed 2006 Stock Incentive Plan (the “Prior Incentive Plan”). During the years ended December 31, 2022, 2021, and 2020 the Company used only the 2016 Plan to make grants.

The 2016 Plan permits the grant of equity awards to the Company’s employees, directors, consultants and advisors for up to 8,400,000 shares of the Company’s common stock plus (i) the number of shares of the Company’s common stock that remain available for issuance under the Prior Incentive Plan, and (ii) the number of shares that are represented by outstanding awards that later become available because of the expiration or forfeiture of the award without the issuance of the underlying shares. Awards granted under the 2016 Plan are subject to a vesting schedule as set forth in each individual agreement.

Stock Options

A summary of stock option activity for the year ended December 31, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(312,001)	2.09
Unvested options forfeited	—	—
Vested options expired	(198,950)	4.02
Outstanding at December 31, 2022	933,894	6.46		0.87	—
Exercisable at December 31, 2022	933,894	$	6.46	0.87	$	—

The intrinsic values of the options exercised during the years ended December 31, 2022, 2021 and 2020 were $0.6 million, $3.3 million, and $1.9 million, respectively. Cash received from option exercise under all share-based payment arrangements for the years ended December 31, 2022, 2021 and 2020 was $0.7 million, $1.4 million, and $0.4 million, respectively. The actual tax

benefit for the tax deductions from option exercise of the share-based payment arrangements totaled $0.2 million, $2.0 million, and $1.6 million, respectively, for the years ended December 31, 2022, 2021 and 2020. The Company has a policy of using its available repurchased treasury stock to satisfy option exercises prior to the issuance of new shares of common stock.

No options vested during the years ended December 31, 2022, 2021 and 2020. There was no unrecognized compensation expense at December 31, 2022.

During 2021 and 2020, certain stock option holders elected to return restricted shares to the Company as consideration to exercise stock options. In total, 41,810 and 148,972 shares were returned to the Company during the year ended December 31, 2021 and 2020, respectively, for an aggregate fair value of $0.4 million and $0.9 million, respectively. There were no similar transactions for the year ended December 31, 2022.

Equity Incentive Awards

The Company has issued several classes of stock awards to employees: restricted stock (“RSAs”), restricted stock unit awards (“RSUs”), and performance stock unit awards (“PSUs”, collectively the “Equity Incentive Awards”). The following is summary information for such awards for the year ended December 31, 2022.

Restricted stock and RSUs generally vest over a one- to three-year period in equal annual increments and require the recipient to provide continuous service through each vesting date. PSUs vest based on the achievement of specific performance targets subject to agreements with employees and also require the recipient to provide continuous service through a specified date or event.

As of December 31, 2022, there was $19.8 million of total unrecognized stock-based compensation related to unvested Equity Incentive Awards. That expense is expected to be recognized over a weighted-average period of 1.72 years, which approximates the remaining vesting period of these grants. RSAs are considered common shares issued and outstanding upon grant, while shares underlying the RSUs and PSUs are considered issued and outstanding only upon vesting. Therefore, all RSAs noted below as unvested are considered issued and outstanding as of December 31, 2022, while unvested RSUs and PSUs are not considered issued and outstanding as of December 31, 2022. RSAs, RSUs, and PSUs are not reflected in weighted average common shares outstanding for purposes of calculated basic net loss per common share.

A summary of Equity Incentive Award activity, by class of award, for the year ended December 31, 2022 is presented below:


	RSA			RSU			PSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64	—	$	—
Granted	—	—		4,232,390	4.80		441,965	4.62
Vested	(749,104)	3.95		(1,724,530)	8.33		—	—
Forfeited	(5,338)	5.11		(1,961,808)	6.37		(200,893)	4.62
Unvested at December 31, 2022	122,755	$	6.13	4,774,971	$	6.28	241,072	$	4.62

The total fair value of equity incentive awards vested during the years ended December 31, 2022, 2021 and 2020, was $10.9 million, $20.1 million, and $10.1 million, respectively.

For the years ended December 31, 2022, 2021, and 2020 the Company recognized share-based compensation as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Cost of sales	$	1,213	$	813	$	520
Selling, general and administrative expenses	9,578		13,108		14,549
Research and development expense	1,875		836		288
Total share-based compensation	12,666		14,757		15,357
Income tax benefit, before consideration of valuation allowance	(3,132)		(3,649)		(3,792)
Total share-based compensation, net of tax benefit	$	9,533	$	11,108	$	11,565

Performance Stock Units

The Company granted 441,965 PSUs to certain executive officers during the year ended December 31, 2022. These PSUs vest based on and to the extent that stipulated cumulative net sales targets are achieved. Of the granted PSUs:

•25% can vest based on net sales achieved for the year ended December 31, 2022,

•25% can vest based on net sales achieved for the two-year period ending December 31, 2023, and

•the remaining award can vest based on net sales achieved for the three-year period ending December 31, 2024.

Achievement of the performance targets allow for vesting of 50% to 150% of the PSUs granted. If performance is below 50%, the PSUs do not vest. To the extent that the vesting percentage in a subsequent period exceeds the vesting percentage achieved in a previous period, a recipient is eligible to receive the amount of shares from the previous period based on the vesting percentage in the subsequent period. If total shareholder return (“TSR”), as defined below, is negative, vesting is limited to 100% of the award for all periods, regardless of actual achievement against the stipulated net sales targets.

All of the PSUs require recipients to continue employment with the Company through the vesting date, which will occur upon approval of the results with respect to the established targets by the Compensation Committee of the Board of Directors after December 31, 2024, but no later than March 15, 2025.

The TSR is calculated as the average trading price of the Company’s common stock during the final 30 trading days of 2024, adjusted for dividends paid on the Company’s common stock, less the average trading price during the final 30 trading days of 2021. Since TSR is based on the Company’s share price, it represents a market condition, which is incorporated in the grant date fair value of the shares in excess of 100% vesting. These awards are not reflected in the table above.

The fair value of these awards on the date of grant was estimated using a Monte Carlo simulation, the inputs for which were informed by a Black-Scholes option pricing model. The assumptions used in determining the fair value of these PSUs were as follows:


	Assumption
Risk-free interest rate	2.68		%
Expected term (years)	2.74
Expected volatility (annualized)	63.7		%
Dividend yield	—		%
Closing stock price on grant date	$	4.62
Grant date fair value	$	2.78

The expected term was derived from the date of the grant through the latest date of the resolution of the market condition. The risk-free interest rate was derived based on the U.S. Treasury Yield curve in effect at the date of grant for maturities of similar periods to the concluded term. The expected volatility was based on the Company’s historical daily stock price movements for a term similar in length to the expected term. The dividend yield was based on the Company’s history of dividends on its common stock.

Expense related to PSUs is recognized, straight-line, based on the grant date fair value of the relevant shares, over the requisite service period related to each individual tranche, limited to the extent that the achievement of the associated performance condition associated with that tranche is probable. These expectations are derived from the Company’s actual results, latest budget, and forecasts for net sales in the associated periods. Subsequent adjustments to the expectation for vesting are reflected as a cumulative adjustment to expense. The fair value of the portion of the award subject to a market condition and expense recognized on such awards are not subsequently reconsidered based on the probability of or actual achievement of the market condition. Accordingly, the Company may recognize share-based compensation expense for awards that do not ultimately vest.

Employee Stock Purchase Plan

On June 7, 2022, the Company adopted the Employee Stock Purchase Plan of MiMedx Group, Inc. (the “ESPP”). The ESPP is intended to qualify as an “employee stock purchase plan” under Section 423 of the Internal Revenue Code. All regular full-time employees of the Company (including officers) and all other employees who meet the eligibility requirements of the plan may participate in the ESPP. The ESPP provides eligible employees an opportunity to acquire the Company’s common stock on a semi-annual basis at a purchase price of 85% of the lower of the closing price per share of the Company’s common stock on the first day and the last day of each six-month purchase period (the “Purchase Period”). The aggregate number of shares which may be issued and sold under the ESPP is 3 million shares of common stock. The first Purchase Period under the ESPP commenced on August 1, 2022 and resulted in a purchase of shares on January 31, 2023.

For the year ended December 31, 2022, the Company recorded $0.2 million in stock-based compensation related to the ESPP. As of December 31, 2022, the Company had cumulative payroll deferrals under the ESPP for future share purchases of $0.6 million. This amount is included in accrued compensation in the consolidated balance sheet. No shares have been issued under the plan to date.

Unrecognized stock compensation for the period is less than $0.1 million to be recognized over a weighted average period of 0.08 years.

2020 RSU Modification

During the year ended December 31, 2019, the Company granted a fixed-dollar value RSU award to the members of its Board in the amount of $1.6 million. The RSU awards vested at the date of the 2019 Annual Meeting and were settled in common stock with the number of shares of common stock based on the closing price of the Company’s share price on August 5, 2020, a date thirty days after the Company became current on its SEC filings. Upon this event, these awards were modified from a fixed dollar-amount of awards to be settled in a variable number of shares to a fixed number of shares based on the closing price of the Company’s common stock on August 5, 2020. This event constituted a modification of the awards from liability-based awards to equity-based awards. This event did not change the total amount of expense recognized. Prior to August 5, 2020, the Company recorded $1.3 million of expense, of which $0.9 million was recognized during the year ended December 31, 2020. The Company reclassified $1.3 million of recorded liability to additional paid-in capital to reflect this modification on August 5, 2020. Subsequent to the modification, $0.3 million of expense was recognized as additional paid-in capital during the year ended December 31, 2020.

Treasury Stock

Repurchases of shares of Common Stock in connection with the satisfaction of employee tax withholding obligations upon vesting of restricted stock and exercise of stock options for the years ended December 31, 2022, 2021, and 2020 were 249,442, 469,239, and 435,492, respectively, for an aggregate purchase price of $1.2 million, $4.8 million, and $2.3 million, respectively.

Revenue

12 Months Ended

Dec. 31, 2022

Revenue from Contract with Customer [Abstract]

Revenue

Net Sales by Product

MIMEDX has two classes of products: (1) Advanced Wound Care, or Section 361, products, consisting of its tissue and cord sheet allograft products as well as certain particulate products regulated under Section 361, and (2) Section 351 products, consisting of the Company’s micronized and certain other particulate products. Advanced Wound Care is further disaggregated between the Company’s Tissue/Other and Cord products.

Information regarding the business units responsible for the sale of each of these classes of product can be found in Note 13, Segment Information.

Below is a summary of net sales by each class of product (in thousands):


	Year Ended December 31,
	2022		2021		2020
Advanced Wound Care
Tissue/Other	$	241,992	$	216,418	$	192,566
Cord	23,211		23,599		16,073
Advanced Wound Care	265,203		240,017		208,639
Section 351	2,379		17,610		31,828
Other(1)	259		988		7,767
Total	$	267,841	$	258,615	$	248,234

(1) “Other” includes the Remaining Contracts and other revenue transactions in the indicated period relating to performance obligations settled prior to October 1, 2019, the date at which the Company changed its pattern of revenue recognition. For all practical purposes, the Company is not able to allocate these revenue transactions to different product groups. This revenue is reflected as part of the Wound & Surgical segment.

Net Sales by Site of Service

MIMEDX has three sites of service for its products (1) Hospital settings and wound care clinics, which are stable reimbursement settings in which products are used for surgical applications, (2) Private offices, which generally represents doctors and practitioners with independent operations, and (3) Other, which includes federal facilities, international sales, and other sites of service.

Below is a summary of net sales by site of service (in thousands):


	Year Ended December 31,
	2022		2021		2020
Hospital	$	163,206	$	154,580	$	144,285
Private Office	77,158		$	75,816	$	75,638
Other	27,477		28,219		28,311
Total	$	267,841	$	258,615	$	248,234

Disaggregation of Revenue by Customer

Prior to May 31, 2021, the conclusion of the FDA’s enforcement discretion period, the Company evaluated its revenue on the basis of its two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“Direct Customers”); and (2) sales through distributors (“Distributors”).

Below is a summary of net sales by each customer type (in thousands):


	Year Ended December 31,
	2022		2021		2020
Direct Customers	$	261,508	$	250,009	$	240,690
Distributors	6,333		8,606		7,544
Total	$	267,841	$	258,615	$	248,234

The Company did not have significant foreign operations or a single external customer from which 10% or more of revenues were derived during the years ended December 31, 2022, 2021, or 2020.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Segment Information

12 Months Ended

Dec. 31, 2022

Segment Reporting [Abstract]

Segment Information

The Company has two reportable segments: Wound & Surgical and Regenerative Medicine.

•Wound & Surgical focuses on the Advanced Wound Care and Surgical Recovery markets through the sale of the Company’s existing product portfolio and product development to serve these primary end markets. Its platform technologies include tissue allografts derived from human placental membrane (EPIFIX®, AMNIOFIX®, and AMNIOEFFECT®), tissue allografts derived from human umbilical cord (EPICORD® and AMNIOCORD®), and a particulate extracellular matrix derived from human placental disc (AXIOFILL®™). This segment is also responsible for the international sales of the Company’s Section 351 products.

•The Regenerative Medicine business focuses solely on Regenerative Medicine technologies, specifically progressing the Company’s placental biologics platform towards registration as an FDA-approved biological drug. mDHACM is the lead product candidate in its late-stage pipeline targeted at achieving FDA approval for an indication to help decrease pain and improve function in patients suffering from KOA.

The Company’s Corporate function includes expenses incurred by executive, finance, human resource, information systems, legal, other functions which are generally shared and whose activities are not specifically identifiable solely to either of the other segments. It also includes amortization of intangible assets. The Company has another operating segment related to an expiring dental sales contract, reflecting all sales of the Company’s dental product. All net sales and cost of sales presented in the Corporate & Other columns below relate to this operating segment.

Wound & Surgical net sales reflects sales of the Company’s Advanced Wound Care products (as discussed in Note 12, Revenue), except for sales of the Company’s dental product. In addition, Wound & Surgical reflects international sales of the Company’s Section 351 products, which represent all Section 351 sales not reflected in Regenerative Medicine.

The Company evaluates the performance of its segments and allocates resources based on segment contribution, defined as net sales less (i) cost of sales, (ii) selling, general and administrative expense, (iii) research and development expense, and (iv) amortization of intangible assets. Prior period results were recast on the basis of new operating segments. The only components which comprise loss before income tax provision that are not included in operating loss are interest expense, net and other expense, net.

Net sales and segment contribution for each reportable segment for the year ended December 31, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	264,906	$	—	$	2,935	$	267,841
Cost of sales	44,462		—		3,854		48,316
Selling, general and administrative expense	145,887		—		62,902		208,789
Research and development expense	7,836		14,993		—		22,829
Amortization of intangible assets	—		—		701		701
Segment contribution	$	66,721	$	(14,993)
Investigation, restatement and related expense							12,177
Operating loss							$	(24,971)
Supplemental information
Depreciation expense	$	1,791	$	165	$	1,389	$	3,345
Share-based compensation	$	6,513	$	1,158	$	4,995	$	12,666

Net sales and segment contribution for each reportable segment for the year ended December 31, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	238,940	$	16,596	$	3,079	$	258,615
Cost of sales	35,204		3,655		4,424		43,283
Selling, general and administrative expense	123,583		12,910		61,866		198,359
Research and development expense	5,864		11,480		—		17,344
Amortization of intangible assets	—		—		820		820
Segment contribution	$	74,289	$	(11,449)
Investigation, restatement and related expense							3,791
Impairment of intangible assets							53
Operating loss							$	(5,035)
Supplemental information
Depreciation expense	$	1,644	$	246	$	2,473	$	4,363
Share-based compensation	$	5,158	$	1,461	$	8,138	$	14,757

Net sales and segment contribution for each reportable segment for the year ended December 31, 2020 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	213,489	$	32,362	$	2,383	$	248,234
Cost of sales	30,185		5,856		3,289		39,330
Selling, general and administrative expense	103,039		17,546		60,437		181,022
Research and development expense	3,979		7,736		—		11,715
Amortization of intangible assets	—		—		1,073		1,073
Segment contribution	$	76,286	$	1,224
Investigation, restatement and related expense							59,465
Impairment of intangibles							1,027
Operating loss							$	(45,398)
Supplemental information
Depreciation expense	$	1,755	$	451	$	3,576	$	5,782
Share-based compensation	$	4,373	$	1,256	$	9,728	$	15,357

The Company does not allocate any assets to the reportable segments. No asset information is reported or disclosed to the CODM in the financial information for each segment.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

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+ Details

Income Taxes

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Income Taxes

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes.

Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2022		2021
Deferred Tax Assets:
Net operating loss	$	23,719	$	23,333
Research and development and other tax credits	8,384		6,297
Interest limitation carry forward	4,898		3,970
Accrued expenses	3,501		3,385
Capitalized research and development expenditures	3,586		—
Share-based compensation	3,145		4,220
Allowance for doubtful accounts	1,033		601
Lease liabilities	962		1,277
Sales return and allowances	163		195
Accrued settlement costs	50		235
Other	885		1,115
Deferred Tax Liabilities:
Prepaid expenses	(1,400)		(1,337)
Right of use asset	(867)		(1,197)
Intangible assets	(351)		(263)
Property and equipment	(77)		(705)


Net Deferred Tax Assets	47,631		41,126
Less: Valuation allowance	(47,631)		(41,126)
Net Deferred Tax Assets after Valuation Allowance	$	—	$	—

The reconciliation of the federal statutory income tax rate of 21% to the effective rate is as follows:


	Year ended December 31,
	2022		2021		2020
Federal statutory rate	21.00	%	21.00	%	21.00	%
Tax credits	5.85	%	2.01	%	0.32	%

Employee retention credit	—	%	3.37	%	—	%
NOL carryback rate differential	—	%	—	%	10.99	%
Meals and entertainment	(0.10)	%	(1.13)	%	(0.50)	%
State taxes, net of federal benefit	(0.55)	%	4.53	%	(0.20)	%
Uncertain tax positions	(0.58)	%	0.02	%	0.24	%
Nondeductible compensation	(2.22)	%	(13.77)	%	(0.89)	%
Deferred tax adjustments	(2.89)	%	14.63	%	—	%
Share-based compensation	(4.03)	%	23.31	%	(1.24)	%
Valuation allowance	(17.59)	%	(52.70)	%	(8.14)	%
Other	0.42	%	(3.73)	%	(1.66)	%
Effective tax rate	(0.69)	%	(2.46)	%	19.92	%

Current and deferred income tax (benefit) expense is as follows (in thousands):


	Year Ended December 31,
	2022		2021		2020
Current:
Federal	$	—	$	91	$	(12,418)
State	206		156		159
Total current	206		247		(12,259)

Deferred:
Federal	—		—		—
State	—		—		—
Total deferred	—		—		—

Total expense (benefit)	$	206	$	247	$	(12,259)

Certain items of income and expense are not reported in tax returns and financial statements in the same year. The tax effects of such temporary differences are reported as deferred income tax assets and liabilities. The measurement of deferred tax assets is reduced, if necessary, by the amount of any tax benefit that, based on available evidence, is not expected to be realized. The Company establishes a valuation allowance for deferred tax assets for which realization is not more likely than not. As of each reporting date, management considers new evidence, both positive and negative, that could affect its view of the future realization of deferred tax assets.

A valuation allowance of $47.6 million and $41.1 million was recorded against the deferred tax asset balance as of December 31, 2022 and 2021, respectively. The Company maintains a full valuation allowance because it is not more likely than not the deferred tax assets will be utilized based on all available positive and negative evidence. In the event that the weight of the evidence changes in the future, any reduction in the valuation allowance would result in an income tax benefit.

At December 31, 2022 and 2021, the Company had income tax net operating loss (“NOL”) carryforwards for federal and state purposes of $84.9 million and $109.8 million and $84.2 million and $104.2 million, respectively. A portion of the Company’s NOLs and tax credits are subject to annual limitations due to ownership change limitations provided by Internal Revenue Code Section 382. All of the Company’s federal NOL carryforwards have been generated since 2018 and will carry forward indefinitely. The majority of the Company’s state NOL carryforwards will expire between 2027 and 2042; the remainder of the Company’s state NOLs will carryforward indefinitely. As of December 31, 2022, the Company has recorded a deferred tax asset for both federal and state NOL carryforwards of approximately $17.8 million and $5.9 million, respectively. As of December 31, 2021, the Company has recorded a deferred tax asset for federal and state NOL carryforwards of $17.7 million and approximately $5.6 million, respectively.

Unrecognized Tax Benefits

The following is a tabular reconciliation of the total amounts of unrecognized tax benefits (in thousands) included in other liabilities in the consolidated balance sheets:


	2022		2021		2020
Unrecognized tax benefits - January 1	$	469	$	477	$	627
Increases - tax positions in current period	98		20		—
Increases - tax positions in prior period	78		—		—
Decreases in prior year positions	—		(28)		(150)
Unrecognized tax benefits - December 31	$	645	$	469	$	477

Included in the balance of unrecognized tax benefits are tax benefits of $0.6 million and $0.5 million for the years ended December 31, 2022 and 2021, respectively, that, if recognized, would affect the effective tax rate.

The Company recognizes accrued interest related to unrecognized tax benefits and penalties as income tax expense. Related to the unrecognized tax benefits noted above, the Company accrued $0.0 million of interest during the years ended December 31, 2022 and 2021. The Company accrued and recognized $0.1 million of interest during 2020.

The Company is subject to taxation in the U.S. and various state jurisdictions. As of December 31, 2022, the Company’s tax returns for 2019 through 2022 generally remain open for exam by taxing jurisdictions. Additional prior years may be open to the extent attributes are being carried forward to an open tax year.

CARES Act

On March 27, 2020, the U.S. government enacted the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) which, among other changes, eliminated the taxable income limit for certain net operating losses (“NOL”), allowed businesses to carry back NOLs arising in 2018, 2019, and 2020 to the five prior years, and provided a payment delay of employer payroll taxes during 2020 after the date of enactment. These provisions allowed the Company to carry back federal tax losses related to 2018 and 2019. The Company recorded net tax receivable totaling $11.3 million in 2020 related to these provisions, of which $1.2 million had been collected as of December 31, 2020, and another $9.2 million was collected during the year ended December 31, 2021. The remaining $0.9 million is reflected in income tax receivable on the consolidated balance sheets as of December 31, 2022 and 2021.

The Company had a deferred payment of $2.2 million in employer taxes that was included as part of accrued compensation on the consolidated balance sheet as of December 31, 2021. $1.1 million was paid in January 2022 and the remaining balance paid in December 2022.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
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+ Details

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities

12 Months Ended

Dec. 31, 2022

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Cash paid for interest	$	4,569	$	4,327	$	7,456
Income taxes paid	181		169		208
Cash paid for operating leases	1,567		1,522		1,569
Non-cash activities:
Purchases of equipment included in accounts payable	417		8		1,062
Lease right of use asset and liability	(37)		2,251		1,169
Deemed dividends of Series B Preferred Stock	—		926		32,028
Fair value of non-cash consideration received for option exercise	—		380		922
Note receivable for sale of property and equipment	—		75		—
Amendment fee on previous term loan	—		—		722
Deferred financing costs	—		—		53

Commitments and Contingencies

12 Months Ended

Dec. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Contractual Commitments

The Company has commitments for meeting spaces, generally for hotel and conference spaces for company functions. These commitments generally contain renewal options.

The estimated meeting space commitments are as follows (in thousands):


Year ending December 31,	Meeting Space Commitments
2023	$	989
2024	394

Total	$	1,383

Separation Agreement with Timothy R. Wright

On September 15, 2022, the Company entered into a Separation Agreement and General Release with Timothy R. Wright, the former Chief Executive Officer of the Company (the “Separation Agreement”). Pursuant to the terms of the Separation Agreement and Mr. Wright’s general release of all claims against the Company, the Company will pay Mr. Wright a total of $3.1 million in cash in a series of installments through September 2024. The terms of the severance benefits provided in the Separation Agreement were the same as those provided for in the original employment Letter Agreement between Mr. Wright and the Company dated April 8, 2019. The $3.1 million was recorded as part of selling, general and administrative expense on the consolidated statement of operations for the year ended December 31, 2022.

Of the $3.1 million, $1.9 million is reflected in accrued compensation and $1.2 million is reflected in other liabilities in the consolidated balance sheet as of December 31, 2022. No payments were required to be made to Mr. Wright under the terms of the Separation Agreement during the year ended December 31, 2022.

Nordic Agreement

In June 2022, the Company entered into a collaboration agreement (the “Nordic Agreement”) with Nordic Bioscience Clinical Development A/S (“NBCD”) to provide full operational support for the Company’s upcoming Knee Osteoarthritis (“KOA”) clinical trial program. As part of the agreement, NBCD will perform site selection and monitoring, manage patient recruitment and enrollment, data management, statistical analysis and reporting activities for the duration of the trial. Under the terms of the Nordic Agreement, as of December 31, 2022, the Company was obligated to pay $13.3 million upon the achievement of specified milestones over the course of the clinical trial. The milestones are based upon various factors including, but not limited to, site selection and enrollment, patient enrollment, patient completion, and certain other activities related to clinical trial operations. These milestone payments are revised semi-annually based on fluctuations in the consumer price index. The Company has the ability to terminate the Nordic Agreement with 30 days written notice to NBCD. At such time, the Company would be required to pay for services performed through the date of termination and any non-cancelable obligations.

In addition to the $13.3 million, the Company will reimburse NBCD for actual expenses incurred related to third-party vendors to be contracted and managed by NBCD.

As of December 31, 2022, the Company has paid $2.0 million under the Nordic Agreement, relating to milestones which have been achieved from inception through that date. During the year ended December 31, 2022, the Company recognized $1.0 million of expense related to the Nordic Agreement. This amount is included as part of research and development expense in the consolidated statement of operations. The remaining $1.0 million is reflected in prepaid expenses on the consolidated balance sheet as of December 31, 2022.

In January 2023, the Company executed a change order to the Nordic Agreement. Refer to Note 21, Subsequent Events, for more details.

Turn Agreement

On December 7, 2022, the Company acquired intellectual property rights pursuant to a Platform Intellectual Property License (the “Turn Agreement”) with Global Health Solutions, Inc. (d.b.a. Turn Therapeutics or “Turn”). The Turn Agreement provided MIMEDX with an exclusive, worldwide, sub-licensable license to use Turn’s proprietary antimicrobial technology platform (PermaFusion®) to develop antimicrobial line extensions and new products. In addition, the Turn Agreement granted the Company the commercial rights to Turn’s placental collagen matrix product, FleX™ AM (“FleX”), contingent upon Turn’s receipt of FDA 510(k) clearance and other conditions.

During the year ended December 31, 2022, the Company paid $1.0 million upon the execution of the Turn Agreement to acquire the license. This amount was capitalized and is included as part of intangible assets, net, on the consolidated balance sheet as of December 31, 2022. The Company is obligated to make additional payments upon the meeting of regulatory and product commercial milestones, including $9.6 million if and when Turn receives 510(k) clearance from the FDA for FleX. This amount is not reflected in the consolidated balance sheet as of December 31, 2022.

Litigation and Regulatory Matters

In the ordinary course of business, the Company and its subsidiaries may be a party to pending and threatened legal, regulatory, and governmental actions and proceedings (including those described below). In view of the inherent difficulty of predicting the outcome of such matters, particularly where the plaintiffs or claimants seek very large or indeterminate damages or where the matters present novel legal theories or involve a large number of parties, the Company generally cannot predict what the

eventual outcome of the pending matters will be, what the timing of the ultimate resolution of these matters will be, or what the eventual recovery, loss, fines or penalties related to each pending matter may be.

In accordance with applicable accounting guidance, the Company accrues a liability when those matters present loss contingencies that are both probable and estimable. The Company's financial statements at December 31, 2022 reflect the Company's current best estimate of probable losses associated with these matters, including costs to comply with various settlement agreements, where applicable. As of December 31, 2022, the Company had reserved $0.2 million related to expected settlement costs related to legal matters.

The Company paid $0.7 million toward the resolution of legal matters involving the Company during the year ended December 31, 2022. In addition, insurance providers paid $0.6 million on the Company’s behalf to settle legal matters.

The Company paid $6.7 million to settle legal proceedings during 2021. In addition, $1.1 million was paid on the Company’s behalf through an insurance provider during 2021 relating directly to settlement matters. In addition, during 2021, the Company received funds from certain director and officer insurance policies for previously-incurred legal expenses under the Company’s indemnification agreements. These funds were recognized as a reduction to investigation, restatement and related expense on the consolidated statement of operations.

The Company paid $7.4 million to settle legal proceedings during 2020. In addition, $3.5 million was paid on the Company’s behalf through an insurance provider during 2020.

The actual costs of resolving these matters may be in excess of the amounts reserved.

Securities Class Action

On January 16, 2019, the United States District Court for the Northern District of Georgia entered an order consolidating two purported securities class actions (MacPhee v. MiMedx Group, Inc., et al. filed February 23, 2018 and Kline v. MiMedx Group, Inc., et al. filed February 26, 2018). The order also appointed Carpenters Pension Fund of Illinois (“CPFI”) as lead plaintiff. On May 1, 2019, CPFI filed a consolidated amended complaint, naming as defendants the Company, Michael J. Senken, Parker H. “Pete” Petit, William C. Taylor, Christopher M. Cashman and Cherry Bekaert & Holland LLP. The amended complaint alleged violations of Section 10(b) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 10b-5 promulgated thereunder, and Section 20(a) of the Exchange Act. It asserted a class period of March 7, 2013 through June 29, 2018. Following the filing of motions to dismiss by the various defendants, CPFI was granted leave to file an amended complaint. CPFI filed its amended complaint against the Company, Michael J. Senken, Parker H. Petit, William C. Taylor, and Cherry Bekaert & Holland (Christopher Cashman was dropped as a defendant) on March 30, 2020; defendants filed motions to dismiss on May 29, 2020. On March 25, 2021, the Court granted defendants’ respective motions to dismiss, finding that CPFI lacked standing to bring the underlying claims and also could not establish loss causation because it sold all of its shares in MIMEDX prior to any corrective disclosures, and dismissed the case. On April 22, 2021, CPFI filed a motion for reconsideration of the dismissal and for leave to amend to add a new plaintiff to attempt to cure the standing and loss causation issues. The Company opposed CPFI’s motions and the hearing on the same was held on September 24, 2021.

On January 28, 2022, the Court denied CPFI’s motion to reconsider and motion to substitute class representative. On February 25, 2022, CPFI filed a Notice of Appeal in the 11th Circuit Court of Appeals. Oral arguments were held on January 24, 2023.

Welker v. MiMedx, et. al.

On November 4, 2022, Troy Welker and Min Turner, former optionholders of the Company, brought a lawsuit in Fulton County State Court against the Company, former directors Terry Dewberry and Charles Evans, and former officers Parker H. “Pete” Petit, William C. Taylor, and Michael Senken alleging violations of the Georgia Racketeer Influenced and Corrupt Organizations (“RICO”) Act against all defendants and conspiracy to violate the Georgia RICO Act and breach of fiduciary duty against the individual defendants.

The Company is defending against the allegations and removed the case to the United States District Court for the Northern District of Georgia. Plaintiffs have filed a motion to remand back to state court, which is currently pending.

Investigations

On February 8, 2021, the Company received a subpoena issued by the Department of Defense Office of Inspector General seeking records regarding the sales of the Company’s micronized and other products to federal medical facilities and federal contracting offices, including those operated by the Department of Veterans Affairs or the Department of Defense. The subpoena also seeks information regarding the Company’s communications with the FDA regarding its products. The Company understands that the Office of the United States Attorney for the Western District of Washington Civil Division is overseeing the investigation, which is being conducted principally by agents employed by the Department of the Army Criminal Investigation Command. The Company is cooperating with the government’s investigation and at this time the Company is unable to predict the outcome of the investigation, including whether the investigation will result in any action or proceeding against the Company.

Former Employee Litigation and Related Matters

On January 12, 2021, the Company filed suit in the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida (MiMedx Group, Inc. v. Petit, et. al.) against its former CEO, Parker H. “Pete” Petit, and its former COO, William C. Taylor, seeking a determination of its rights and obligations under indemnification agreements with Petit and Taylor following a federal jury’s guilty verdict against Petit for securities fraud and Taylor for conspiracy to commit securities fraud. The Company is seeking a declaratory judgment that it is not obligated to indemnify or advance expenses to Petit and Taylor in connection with certain cases to which Petit and Taylor are parties and also seeking to recoup amounts previously paid on behalf of Petit and Taylor in connection with such cases. On April 22, 2021, Petit and Taylor filed an answer and asserted counterclaims against the Company alleging breach of their indemnification agreements, breach of the covenant of good faith and fair dealing with respect to their indemnification agreements, and seeking a declaration that the Company remains obligated to indemnify and advance fees in connection with certain cases. Petit and Taylor simultaneously filed a motion seeking to compel the Company to advance and reinstate its payments of Petit and Taylor’s legal expenses. The Company opposed Petit and Taylor’s motion and a hearing was set for June 23, 2021. At the joint request of the parties, the hearing was cancelled to allow the parties to attend a mediation to attempt a resolution of this matter; such mediation was held on August 11, 2021.

Following the mediation, the Company and Taylor reached an agreement to settle the matter between them. Negotiations with Petit are ongoing.

Other Matters

Under the Florida Business Corporation Act and agreements with its current and former officers and directors, the Company is obligated to indemnify its current and former officers and directors who are made party to a proceeding, including a proceeding brought by or in the right of the corporation, with certain exceptions, and to advance expenses to defend such matters. The Company has already borne substantial costs to satisfy these indemnification and expense advance obligations and may continue to do so in the future.

In addition to the matters described above, the Company is a party to a variety of other legal matters that arise in the ordinary course of the Company’s business, none of which is deemed to be individually material at this time.

Previously-Settled Matters

The matters discussed below have been settled with the counterparty and their resolution has been disclosed in previously-issued financial statements. There are no contingent or continuing obligations associated with these matters.

Shareholder Derivative Suits

On December 6, 2018, the United States District Court for the Northern District of Georgia entered an order consolidating three shareholder derivative actions (Evans v. Petit, et al. filed September 25, 2018, Georgalas v. Petit, et al. filed September 27, 2018, and Roloson v. Petit, et al. filed October 22, 2018) that had been filed in the Northern District of Georgia. On January 22, 2019, plaintiffs filed a verified consolidated shareholder derivative complaint. The consolidated action sets forth claims of breach of fiduciary duty, corporate waste and unjust enrichment against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Alexandra O. Haden, Joseph G. Bleser, J. Terry Dewberry, Charles R. Evans, Larry W. Papasan, Luis A. Aguilar, Bruce L. Hack, Charles E. Koob, Neil S. Yeston and Christopher M. Cashman. The allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. The Company filed a motion to stay on February 18, 2019, pending the completion of the investigation by the Company’s Special Litigation Committee. The Special Litigation Committee completed its investigation relating to this action and filed an executive summary of its findings with the Court on July 1, 2019. The parties (together with parties from the

Hialeah derivative lawsuit, the Nix and Demaio derivative lawsuit, and the Murphy derivative lawsuit, each described below) held a mediation on February 11, 2020. Following continued discussions, on May 1, 2020, the parties notified the Court that plaintiffs and the Company had reached an agreement in principle to settle this consolidated derivative action, which settlement also encompasses all claims asserted in the Hialeah derivative lawsuit, the Nix and Demaio derivative lawsuit, and the Murphy derivative lawsuit. The hearing on final approval was held on December 21, 2020 and the Court entered an Order granting final approval of the settlement the same day.

On October 29, 2018, the City of Hialeah Employees Retirement System (“Hialeah”) filed a shareholder derivative complaint in the Circuit Court for the Second Judicial Circuit in and for Leon County, Florida (the “Florida Court”). The complaint alleges claims for breaches of fiduciary duty and unjust enrichment against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Alexandra O. Haden, Joseph G. Bleser, J. Terry Dewberry, Charles R. Evans, Bruce L. Hack, Charles E. Koob, Larry W. Papasan, and Neil S. Yeston. The allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. The Company moved to stay the action on February 7, 2019, to allow the prior-filed consolidated derivative action in the Northern District of Georgia to be resolved first and to allow the Company’s Special Litigation Committee time to complete its investigation. The Company also filed a motion to dismiss on April 8, 2019. As discussed above, the plaintiff participated in the mediation that took place in connection with the prior-filed consolidated derivative action in the Northern District of Georgia and is a party to the agreement settling that consolidated derivative action. In accordance with the terms of the settlement, Hialeah filed a motion for leave to dismiss its derivative action with prejudice on January 4, 2021.

On May 15, 2019, two individuals purporting to be shareholders of the Company filed a shareholder derivative complaint in the Superior Court for Cobb County, Georgia. (Nix and Demaio v. Evans, et al.) The complaint alleges claims for breaches of fiduciary duty, corporate waste and unjust enrichment against certain current and former directors and officers of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Alexandra O. Haden, Chris Cashman, Lou Roselli, Mark Diaz, Charles R. Evans, Luis A. Aguilar, Joseph G. Bleser, J. Terry Dewberry, Bruce L. Hack, Charles E. Koob, Larry W. Papasan and Neil S. Yeston. The allegations generally involved claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. The Court ordered this matter stayed pending the resolution of the consolidated derivative suit pending in the Northern District of Georgia. As discussed above, the plaintiffs participated in the mediation that took place in connection with the prior-filed consolidated derivative action in the Northern District of Georgia and are a party to the agreement settling that consolidated derivative action. In accordance with the terms of the settlement, plaintiffs filed a notice of settlement and voluntary dismissal with prejudice on January 13, 2021.

On August 12, 2019, John Murphy filed a shareholder derivative complaint in the United States District Court for the Southern District of Florida (Murphy v. Petit, et al.). The complaint alleged claims for breaches of fiduciary duty and unjust enrichment against certain former officers, and certain current and former directors, of the Company: Parker H. Petit, William C. Taylor, Michael J. Senken, John E. Cranston, Alexandra O. Haden, Charles R. Evans, Luis A. Aguilar, Joseph G. Bleser, J. Terry Dewberry, Bruce L. Hack, Charles E. Koob, Larry W. Papasan and Neil S. Yeston. The allegations generally involve claims that the defendants breached their fiduciary duties by causing or allowing the Company to misrepresent its financial statements as a result of improper revenue recognition. The Company filed a motion to transfer this action to the Northern District of Georgia. Prior to resolution of that motion, the plaintiff voluntarily dismissed this action without prejudice. As discussed above, the plaintiff participated in the mediation that took place in connection with the prior-filed consolidated derivative action in the Northern District of Georgia and is a party to the agreement settling that consolidated derivative action. Pursuant to the terms of the settlement, this action is deemed dismissed with prejudice.

Qui Tam Matters

On January 19, 2017, a former employee of the Company filed a qui tam False Claims Act complaint in the United States District Court for the District of South Carolina (United States of America, ex rel. Jon Vitale v. MiMedx Group, Inc.) alleging that the Company’s donations to the patient assistance program, Patient Access Network Foundation, violated the Anti-Kickback Statute and resulted in submission of false claims to the government. The government declined to intervene and the complaint was unsealed on August 10, 2018. The Company filed a motion to dismiss on October 1, 2018. The Company’s motion to dismiss was granted in part and denied in part on May 15, 2019. The parties have reached an agreement to resolve this matter.

On January 20, 2017, two former employees of the Company, filed a qui tam False Claims Act complaint in the United States District Court for the District of Minnesota (Kruchoski et. al. v. MiMedx Group, Inc.). An amended complaint was filed on January 27, 2017. The operative complaint alleges that the Company failed to provide truthful, complete and accurate information about the pricing offered to commercial customers in connection with the Company’s Federal Supply Schedule contract. On May 7, 2019, the Department of Justice (“DOJ”) declined to intervene, and the case was unsealed. In April 2020,

without admitting the allegations, the Company agreed to pay $6.5 million to the DOJ to resolve this matter. This amount was paid during the year ended December 31, 2020.

Former Employee Matters

In December 2019, MiMedx received notice of a complaint filed in July 2018 with the Occupational Safety and Health Administration (“OSHA”) section of the Department of Labor (“DOL”) by Thomas Tierney, a former Regional Sales Director, against MiMedx and the referenced individuals, Tierney v. MiMedx Group, Inc., Parker Petit, William Taylor, Christopher Cashman, Thornton Kuntz, Jr. and Alexandra Haden, DOL No. 4-5070-18-243. Mr. Tierney alleged that he was terminated from MiMedx in retaliation for reporting concerns about revenue recognition practices, compliance issues, and the corporate culture, in violation of the anti-retaliation provisions of the Sarbanes-Oxley Act. The parties settled this matter and OSHA dismissed the complaint on May 20, 2020.

Intellectual Property Litigation

The NuTech Action

On March 2, 2015, the Company filed a patent infringement lawsuit against NuTech Medical, Inc. (“NuTech”) and DCI Donor Services, Inc. (“DCI”) in the United States District Court for the Northern District of Alabama (MiMedx Group, Inc. v. NuTech Medical, Inc. et. al.). The Company has alleged that NuTech and DCI infringed and continue to infringe on the Company’s patents through the manufacture, use, sale and/or offering of their tissue graft product. The Company also asserted that NuTech knowingly and willfully made false and misleading representations about its products to customers and prospective customers. The Company is seeking permanent injunctive relief and unspecified damages. The case was stayed pending the restatement of the Company’s financial statements. Since the Company has completed its restatement, the case resumed. The parties reached a settlement in the matter and the case was dismissed with prejudice.

The Osiris Action

On February 20, 2019, Osiris Therapeutics, Inc. (“Osiris”) refiled its trade secret and breach of contract action against the Company (which had been dismissed in a different forum) in the United States District Court for the Northern District of Georgia (Osiris Therapeutics, Inc. v. MiMedx Group, Inc.). The parties reached a settlement in the matter and the case was dismissed with prejudice on October 26, 2020.

401(k) Plan	12 Months Ended
401(k) Plan	Dec. 31, 2022
Retirement Benefits [Abstract]
401(k) Plan	401(k) PlanThe Company has a 401(k) plan (the “401(k) Plan”) covering all employees who have completed one month of service. Under the 401(k) Plan, participants could defer up to 90% of their eligible wages to a maximum of $20,500 per year (annual limit for 2022). Employees age 50 or over in 2022 could make additional pre-tax contributions up to $6,500. In 2022 and 2021, the Company matched 50% of employee contributions up to 8% of the employee’s eligible compensation. In 2020, the Company matched 50% of employee contributions up to 5% of the employee’s eligible compensation. The matching contribution for the years ended December 31, 2022, 2021, and 2020 was $3.3 million, $2.7 million, and $1.5 million, respectively.

- Definition

The entire disclosure for retirement benefits.

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-URI https://asc.fasb.org/extlink&oid=123447040&loc=d3e1928-114920

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 715
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (r)(2)
-URI https://asc.fasb.org/extlink&oid=123447040&loc=d3e1928-114920

+ Details

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2022
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions The Company has employed Thomas Koob as its Chief Scientific Officer (a non-executive officer) since 2006. Thomas Koob is the brother of a former director, Charles Koob. Subsequent to the Company’s employment of Thomas Koob, Charles Koob was appointed as a director of the Company in March 2008. Charles Koob's term as a Director expired at the 2020 Annual Meeting held on November 20, 2020. In 2020, the Company paid Thomas Koob an annual salary of $0.2 million and provided equity, incentive compensation and other compensation of $0.3 million. The Company had no related party transactions for the years ended December 31, 2022 or 2021.

Restructuring

12 Months Ended

Dec. 31, 2022

Restructuring and Related Activities [Abstract]

Restructuring

2018 Restructuring

Set forth below are disclosures relating to restructuring initiatives that resulted in material cash expenditures during the year ended December 31, 2020. Employee retention and certain other employee benefit-related costs related to the Company’s restructuring were expensed ratably over an agreed-upon service period. One-time employee separation and related employee benefit costs were generally expensed as incurred.

In December 2018, the Company announced a reduction of the Company’s workforce by approximately 240 full-time employees, or 24% of its total workforce, of which approximately half were sales personnel as part of the plans to implement a broad-based organizational realignment, cost reduction and efficiency program to better ensure the Company’s cost structure was appropriate given its revenue expectations.

The Company’s restructuring program concluded in 2020. All obligations related to the Company’s restructuring program were settled as of December 31, 2020.

Changes to this liability during the year ended December 31, 2020 was as follows (in thousands):








Liability balance as of December 31, 2019	3,561
Expenses	—
Cash distributions	(3,561)
Liability balance as of December 31, 2020	$	—

2022 Reorganization

On September 2, 2022, the Company separated from its Chief Executive Officer. Subsequent to this event, the Company realigned the organization to improve profitability. As part of these efforts, the Company incurred $2.0 million of one-time employee separation costs. Of this amount, $0.6 million was outstanding as of December 31, 2022. The remaining amount is reflected as part of accrued compensation on the consolidated balance sheet as of that date.

Government Assistance	12 Months Ended
Government Assistance	Dec. 31, 2022
Government Assistance [Abstract]
Government Assistance	Government Assistance Employee Retention Credit The CARES Act provided an employee retention credit (“ERC”), which was a refundable tax credit against certain payroll taxes. Upon determination that the Company overcame the barriers required to receive the credit, the Company qualified and filed to claim the ERC. The Company reflected the ERC as a reduction to the respective captions on the consolidated statements of operations associated with the employees to which the payroll tax benefit related. For the year ended December 31, 2021, the Company recorded $1.6 million as a reduction to selling, general and administrative expense. Of this amount, $1.4 million and $1.6 million were reflected as part of other current assets in the consolidated balance sheets as December 31, 2022 and 2021, respectively. During year ended December 31, 2022, the Company received $0.2 million relating to the ERC.

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Nordic Agreement Change Order On January 24, 2023, the Company executed a change order to the Nordic Agreement (the “Change Order”), primarily to reflect additional elements required in conducting the trial. The Change Order modified the scope of NBCD’s responsibilities under the Nordic Agreement, shifting certain activities to other vendors to be administered by NBCD and certain other activities to MIMEDX. These responsibilities primarily related to areas of patient recruitment and screening and statistical analysis, among other areas of the trial. Pursuant to the Change Order, the total payments owed to NBCD relating to NBCD’s responsibilities decreased from $13.3 million to $10.2 million. Hiring of Chief Executive Officer On January 27, 2023, the Board of Directors appointed Joseph H. Capper to serve as Chief Executive Officer. The Company entered into a Letter Agreement with Mr. Capper that included, among other things, a grant of 3,300,000 PSUs and a grant of a non-qualified stock option (the “Option”) for 3,600,000 shares of the Company’s common stock. The PSUs vest over a four-year performance period ending December 31, 2026 based upon the achievement of specified performance conditions, up to a maximum of 200% of the granted PSUs, and subject to Mr. Capper’s continued employment. The Option vests over a four-year period ending January 31, 2027 contingent upon the achievement of share price performance goals and subject to Mr. Capper’s continued employment. Mr. Capper will is eligible to vest in 25% of the Option on or after each of the first four anniversary dates subsequent to the date of grant, provided certain share price performance targets are achieved at any point during the four-year vesting period. In concert with the hiring of Mr. Capper’s, K. Todd Newton stepped down and ceased to serve as Interim Chief Executive Officer. Upon Mr. Capper’s hiring, 200,000 RSUs granted to Mr. Newton pursuant to the Interim Executive Employment Agreement between him and the Company vested immediately. Mr. Newton remains on the Board of Directors.

Schedule II Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2022

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Schedule II Valuation and Qualifying Accounts


MIMEDX GROUP, INC. AND SUBSIDIARIES SCHEDULE II VALUATION AND QUALIFYING ACCOUNTS
Years ended December 31, 2022, 2021 and 2020 (in thousands)
	Balance at Beginning of Year		Additions charged to Expense or Revenue		Deductions and write-offs		Balance at End of Year
For the year ended December 31, 2022
Allowance for product returns	$	2,549	$	2,449	$	(2,304)	$	2,694

For the year ended December 31, 2021
Allowance for product returns	$	2,321	$	2,508	$	(2,280)	$	2,549

For the year ended December 31, 2020
Allowance for product returns	$	4,115	$	705	$	(2,499)	$	2,321

Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Principles of Consolidation

The consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.

Use of Estimates

Segment Reporting

Cash and Cash Equivalents

Market Concentrations and Credit Risk

Accounts Receivable

Accounts receivable represent amounts due from customers for which revenue has been recognized. Generally, the Company does not require collateral or any other security to support its receivables.

Inventory

Property and Equipment, Net

Asset Retirement Obligations

Impairment of Long-lived Assets

Goodwill and Indefinite-lived Intangible Assets

In performing the quantitative test, impairment loss is recorded to the extent that the carrying value of the reporting unit exceeds its assessed fair value.

Patent Costs

or an alternative future use is available to the Company.

Leases

Treasury Stock

Shares repurchased by the Company are recorded as treasury stock at the cost to acquire such shares. Subsequent issuances of shares held in treasury are assumed to be released on a FIFO basis.

Contingencies

Revenue Recognition

Current Policy

arrangements, the customer takes possession of the product, but the Company retains title until the implantation or application of the Company’s product to the end user.

Sales deductions owed to customers and other parties are accrued and recorded in accrued expenses on the consolidated balance sheets.

Remaining Contracts

The effect of the cash collections on the Remaining Contracts on net sales and cost of sales for each of the years ended December 31, 2022, 2021, and 2020 were as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Net sales	$	259	$	1,038	$	7,767
Cost of sales	—		174		1,087
Gross profit	$	259	$	864	$	6,680

Group Purchasing Organization Fees

Cost of Sales

The Company obtains raw material in the form of human placenta donations from participating mothers who give birth via scheduled Caesarean section.

Research and Development Costs

Research and development costs consist of direct and indirect costs associated with the development of the Company’s technologies. These costs are expensed as incurred.

Advertising expense

Advertising expenseAdvertising expense consists primarily of print media promotional materials. Advertising costs are expensed as incurred.

Income Taxes

Share-based Compensation

Basic and Diluted Net Loss per Common Share

Fair Value of Financial Instruments and Fair Value Measurements

•Level 1: Quoted prices (unadjusted) in active markets that are accessible at the measurement date for identical assets or liabilities;

•Level 2: Quoted prices in active markets for similar assets or liabilities or observable prices that are based on inputs not quoted on active markets, but corroborated by market data.

•Level 3: Unobservable inputs or valuation techniques that are used when little or no market data is available.

Government Assistance

Government AssistanceThe Company receives benefits from various government entities for various purposes from time to time. With respect to any benefits that are not dependent on income (which are subject to the policy described under Income Taxes, above), the Company recognizes such benefits at the point in time in which all barriers to receive the assistance have been overcome in an amount equal to the expected benefit. Benefits are reflected in the consolidated statements of operations in the line item to which the associated benefit relates.

Recently Adopted Accounting Pronouncements and Recently Issued Accounting Pronouncements Not Yet Adopted

Recently Adopted Accounting Pronouncements

Recently Issued Accounting Pronouncements Not Yet Adopted

Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Schedule of Effect of the Cash Collections on the Remaining Contracts on Net Sales and Cost of Sales

The effect of the cash collections on the Remaining Contracts on net sales and cost of sales for each of the years ended December 31, 2022, 2021, and 2020 were as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Net sales	$	259	$	1,038	$	7,767
Cost of sales	—		174		1,087
Gross profit	$	259	$	864	$	6,680

Accounts Receivable, Net (Tables)

12 Months Ended

Dec. 31, 2022

Receivables [Abstract]

Schedule of Accounts Receivable, Net

Accounts receivable, net, consists of the following (in thousands):


	December 31,
	2022		2021
Accounts receivable, gross	$	46,867	$	41,540
Allowance for doubtful accounts	(3,783)		(1,187)
Accounts receivable, net	$	43,084	$	40,353

Schedule of Activity Related to the Allowance for Doubtful Accounts

Activity related to the Company’s allowance for doubtful accounts during the year ended December 31, 2022 was as follows (in thousands):


	Allowance for Doubtful Accounts
Balance at December 31, 2021	$	1,187
Bad debt expense	2,820
Write-offs	(224)
Balance at December 31, 2022	$	3,783

Bad debt expense and write-offs were not material for the year ended December 31, 2021.

Inventory (Tables)

12 Months Ended

Dec. 31, 2022

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventory consists of the following (in thousands):


	December 31,
	2022		2021
Raw materials	$	810	$	364
Work in process	6,855		6,112
Finished goods	5,518		4,913
Inventory	$	13,183	$	11,389

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2022

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

Property and equipment, net, consists of the following (in thousands):


	December 31,
	2022		2021
Lab and clean room equipment	$	16,422	$	16,567
Furniture and office equipment	15,016		14,975
Leasehold improvements	9,190		9,052
Construction in progress	1,983		397
Asset retirement cost	983		863
Finance lease assets	189		189
Property and equipment, gross	43,783		42,043
Less: accumulated depreciation and amortization	(35,927)		(32,878)
Property and equipment, net of accumulated depreciation and amortization	$	7,856	$	9,165

Schedule of Depreciation


	Year Ended December 31,
	2022		2021		2020
Cost of sales	$	1,816	$	1,787	$	2,022
Selling, general, and administrative expense	1,243		2,278		3,416
Research and development expense	286		298		344
Total	$	3,345	$	4,363	$	5,782

Leases (Tables)

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Schedule of Supplemental Balance Sheet Information Related to Leases


	Operating Leases						Finance Leases
	December 31,						December 31,
	2022			2021			2022			2021
Assets
Right of use asset	$	3,400		$	4,696		$	—		$	—
Property and equipment, net	—			—			98			145
Total assets	$	3,400		$	4,696		$	98		$	145

Liabilities
Other current liabilities	$	1,391		$	1,203		$	49		$	45
Other liabilities	2,381			3,812			57			106
Total liabilities	$	3,772		$	5,015		$	106		$	151

Weighted-average remaining lease term (years)	2.8			4.0			2.1			3.1
Weighted-average discount rate	8.3		%	8.4		%	8.3		%	8.3		%

Schedule of Lease Costs for Operating Leases

Information related to lease costs are as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Operating lease cost	$	1,620	$	1,327	$	1,392

Amortization of finance lease ROU assets	47		43		—
Interest expense on finance lease liabilities	10		13		—

Schedule of Maturities of Operating Lease Liabilities

Maturities of lease liabilities are as follows (amounts in thousands):


Year Ending December 31,	Operating Leases		Finance Leases		Total
2023	$	1,638	$	55	$	1,693
2024	1,618		55		1,673
2025	506		5		511
2026	419		—		419
2027	35		—		35
Thereafter	—		—		—
Total lease payments	4,216		115		4,331
Less: imputed interest	(444)		(9)		(453)
Lease liability	$	3,772	$	106	$	3,878

Goodwill and Intangible Assets, Net (Tables)

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

The following table indicates the changes in the carrying amount of goodwill for 2022 and 2021 (in thousands):



	Previous Reporting Unit		Wound & Surgical		Regenerative Medicine		Total Company
Balance as of January 1, 2021	$	19,976	$	—	$	—	$	19,976
Activity	—		—		—		—
Balance as of December 31, 2021	$	19,976	$	—	$	—	$	19,976
Reallocation	(19,976)		19,441		535		—
Balance as of December 31, 2022	$	—	$	19,441	$	535	$	19,976

Schedule of Intangible Assets Activity Summary

Intangible assets, net, are summarized as follows (in thousands):


	December 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,923	$	(7,106)	$	2,817	$	9,578	$	(6,408)	$	3,170
Licenses	1,000		(4)		996		—		—		—


Total amortized intangible assets	$	10,923	$	(7,110)	$	3,813	$	9,578	$	(6,408)	$	3,170

Unamortized intangible assets
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in process	1,031				1,031		1,205				1,205
Total intangible assets	$	12,962			$	5,852	$	11,791			$	5,383

Schedule of Amortization and Impairment Expense

Intangible assets, net, are summarized as follows (in thousands):


	December 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,923	$	(7,106)	$	2,817	$	9,578	$	(6,408)	$	3,170
Licenses	1,000		(4)		996		—		—		—


Total amortized intangible assets	$	10,923	$	(7,110)	$	3,813	$	9,578	$	(6,408)	$	3,170

Unamortized intangible assets
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in process	1,031				1,031		1,205				1,205
Total intangible assets	$	12,962			$	5,852	$	11,791			$	5,383

Amortization expense and impairment expense for the years ended December 31, 2022, 2021, and 2020, is summarized in the table below (amounts in thousands):


	Year ended December 31,
	2022		2021		2020
Amortization of intangible assets	$	701	$	820	$	1,073
Impairment of intangible assets	—		53		1,027

Schedule of Estimated Future Amortization Expense of Intangible Assets

Expected future amortization of intangible assets as of December 31, 2022, is as follows (in thousands):


	Estimated
	Amortization
Year Ending December 31,	Expense
2023	$	756
2024	756
2025	361
2026	207
2027	206
Thereafter	1,527
Total amortization expense	$	3,813

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1A
-URI https://asc.fasb.org/extlink&oid=121556970&loc=SL108378252-109267

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (f)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 2
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13854-109267

Reference 11: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 55
-Paragraph 24
-URI https://asc.fasb.org/extlink&oid=122137925&loc=d3e14258-109268

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

+ Details

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2022

Payables and Accruals [Abstract]

Schedule of Accrued Expenses

Accrued expenses consist of the following (in thousands):


	December 31,
	2022		2021
Legal costs	$	4,447	$	2,806

External commissions	2,941		2,630
Accrued rebates	707		1,343
Estimated returns	659		788
Accrued GPO Fees	638		559
Accrued travel	566		385
Accrued clinical trials	90		694
Other	976		607
Total	$	11,024	$	9,812

Long Term Debt (Tables)

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Schedule of Debt

The allocation of the deferred financing costs and original issue discount between Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands):


	July 2, 2020
	Term Loan		DD TL		Total
Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

The balances of the Term Loan as of December 31, 2022 and 2021 were as follows (amounts in thousands):


	December 31,
	2022		2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,219)		(1,624)
Original issue discount	(187)		(249)
Long term debt, net	$	48,594	$	48,127

Schedule of Interest Expense

Interest expense related to the Term Loan, included in interest expense, net in the consolidated statements of operations, was as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Stated interest	$	4,559	$	4,182	$	2,085
Amortization of deferred financing costs	405		372		173
Accretion of original issue discount	62		58		26
Interest expense	$	5,026	$	4,612	$	2,284

Interest expense related to the DD TL, included in interest expense, net in the consolidated statements of operations, was as follows (amounts in thousands):


	Year Ended December 31,
	2022		2021		2020
Commitment fee	$	—	$	126	$	128
Amortization of deferred financing costs	—		542		542
Accretion of original issue discount	—		83		83
Interest expense	$	—	$	751	$	753

Interest expense related to the BT Term Loan, included in interest expense, net in the consolidated statements of operations was as follows (amounts in thousands):


	Year ended December 31, 2020

Interest on principal balance	$	3,773
Accretion of original issue discount	354
Accretion of amendment fee	53
Amortization of deferred financing costs	1,051
Total BT Term Loan interest expense	$	5,231

Schedule of Future principal payments for the Term Loan

Scheduled principal payments on the Term Loan as of December 31, 2022 are as follows:


Year ending December 31,	Principal
2023	$	—
2024	—
2025	50,000
2026	—
2027	—
Thereafter	—
Outstanding principal	$	50,000

Schedule of Extinguishment of Debt

The composition of the loss on extinguishment of debt was as follows (amounts in thousands):


	July 2, 2020
Unamortized deferred financing costs	$	4,528
Unamortized original issue discount	1,538
Unamortized amendment fee	671
Prepayment premium	1,439
Other fees	25
Loss on extinguishment of debt	$	8,201

Basic and Diluted Net Loss Per Common Share (Tables)

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic


	Year ended December 31,
	2022		2021		2020
Net loss	$	(30,197)	$	(10,285)	$	(49,284)
Adjustments to reconcile to net loss available to common stockholders:
Accumulated dividend on Series B Preferred Stock	6,580		5,210		2,016
Amortization of beneficial conversion feature	—		—		31,110
Accretion of increasing-rate dividend feature	—		926		918
Total adjustments	6,580		6,136		34,044
Net loss available to common stockholders	$	(36,777)	$	(16,421)	$	(83,328)
Weighted average common shares outstanding	112,909,266		110,353,406		108,257,112
Basic net loss per common share	$	(0.33)	$	(0.15)	$	(0.77)

Schedule of Earnings Per Share, Diluted

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per-share amounts):


	Year ended December 31,
	2022		2021		2020
Net loss available to common stockholders	$	(36,777)	$	(16,421)	$	(83,328)
Adjustments:
Dividends on Series B Preferred Stock	6,580		6,136		34,044
Less: antidilutive adjustments	(6,580)		(6,136)		(34,044)
Total adjustments	—		—		—
Numerator	$	(36,777)	$	(16,421)	$	(83,328)
Weighted average common shares outstanding	112,909,266		110,353,406		108,257,112
Adjustments:
Potential common shares	28,705,593		29,801,836		15,687,044
Less: antidilutive potential common shares (a)	(28,705,593)		(29,801,836)		(15,687,044)
Total adjustments	—		—		—
Weighted average common shares outstanding adjusted for potential common shares	112,909,266		110,353,406		108,257,112
Diluted net loss per common share	$	(0.33)	$	(0.15)	$	(0.77)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share


	Year ended December 31,
	2022	2021	2020
Series B Preferred Stock	27,850,916	26,497,570	12,987,013
Restricted stock unit awards	546,883	1,393,910	616,141
Restricted stock awards	217,971	1,121,019	1,299,770
Outstanding stock options	65,720	771,409	752,499
Performance stock unit awards	5,251	17,928	31,621
Employee stock purchase plan	18,852	—	—
Potential common shares	28,705,593	29,801,836	15,687,044

Equity (Tables)

12 Months Ended

Dec. 31, 2022

Equity [Abstract]

Schedule of Series B Preferred Stock

The below table illustrates changes in the Company’s balance of the Series B Preferred Stock for the years ended December 31, 2022, 2021, and 2020 (in thousands, except per share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2019	—	$	—
Issuance of Series B Preferred Stock	100,000	59,540
Deemed dividends	—	32,028
Balance at December 31, 2020	100,000	$	91,568
Deemed dividends	—	926
Balance at December 31, 2021	100,000	$	92,494
Activity	—	—
Balance at December 31, 2022	100,000	$	92,494

Schedule of Stock Options Activity

A summary of stock option activity for the year ended December 31, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(312,001)	2.09
Unvested options forfeited	—	—
Vested options expired	(198,950)	4.02
Outstanding at December 31, 2022	933,894	6.46		0.87	—
Exercisable at December 31, 2022	933,894	$	6.46	0.87	$	—

Schedule of Restricted Stock Awards Roll Forward

A summary of Equity Incentive Award activity, by class of award, for the year ended December 31, 2022 is presented below:


	RSA			RSU			PSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64	—	$	—
Granted	—	—		4,232,390	4.80		441,965	4.62
Vested	(749,104)	3.95		(1,724,530)	8.33		—	—
Forfeited	(5,338)	5.11		(1,961,808)	6.37		(200,893)	4.62
Unvested at December 31, 2022	122,755	$	6.13	4,774,971	$	6.28	241,072	$	4.62

Schedule of Allocation of Share-Based Compensation

For the years ended December 31, 2022, 2021, and 2020 the Company recognized share-based compensation as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Cost of sales	$	1,213	$	813	$	520
Selling, general and administrative expenses	9,578		13,108		14,549
Research and development expense	1,875		836		288
Total share-based compensation	12,666		14,757		15,357
Income tax benefit, before consideration of valuation allowance	(3,132)		(3,649)		(3,792)
Total share-based compensation, net of tax benefit	$	9,533	$	11,108	$	11,565

Schedule of Assumptions Used in Determining the Fair Value of These PSUs

The assumptions used in determining the fair value of these PSUs were as follows:


	Assumption
Risk-free interest rate	2.68		%
Expected term (years)	2.74
Expected volatility (annualized)	63.7		%
Dividend yield	—		%
Closing stock price on grant date	$	4.62
Grant date fair value	$	2.78

Revenue (Tables)

12 Months Ended

Dec. 31, 2022

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

Below is a summary of net sales by each class of product (in thousands):


	Year Ended December 31,
	2022		2021		2020
Advanced Wound Care
Tissue/Other	$	241,992	$	216,418	$	192,566
Cord	23,211		23,599		16,073
Advanced Wound Care	265,203		240,017		208,639
Section 351	2,379		17,610		31,828
Other(1)	259		988		7,767
Total	$	267,841	$	258,615	$	248,234

Below is a summary of net sales by site of service (in thousands):


	Year Ended December 31,
	2022		2021		2020
Hospital	$	163,206	$	154,580	$	144,285
Private Office	77,158		$	75,816	$	75,638
Other	27,477		28,219		28,311
Total	$	267,841	$	258,615	$	248,234

Below is a summary of net sales by each customer type (in thousands):


	Year Ended December 31,
	2022		2021		2020
Direct Customers	$	261,508	$	250,009	$	240,690
Distributors	6,333		8,606		7,544
Total	$	267,841	$	258,615	$	248,234

Segment Information (Tables)

12 Months Ended

Dec. 31, 2022

Segment Reporting [Abstract]

Schedule of Net Sales and Segment Contribution for Each Reportable Segment

Net sales and segment contribution for each reportable segment for the year ended December 31, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	264,906	$	—	$	2,935	$	267,841
Cost of sales	44,462		—		3,854		48,316
Selling, general and administrative expense	145,887		—		62,902		208,789
Research and development expense	7,836		14,993		—		22,829
Amortization of intangible assets	—		—		701		701
Segment contribution	$	66,721	$	(14,993)
Investigation, restatement and related expense							12,177
Operating loss							$	(24,971)
Supplemental information
Depreciation expense	$	1,791	$	165	$	1,389	$	3,345
Share-based compensation	$	6,513	$	1,158	$	4,995	$	12,666

Net sales and segment contribution for each reportable segment for the year ended December 31, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	238,940	$	16,596	$	3,079	$	258,615
Cost of sales	35,204		3,655		4,424		43,283
Selling, general and administrative expense	123,583		12,910		61,866		198,359
Research and development expense	5,864		11,480		—		17,344
Amortization of intangible assets	—		—		820		820
Segment contribution	$	74,289	$	(11,449)
Investigation, restatement and related expense							3,791
Impairment of intangible assets							53
Operating loss							$	(5,035)
Supplemental information
Depreciation expense	$	1,644	$	246	$	2,473	$	4,363
Share-based compensation	$	5,158	$	1,461	$	8,138	$	14,757

Net sales and segment contribution for each reportable segment for the year ended December 31, 2020 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	213,489	$	32,362	$	2,383	$	248,234
Cost of sales	30,185		5,856		3,289		39,330
Selling, general and administrative expense	103,039		17,546		60,437		181,022
Research and development expense	3,979		7,736		—		11,715
Amortization of intangible assets	—		—		1,073		1,073
Segment contribution	$	76,286	$	1,224
Investigation, restatement and related expense							59,465
Impairment of intangibles							1,027
Operating loss							$	(45,398)
Supplemental information
Depreciation expense	$	1,755	$	451	$	3,576	$	5,782
Share-based compensation	$	4,373	$	1,256	$	9,728	$	15,357

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Schedule of Deferred tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2022		2021
Deferred Tax Assets:
Net operating loss	$	23,719	$	23,333
Research and development and other tax credits	8,384		6,297
Interest limitation carry forward	4,898		3,970
Accrued expenses	3,501		3,385
Capitalized research and development expenditures	3,586		—
Share-based compensation	3,145		4,220
Allowance for doubtful accounts	1,033		601
Lease liabilities	962		1,277
Sales return and allowances	163		195
Accrued settlement costs	50		235
Other	885		1,115
Deferred Tax Liabilities:
Prepaid expenses	(1,400)		(1,337)
Right of use asset	(867)		(1,197)
Intangible assets	(351)		(263)
Property and equipment	(77)		(705)


Net Deferred Tax Assets	47,631		41,126
Less: Valuation allowance	(47,631)		(41,126)
Net Deferred Tax Assets after Valuation Allowance	$	—	$	—

Schedule of Reconciliation of the Federal Statutory Income Tax

The reconciliation of the federal statutory income tax rate of 21% to the effective rate is as follows:


	Year ended December 31,
	2022		2021		2020
Federal statutory rate	21.00	%	21.00	%	21.00	%
Tax credits	5.85	%	2.01	%	0.32	%

Employee retention credit	—	%	3.37	%	—	%
NOL carryback rate differential	—	%	—	%	10.99	%
Meals and entertainment	(0.10)	%	(1.13)	%	(0.50)	%
State taxes, net of federal benefit	(0.55)	%	4.53	%	(0.20)	%
Uncertain tax positions	(0.58)	%	0.02	%	0.24	%
Nondeductible compensation	(2.22)	%	(13.77)	%	(0.89)	%
Deferred tax adjustments	(2.89)	%	14.63	%	—	%
Share-based compensation	(4.03)	%	23.31	%	(1.24)	%
Valuation allowance	(17.59)	%	(52.70)	%	(8.14)	%
Other	0.42	%	(3.73)	%	(1.66)	%
Effective tax rate	(0.69)	%	(2.46)	%	19.92	%

Schedule of Current and Deferred Income Tax (Benefit) Expense

Current and deferred income tax (benefit) expense is as follows (in thousands):


	Year Ended December 31,
	2022		2021		2020
Current:
Federal	$	—	$	91	$	(12,418)
State	206		156		159
Total current	206		247		(12,259)

Deferred:
Federal	—		—		—
State	—		—		—
Total deferred	—		—		—

Total expense (benefit)	$	206	$	247	$	(12,259)

Schedule of Reconciliation of Unrecognized Tax Benefits

The following is a tabular reconciliation of the total amounts of unrecognized tax benefits (in thousands) included in other liabilities in the consolidated balance sheets:


	2022		2021		2020
Unrecognized tax benefits - January 1	$	469	$	477	$	627
Increases - tax positions in current period	98		20		—
Increases - tax positions in prior period	78		—		—
Decreases in prior year positions	—		(28)		(150)
Unrecognized tax benefits - December 31	$	645	$	469	$	477

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Tables)

12 Months Ended

Dec. 31, 2022

Supplemental Cash Flow Elements [Abstract]

Schedule of Selected Cash Payments, Receipts, and Non-Cash Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Years Ended December 31,
	2022		2021		2020
Cash paid for interest	$	4,569	$	4,327	$	7,456
Income taxes paid	181		169		208
Cash paid for operating leases	1,567		1,522		1,569
Non-cash activities:
Purchases of equipment included in accounts payable	417		8		1,062
Lease right of use asset and liability	(37)		2,251		1,169
Deemed dividends of Series B Preferred Stock	—		926		32,028
Fair value of non-cash consideration received for option exercise	—		380		922
Note receivable for sale of property and equipment	—		75		—
Amendment fee on previous term loan	—		—		722
Deferred financing costs	—		—		53

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Schedule of Estimated Annual Lease, Royalty, and Employment Agreement Expenses

The estimated meeting space commitments are as follows (in thousands):


Year ending December 31,	Meeting Space Commitments
2023	$	989
2024	394

Total	$	1,383

Restructuring (Tables)

12 Months Ended

Dec. 31, 2022

Restructuring and Related Activities [Abstract]

Schedule of Changes in Restructuring Liability

Changes to this liability during the year ended December 31, 2020 was as follows (in thousands):








Liability balance as of December 31, 2019	3,561
Expenses	—
Cash distributions	(3,561)
Liability balance as of December 31, 2020	$	—

Nature of Business (Details) - segment		6 Months Ended	12 Months Ended
Nature of Business (Details) - segment	Sep. 30, 2022	Jun. 30, 2022	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of business units	2	1	2

Significant Accounting Policies - Narrative (Details)		6 Months Ended	12 Months Ended
Significant Accounting Policies - Narrative (Details)	Sep. 30, 2022 segment reporting_unit	Jun. 30, 2022 segment	Dec. 31, 2022 USD ($) segment depository_institution	Dec. 31, 2021 USD ($) segment reporting_unit	Dec. 31, 2020 USD ($)
Market Concentrations and Credit Risk [Line Items]
Number of operating segments \| segment		1	3	1
Number of reportable segments \| segment	2	1	2
Cash and cash equivalents in excess of the insured amounts			$ 65,200,000	$ 86,400,000
Number of depository institutions \| depository_institution			4
Impairment of intangible assets			$ 0	53,000	$ 1,027,000
Impairment charges on long-lived assets			0	$ 0	0
Number of reporting units \| reporting_unit	2			1
Goodwill impairment			0	$ 0	0
Impairment of indefinite useful lives intangible			$ 0	0	0
GPO administrative fees as percent of purchase volume			3.00%
Advertising expense			$ 200,000	100,000	100,000
Patents and know-how
Market Concentrations and Credit Risk [Line Items]
Patent application costs			$ 170,000	$ 252,000	$ 327,000
Minimum
Market Concentrations and Credit Risk [Line Items]
Property and equipment estimated useful life (in years)			3 years
Maximum
Market Concentrations and Credit Risk [Line Items]
Property and equipment estimated useful life (in years)			7 years

Significant Accounting Policies - Effect of the Cash Collections on the Remaining Contracts on Net Sales and Cost of Sales (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Net sales	$ 267,841	$ 258,615	$ 248,234
Cost of sales	48,316	43,283	39,330
Gross profit	219,525	215,332	208,904
Net sales
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Net sales	259	1,038	7,767
Cost of sales
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Cost of sales	0	174	1,087
Gross profit
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Gross profit	$ 259	$ 864	$ 6,680

- Definition

Aggregate revenue less cost of goods and services sold or operating expenses directly attributable to the revenue generation activity.

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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI https://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Accounts Receivable, Net - Accounts Receivable (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Receivables [Abstract]
Accounts receivable, gross	$ 46,867	$ 41,540
Allowance for doubtful accounts	(3,783)	(1,187)
Accounts receivable, net	$ 43,084	$ 40,353

Accounts Receivable, Net - Schedule of Activity Related to the Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Allowance for Doubtful Accounts
Beginning balance	$ 1,187
Bad debt expense	2,820	$ 0	$ 0
Write-offs	(224)
Ending balance	$ 3,783	$ 1,187

Inventory (Details) - USD ($) $ in Thousands	12 Months Ended
Inventory (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 810	$ 364
Work in process	6,855	6,112
Finished goods	5,518	4,913
Inventory	13,183	11,389
Inventory [Line Items]
Inventory write-down	0	700
Consignment inventory	$ 3,400	2,600
Section 351
Inventory [Line Items]
Inventory write-down		$ 1,000

Property and Equipment, Net - Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property and equipment [Line Items]
Finance lease assets	$ 189	$ 189
Property and equipment, gross	43,783	42,043
Less: accumulated depreciation and amortization	(35,927)	(32,878)
Property and equipment, net of accumulated depreciation and amortization	7,856	9,165
Lab and clean room equipment
Property and equipment [Line Items]
Property and equipment, gross	16,422	16,567
Furniture and office equipment
Property and equipment [Line Items]
Property and equipment, gross	15,016	14,975
Leasehold improvements
Property and equipment [Line Items]
Property and equipment, gross	9,190	9,052
Construction in progress
Property and equipment [Line Items]
Property and equipment, gross	1,983	397
Asset retirement cost
Property and equipment [Line Items]
Property and equipment, gross	$ 983	$ 863

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Depreciation	$ 3,345	$ 4,363	$ 5,782
Cost of sales
Property, Plant and Equipment [Line Items]
Depreciation	1,816	1,787	2,022
Selling, general, and administrative expense
Property, Plant and Equipment [Line Items]
Depreciation	1,243	2,278	3,416
Research and development expense
Property, Plant and Equipment [Line Items]
Depreciation	$ 286	$ 298	$ 344

Leases - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating Leases
Right of use asset	$ 3,400	$ 4,696
Other current liabilities	$ 1,391	$ 1,203
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Other current liabilities	Other current liabilities
Other liabilities	$ 2,381	$ 3,812
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other Liabilities, Noncurrent	Other Liabilities, Noncurrent
Lease liability	$ 3,772	$ 5,015
Weighted-average remaining lease term (years)	2 years 9 months 18 days	4 years
Weighted-average discount rate	8.30%	8.40%
Finance Leases
Property and equipment, net	$ 98	$ 145
Other current liabilities	$ 49	$ 45
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Other current liabilities	Other current liabilities
Other liabilities	$ 57	$ 106
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other Liabilities, Noncurrent	Other Liabilities, Noncurrent
Lease liability	$ 106	$ 151
Weighted-average remaining lease term (years)	2 years 1 month 6 days	3 years 1 month 6 days
Weighted-average discount rate	8.30%	8.30%

Leases - Lease Costs (Details) - USD ($) $ in Thousands	12 Months Ended
Leases - Lease Costs (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating lease cost	$ 1,620	$ 1,327	$ 1,392
Amortization of finance lease ROU assets	47	43	0
Interest expense on finance lease liabilities	$ 10	$ 13	$ 0

Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating Leases
2023	$ 1,638
2024	1,618
2025	506
2026	419
2027	35
Thereafter	0
Total lease payments	4,216
Less: imputed interest	(444)
Lease liability	3,772	$ 5,015
Finance Leases
2023	55
2024	55
2025	5
2026	0
2027	0
Thereafter	0
Total lease payments	115
Less: imputed interest	(9)
Lease liability	106	$ 151
2023	1,693
2024	1,673
2025	511
2026	419
2027	35
Thereafter	0
Lessee, Operating Lease And Financing Lease, Liability, To Be Paid	4,331
Less: imputed interest	(453)
Present value of lease liabilities	$ 3,878

Leases - Narrative (Details) $ in Millions	12 Months Ended
Leases - Narrative (Details) $ in Millions	Dec. 31, 2022 USD ($) warehouse_space	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Leases [Abstract]
Asset retirement obligations	$ 1.2	$ 1.0
Number of subleased warehouse spaces \| warehouse_space	1
Sublet income	$ 0.1	$ 0.1	$ 0.1

Goodwill and Intangible Assets, Net - Narrative (Details)		6 Months Ended	12 Months Ended
	Sep. 30, 2022 segment reporting_unit	Jun. 30, 2022 segment	Dec. 31, 2022 USD ($) segment	Dec. 31, 2021 USD ($) segment reporting_unit	Dec. 31, 2020 USD ($)
Goodwill [Line Items]
Number of operating segments \| segment		1	3	1
Number of reporting units \| reporting_unit	2			1
Number of reportable segments \| segment	2	1	2
Goodwill			$ 19,976,000	$ 19,976,000	$ 19,976,000
Goodwill impairment			0	$ 0	$ 0
Wound & Surgical
Goodwill [Line Items]
Goodwill			19,441,000
Regenerative Medicine
Goodwill [Line Items]
Goodwill			$ 535,000

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Goodwill and Intangible Assets, Net - Changes in Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill, beginning	$ 19,976	$ 19,976
Activity	0	0
Goodwill, ending	19,976	19,976
Previous Reporting Unit
Goodwill [Roll Forward]
Goodwill, beginning	19,976	19,976
Activity	(19,976)	0
Goodwill, ending		$ 19,976
Wound & Surgical
Goodwill [Roll Forward]
Activity	19,441
Goodwill, ending	19,441
Regenerative Medicine
Goodwill [Roll Forward]
Activity	535
Goodwill, ending	$ 535

- Definition

+ References + Details

Goodwill and Intangible Assets, Net - Activity Summary (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	$ 10,923	$ 9,578
Accumulated amortization	(7,110)	(6,408)
Total amortization expense	3,813	3,170
Indefinite-lived Intangible Assets [Line Items]
Total intangible assets, gross carrying amount	12,962	11,791
Total intangible assets, net carrying amount	5,852	5,383
Tradenames and trademarks
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Patents in process
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,031	1,205
Patents and know-how
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	9,923	9,578
Accumulated amortization	(7,106)	(6,408)
Total amortization expense	2,817	3,170
Licenses
Finite-Lived Intangible Assets [Line Items]
Gross carrying amount	1,000	0
Accumulated amortization	(4)	0
Total amortization expense	$ 996	$ 0

Goodwill and Intangible Assets, Net - Amortization Expense and Impairment Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 701	$ 820	$ 1,073
Impairment of intangible assets	$ 0	$ 53	$ 1,027

Goodwill and Intangible Assets, Net - Expected Future Amortization of Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
2023	$ 756
2024	756
2025	361
2026	207
2027	206
Thereafter	1,527
Total amortization expense	$ 3,813	$ 3,170

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Legal costs	$ 4,447	$ 2,806
External commissions	2,941	2,630
Accrued rebates	707	1,343
Estimated returns	659	788
Accrued GPO Fees	638	559
Accrued travel	566	385
Accrued clinical trials	90	694
Other	976	607
Total	$ 11,024	$ 9,812

Long Term Debt - Narrative (Details) - USD ($)					12 Months Ended
Long Term Debt - Narrative (Details) - USD ($)	Feb. 28, 2022	Apr. 24, 2020	Apr. 22, 2020	Jun. 10, 2019	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jul. 02, 2020
Debt Instrument [Line Items]
Loss on extinguishment of debt					$ 0	$ 0	$ 8,201,000
Paycheck Protection Program Loan
Debt Instrument [Line Items]
Proceeds from short-term debt		$ 10,000,000
Notes Payable, Other Payables \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Face value of debt								$ 50,000,000
Interest rate, effective percentage (percent)					11.50%			8.30%
Original issue discount					$ 187,000	$ 249,000
Notes Payable, Other Payables \| Hayfin Loan Agreement Term Loan \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, interest rate, floor (percent)	1.50%
Basis spread on variable rate (percent)	6.75%
Default interest rate (percent)	3.00%
Notes Payable, Other Payables \| Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Face value of debt								$ 25,000,000
Notes Payable, Other Payables \| Credit Facilities
Debt Instrument [Line Items]
Minimum Liquidity	$ 20,000,000
Original issue discount								500,000
Deferred financing costs								$ 3,253,000
Notes Payable, Other Payables \| Credit Facilities \| On or before July 2, 2023
Debt Instrument [Line Items]
Prepayment penalty as percent of prepaid principal	2.00%
Notes Payable, Other Payables \| Credit Facilities \| After July 2, 2023, but on or before July 2, 2024
Debt Instrument [Line Items]
Prepayment penalty as percent of prepaid principal	1.00%
Notes Payable, Other Payables \| Credit Facilities \| After July 2, 2024
Debt Instrument [Line Items]
Prepayment penalty as percent of prepaid principal	0.00%
Notes Payable, Other Payables \| BT Loan Agreement
Debt Instrument [Line Items]
Face value of debt				$ 75,000,000
Fair value of term loan					$ 46,700,000
Quarterly installments				900,000
Original issue discount				2,300,000
Deferred financing costs				$ 6,700,000
Notes Payable, Other Payables \| Amended Term Loan Agreement
Debt Instrument [Line Items]
Deferred financing costs			$ 700,000
Notes Payable, Other Payables \| Amended Term Loan Agreement \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Basis spread on variable rate (percent)			9.00%
Increase in interest rate (percent)			1.00%
Minimum \| Notes Payable, Other Payables \| Hayfin Loan Agreement Term Loan \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate (percent)	0.50%
Maximum \| Notes Payable, Other Payables \| Hayfin Loan Agreement Term Loan \| Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate (percent)	2.50%

Long Term Debt - Term Loan Debt Issuance Costs (Details) - Notes Payable, Other Payables - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Jul. 02, 2020
Credit Facilities
Debt Instrument [Line Items]
Original issue discount			$ 500
Deferred financing costs			3,253
Term Loan
Debt Instrument [Line Items]
Original issue discount	$ 187	$ 249
Long term debt \| Term Loan
Debt Instrument [Line Items]
Original issue discount			333
Deferred financing costs			2,169
Other current assets \| Hayfin Loan Agreement Delayed Draw Term Loan [Member]
Debt Instrument [Line Items]
Original issue discount			167
Deferred financing costs			$ 1,084

Long Term Debt - Term Loan Balances (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Long term debt, net	$ 50,000
Notes Payable, Other Payables \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Outstanding principal	50,000	$ 50,000
Deferred financing costs	(1,219)	(1,624)
Original issue discount	(187)	(249)
Long term debt, net	$ 48,594	$ 48,127

- Definition

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Long Term Debt - Term Loan Interest Expense (Details) - Notes Payable, Other Payables - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Stated interest	$ 4,559	$ 4,182	$ 2,085
Amortization of deferred financing costs	405	372	173
Accretion of original issue discount	62	58	26
Interest expense	5,026	4,612	2,284
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee	0	126	128
Amortization of deferred financing costs	0	542	542
Accretion of original issue discount	0	83	83
Interest expense	$ 0	$ 751	753
BT Loan Agreement
Debt Instrument [Line Items]
Stated interest			3,773
Accretion of amendment fee			53
Amortization of deferred financing costs			1,051
Accretion of original issue discount			354
Interest expense			$ 5,231

Long Term Debt - Term Loan Maturity (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
2023	$ 0
2024	0
2025	50,000
2026	0
2027	0
Thereafter	0
Long term debt, net	$ 50,000

- Definition

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Long Term Debt - Term Loan Extinguishment of Debt (Details) - USD ($) $ in Thousands		12 Months Ended
	Jul. 02, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Extinguishment of Debt [Line Items]
Loss on extinguishment of debt		$ 0	$ 0	$ 8,201
BT Loan Agreement \| BT Loan Agreement
Extinguishment of Debt [Line Items]
Unamortized deferred financing costs	$ 4,528
Unamortized original issue discount	1,538
Unamortized amendment fee	671
Prepayment premium	1,439
Other fees	25
Loss on extinguishment of debt	$ 8,201

Basic and Diluted Net Loss Per Common Share - Basic Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Earnings Per Share [Abstract]
Net loss	$ (30,197)	$ (10,285)	$ (49,284)
Adjustments to reconcile to net loss available to common stockholders:
Accumulated dividend on Series B Preferred Stock	6,580	5,210	2,016
Amortization of beneficial conversion feature	0	0	31,110
Accretion of increasing-rate dividend feature	0	926	918
Total adjustments	6,580	6,136	34,044
Net loss available to common stockholders	$ (36,777)	$ (16,421)	$ (83,328)
Weighted average common shares outstanding (in shares)	112,909,266	110,353,406	108,257,112
Basic net loss per common share (in dollars per share)	$ (0.33)	$ (0.15)	$ (0.77)

Basic and Diluted Net Loss Per Common Share - Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Earnings Per Share [Abstract]
Net loss available to common stockholders	$ (36,777)	$ (16,421)	$ (83,328)
Dividends on Series B Preferred Stock	6,580	6,136	34,044
Less: antidilutive adjustments	(6,580)	(6,136)	(34,044)
Numerator	$ (36,777)	$ (16,421)	$ (83,328)
Weighted average common shares outstanding (in shares)	112,909,266	110,353,406	108,257,112
Potential common shares (in shares)	28,705,593	29,801,836	15,687,044
Less: antidilutive potential common shares (in shares)	(28,705,593)	(29,801,836)	(15,687,044)
Weighted average common shares outstanding adjusted for potential common shares (in shares)	112,909,266	110,353,406	108,257,112
Diluted net loss per common share (in dollars per share)	$ (0.33)	$ (0.15)	$ (0.77)

Basic and Diluted Net Loss Per Common Share - Antidilutive Securities (Details) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	28,705,593	29,801,836	15,687,044
Series B Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	27,850,916	26,497,570	12,987,013
Restricted stock unit awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	546,883	1,393,910	616,141
Restricted stock awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	217,971	1,121,019	1,299,770
Outstanding stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	65,720	771,409	752,499
Performance stock unit awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	5,251	17,928	31,621
Employee stock purchase plan
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share	18,852	0	0

Equity - Convertible Preferred Stock Series B (Details) $ / shares in Units, $ in Thousands		12 Months Ended
	Jul. 02, 2020 day director $ / shares	Dec. 31, 2022 USD ($) shares	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Jun. 30, 2021 USD ($)
Dividends Payable [Line Items]
Series B preferred stock, conversion price (in dollars per share) \| $ / shares	$ 5.25
Amortization of beneficial conversion feature		$ 0	$ 0	$ 31,110
Accretion of increasing-rate dividend feature		0	926	918
Series B Preferred Stock
Dividends Payable [Line Items]
Liquidation preference (in dollars per share) \| $ / shares	1,000
Series B preferred stock, conversion price (in dollars per share) \| $ / shares	3.85
Trading price (in dollars per share) \| $ / shares	$ 7.70
Number of trading days within consecutive day trading period common stock must exceed trigger conversion price \| day	20
Series B preferred stock, threshold number of consecutive trading days \| day	30
Number of board seats elected by Series B preferred stockholders \| director	2
Series B preferred stock, maximum voting stock percentage on an as-converted basis (percent)	19.90%
Series B preferred convertible stock, dividends in arrears		$ 13,800
Series B Preferred convertible stock, shares issuable upon conversion (in shares) \| shares		29,559,946
Series B Preferred Stock \| Discounted Dividend Rate prior to Quarterly Dividend Payment ending on June 30,2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	4.00%
Series B Preferred Stock \| Perpetual Dividend Rate after Quarterly Dividend Payment ending on June 30, 2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	6.00%
Preferred Class B Convertible Stock
Dividends Payable [Line Items]
Series B preferred stock, increasing-rate dividend feature					$ 1,800
Accretion of increasing-rate dividend feature			$ 900	$ 900

Equity - Changes in Series B Preferred Stock (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)	100,000	0
Series B Preferred Stock, outstanding, beginning	$ 91,568	$ 0
Issuance of Series B Preferred Stock (in shares)		100,000
Issuance of Series B Preferred Stock		$ 59,540
Deemed dividends	$ 926	$ 32,028
Series B Preferred Stock, outstanding, ending (in shares)	100,000	100,000
Series B Preferred Stock, outstanding, ending	$ 92,494	$ 91,568

- Definition

Carrying amount, attributable to parent, of an entity's issued and outstanding stock which is not included within permanent equity. Temporary equity is a security with redemption features that are outside the control of the issuer, is not classified as an asset or liability in conformity with GAAP, and is not mandatorily redeemable. Includes any type of security that is redeemable at a fixed or determinable price or on a fixed or determinable date or dates, is redeemable at the option of the holder, or has conditions for redemption which are not solely within the control of the issuer. Includes stock with a put option held by an ESOP and stock redeemable by a holder only in the event of a change in control of the issuer.

+ References + Details

Equity - Stock Incentive Plans & Stock Options Narrative (Details)	12 Months Ended
	Dec. 31, 2022 USD ($) plan shares	Dec. 31, 2021 USD ($) shares	Dec. 31, 2020 USD ($) shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of share-based compensation plans \| plan	2
Intrinsic value of options exercised	$ 600,000	$ 3,300,000	$ 1,900,000
Proceeds from exercise of stock options	651,000	1,437,000	411,000
Tax benefit from exercise of stock options	200,000	$ 2,000,000	$ 1,600,000
Total unrecognized compensation expense	0
Shares repurchased (in shares) \| shares		41,810	148,972
Fair value of non-cash consideration received for option exercise	$ 0	$ 380,000	$ 922,000
2016 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares authorized for grant under the plan (in shares) \| shares	8,400,000

Equity - Stock Option Activity (Details)	12 Months Ended
Equity - Stock Option Activity (Details)	Dec. 31, 2022 USD ($) $ / shares shares
Number of Shares
Outstanding, beginning of period (in shares) \| shares	1,444,845
Granted (in shares) \| shares	0
Exercised (in shares) \| shares	(312,001)
Unvested options forfeited (in shares) \| shares	0
Vested options expired (in shares) \| shares	(198,950)
Outstanding, end of period (in shares) \| shares	933,894
Exercisable options, vested and expected to vest (in shares) \| shares	933,894
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share) \| $ / shares	$ 5.18
Granted (in dollars per share) \| $ / shares	0
Exercised (in dollars per share) \| $ / shares	2.09
Unvested options forfeited (in dollars per share) \| $ / shares	0
Vested options expired (in dollars per share) \| $ / shares	4.02
Outstanding, weighted average exercise price, end of period (in dollars per share) \| $ / shares	6.46
Exercisable (in dollars per share) \| $ / shares	$ 6.46
Weighted- Average Remaining Contractual Term (in years)
Outstanding (in years)	10 months 13 days
Aggregate Intrinsic Value
Outstanding \| $	$ 0
Exercisable \| $	$ 0

Equity - Restricted Stock Awards Narrative (Details) - USD ($) $ in Thousands			5 Months Ended	12 Months Ended
	Aug. 05, 2020	Aug. 04, 2020	Dec. 31, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total share-based compensation				$ 12,666	$ 14,757	$ 15,357
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized stock-based compensation related to unvested restricted stock awards				$ 19,800
Expenses expected to be recognized over a weighted-average period				1 year 8 months 19 days
Fair value of restricted stock awards vested				$ 10,900	$ 20,100	10,100
Restricted stock unit awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted share unit awards granted, fair value							$ 1,600
Total share-based compensation		$ 1,300				$ 900
Recorded liability reclassified as additional paid-in capital	$ 1,300		$ 300
Minimum \| Restricted Stock And RSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				1 year
Maximum \| Restricted Stock And RSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period				3 years

Equity - Summary of Restricted Stock Awards (Details)	12 Months Ended
Equity - Summary of Restricted Stock Awards (Details)	Dec. 31, 2022 $ / shares shares
Restricted stock awards
Number of Shares
Unvested, beginning of period (in shares) \| shares	877,197
Granted (in shares) \| shares	0
Vested (in shares) \| shares	(749,104)
Forfeited (in shares) \| shares	(5,338)
Unvested, end of period (in shares) \| shares	122,755
Weighted-Average Grant Date Fair Value
Unvested, beginning of period (in dollars per share) \| $ / shares	$ 4.26
Granted (in dollars per share) \| $ / shares	0
Vested (in dollars per share) \| $ / shares	3.95
Forfeited (in dollars per share) \| $ / shares	5.11
Unvested, end of period (in dollars per share) \| $ / shares	$ 6.13
Restricted stock unit awards
Number of Shares
Unvested, beginning of period (in shares) \| shares	4,228,919
Granted (in shares) \| shares	4,232,390
Vested (in shares) \| shares	(1,724,530)
Forfeited (in shares) \| shares	(1,961,808)
Unvested, end of period (in shares) \| shares	4,774,971
Weighted-Average Grant Date Fair Value
Unvested, beginning of period (in dollars per share) \| $ / shares	$ 8.64
Granted (in dollars per share) \| $ / shares	4.80
Vested (in dollars per share) \| $ / shares	8.33
Forfeited (in dollars per share) \| $ / shares	6.37
Unvested, end of period (in dollars per share) \| $ / shares	$ 6.28
Performance stock unit awards
Number of Shares
Unvested, beginning of period (in shares) \| shares	0
Granted (in shares) \| shares	441,965
Vested (in shares) \| shares	0
Forfeited (in shares) \| shares	(200,893)
Unvested, end of period (in shares) \| shares	241,072
Weighted-Average Grant Date Fair Value
Unvested, beginning of period (in dollars per share) \| $ / shares	$ 0
Granted (in dollars per share) \| $ / shares	4.62
Vested (in dollars per share) \| $ / shares	0
Forfeited (in dollars per share) \| $ / shares	4.62
Unvested, end of period (in dollars per share) \| $ / shares	$ 4.62

Equity - Recognized Stock-Based Compensation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Payment Arrangement, Noncash Expense [Abstract]
Total share-based compensation	$ 12,666	$ 14,757	$ 15,357
Income tax benefit, before consideration of valuation allowance	(3,132)	(3,649)	(3,792)
Total share-based compensation, net of tax benefit	9,533	11,108	11,565
Cost of sales
Share-based Payment Arrangement, Noncash Expense [Abstract]
Total share-based compensation	1,213	813	520
Selling, general and administrative expenses
Share-based Payment Arrangement, Noncash Expense [Abstract]
Total share-based compensation	9,578	13,108	14,549
Research and development expense
Share-based Payment Arrangement, Noncash Expense [Abstract]
Total share-based compensation	$ 1,875	$ 836	$ 288

Equity - Performance Stock Units (Details) - Performance stock unit awards	12 Months Ended
	Dec. 31, 2022 day shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares) \| shares	441,965
Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	100.00%
Trading days \| day	30
Executive Officer \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	50.00%
Executive Officer \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting percentage	150.00%
Executive Officer \| Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of awards that can vest during performance period	25.00%
Performance period (in years)	1 year
Executive Officer \| Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of awards that can vest during performance period	25.00%
Performance period (in years)	2 years
Executive Officer \| Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of awards that can vest during performance period	50.00%
Performance period (in years)	3 years

Equity - Fair Value Assumptions (Details) - Performance stock unit awards	12 Months Ended
	Dec. 31, 2022 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grant date fair value (in dollars per share)	$ 4.62
Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.68%
Expected term (years)	2 years 8 months 26 days
Expected volatility (annualized)	63.70%
Dividend yield	0.00%
Closing stock price on grant date (in dollars per share)	$ 4.62
Grant date fair value (in dollars per share)	$ 2.78

Equity - Employee Stock Purchase Plan (Details) - USD ($) $ in Thousands		12 Months Ended
	Jun. 07, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total share-based compensation		$ 12,666	$ 14,757	$ 15,357
Accrued compensation		21,852	$ 23,595
Employee stock purchase plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Purchase price of common stock	85.00%
Purchase period	6 months
Shares authorized for grant under the plan (in shares)	3,000,000
Total share-based compensation		200
Accrued compensation		$ 600
Shares issued during period (in shares)		0
Unrecognized stock-based compensation related to unvested restricted stock awards		$ 100
Expenses expected to be recognized over a weighted-average period		29 days

Equity - Treasury Stock (Details) - USD ($) $ in Thousands	12 Months Ended
Equity - Treasury Stock (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Deferred Compensation Arrangement with Individual, Share-based Payments [Line Items]
Aggregate purchase price	$ 1,190	$ 4,751	$ 2,334
Treasury Stock
Deferred Compensation Arrangement with Individual, Share-based Payments [Line Items]
Shares repurchased for tax withholding on vesting of restricted stock units (in shares)	249,442	469,239	435,492
Aggregate purchase price	$ 1,190	$ 4,751	$ 2,334

Revenue - Summary of Revenue by Product Type (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) product	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Revenue from Contract with Customer [Abstract]
Number of products \| product	2
Revenue, Major Customer [Line Items]
Net sales	$ 267,841	$ 258,615	$ 248,234
Advanced Wound Care
Revenue, Major Customer [Line Items]
Net sales	265,203	240,017	208,639
Tissue/Other
Revenue, Major Customer [Line Items]
Net sales	241,992	216,418	192,566
Cord
Revenue, Major Customer [Line Items]
Net sales	23,211	23,599	16,073
Section 351
Revenue, Major Customer [Line Items]
Net sales	2,379	17,610	31,828
Other
Revenue, Major Customer [Line Items]
Net sales	$ 259	$ 988	$ 7,767

- Definition

+ References

+ Details

Revenue - Summary of Revenue by Site Of Service (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) service_site	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Revenue from Contract with Customer [Abstract]
Number of sites of service \| service_site	3
Revenue, Major Customer [Line Items]
Net sales	$ 267,841	$ 258,615	$ 248,234
Hospital
Revenue, Major Customer [Line Items]
Net sales	163,206	154,580	144,285
Private Office
Revenue, Major Customer [Line Items]
Net sales	77,158	75,816	75,638
Other
Revenue, Major Customer [Line Items]
Net sales	$ 27,477	$ 28,219	$ 28,311

- Definition

+ References

+ Details

Revenue - Summary of Revenue by Customer Type (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenue, Major Customer [Line Items]
Net sales	$ 267,841	$ 258,615	$ 248,234
Direct Customers
Revenue, Major Customer [Line Items]
Net sales	261,508	250,009	240,690
Distributors
Revenue, Major Customer [Line Items]
Net sales	$ 6,333	$ 8,606	$ 7,544

- Definition

+ References

+ Details

Segment Information - Narrative (Details) - segment		6 Months Ended	12 Months Ended
Segment Information - Narrative (Details) - segment	Sep. 30, 2022	Jun. 30, 2022	Dec. 31, 2022
Segment Reporting [Abstract]
Number of reportable segments	2	1	2

Segment Information - Net Sales and Operating Income (Loss) by each Reportable Segment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Net sales	$ 267,841	$ 258,615	$ 248,234
Cost of sales	48,316	43,283	39,330
Selling, general and administrative expense	208,789	198,359	181,022
Research and development expense	22,829	17,344	11,715
Amortization of intangible assets	701	820	1,073
Investigation, restatement and related expense	12,177	3,791	59,465
Impairment of intangible assets	0	53	1,027
Operating loss	(24,971)	(5,035)	(45,398)
Supplemental information
Depreciation expense	3,345	4,363	5,782
Share-based compensation	12,666	14,757	15,357
Corporate & Other
Segment Reporting Information [Line Items]
Net sales	2,935	3,079	2,383
Cost of sales	3,854	4,424	3,289
Selling, general and administrative expense	62,902	61,866	60,437
Research and development expense	0	0	0
Amortization of intangible assets	701	820	1,073
Supplemental information
Depreciation expense	1,389	2,473	3,576
Share-based compensation	4,995	8,138	9,728
Wound & Surgical
Segment Reporting Information [Line Items]
Amortization of intangible assets		0
Wound & Surgical \| Operating Segments
Segment Reporting Information [Line Items]
Net sales	264,906	238,940	213,489
Cost of sales	44,462	35,204	30,185
Selling, general and administrative expense	145,887	123,583	103,039
Research and development expense	7,836	5,864	3,979
Amortization of intangible assets	0		0
Segment contribution	66,721	74,289	76,286
Supplemental information
Depreciation expense	1,791	1,644	1,755
Share-based compensation	6,513	5,158	4,373
Regenerative Medicine
Segment Reporting Information [Line Items]
Amortization of intangible assets		0
Regenerative Medicine \| Operating Segments
Segment Reporting Information [Line Items]
Net sales	0	16,596	32,362
Cost of sales	0	3,655	5,856
Selling, general and administrative expense	0	12,910	17,546
Research and development expense	14,993	11,480	7,736
Amortization of intangible assets	0		0
Segment contribution	(14,993)	(11,449)	1,224
Supplemental information
Depreciation expense	165	246	451
Share-based compensation	$ 1,158	$ 1,461	$ 1,256

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Deferred Tax Assets:
Net operating loss	$ 23,719	$ 23,333
Research and development and other tax credits	8,384	6,297
Interest limitation carry forward	4,898	3,970
Accrued expenses	3,501	3,385
Capitalized research and development expenditures	3,586	0
Share-based compensation	3,145	4,220
Allowance for doubtful accounts	1,033	601
Lease liabilities	962	1,277
Sales return and allowances	163	195
Accrued settlement costs	50	235
Other	885	1,115
Deferred Tax Liabilities:
Prepaid expenses	(1,400)	(1,337)
Right of use asset	(867)	(1,197)
Intangible assets	(351)	(263)
Property and equipment	(77)	(705)
Net Deferred Tax Assets	47,631	41,126
Less: Valuation allowance	(47,631)	(41,126)
Net Deferred Tax Assets after Valuation Allowance	$ 0	$ 0

Income Taxes - Reconciliation of the Federal Statutory Income Tax (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	21.00%
Tax credits	5.85%	2.01%	0.32%
Employee retention credit	0.00%	3.37%	0.00%
NOL carryback rate differential	0.00%	0.00%	10.99%
Meals and entertainment	(0.10%)	(1.13%)	(0.50%)
State taxes, net of federal benefit	(0.55%)	4.53%	(0.20%)
Uncertain tax positions	(0.58%)	0.02%	0.24%
Nondeductible compensation	(2.22%)	(13.77%)	(0.89%)
Deferred tax adjustments	(2.89%)	14.63%	0.00%
Share-based compensation	(4.03%)	23.31%	(1.24%)
Valuation allowance	(17.59%)	(52.70%)	(8.14%)
Other	0.42%	(3.73%)	(1.66%)
Effective tax rate	(0.69%)	(2.46%)	19.92%

Income Taxes - Schedule of current and deferred income tax expense (benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Current:
Federal	$ 0	$ 91	$ (12,418)
State	206	156	159
Total current	206	247	(12,259)
Deferred:
Federal	0	0	0
State	0	0	0
Total deferred	0	0	0
Total expense (benefit)	$ 206	$ 247	$ (12,259)

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
Income Taxes - Narrative (Details) - USD ($) $ in Thousands	Jan. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Operating Loss Carryforwards [Line Items]
Valuation allowance		$ 47,631	$ 41,126
Deferred tax assets, operating loss carryforwards, federal		17,800	17,700
Deferred tax assets, operating loss carryforwards, state		5,900	5,600
Unrecognized tax benefits that, if recognized, would impact effective tax rate		600	500
Accrued interest related to unrecognized tax benefits		0	0	$ 100
Unusual or Infrequent Item, or Both [Line Items]
Income tax benefit		(206)	(247)	12,259
Income tax receivable		704	743
Deferred employer tax payments			2,200
Payments of employer payroll taxes, CARES Act	$ 1,100
CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Income tax benefit				11,300
Federal tax refund			9,200	$ 1,200
Income tax receivable			900
Federal
Operating Loss Carryforwards [Line Items]
Income tax net operating loss carryforwards		84,900	109,800
State
Operating Loss Carryforwards [Line Items]
Income tax net operating loss carryforwards		$ 84,200	$ 104,200

Income Taxes - Reconciliation of unrecognized tax benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Unrecognized tax benefits, beginning of period	$ 469	$ 477	$ 627
Increases - tax positions in current period	98	20	0
Increases - tax positions in prior period	78	0	0
Decreases in prior year positions	0	(28)	(150)
Unrecognized tax benefits, end of period	$ 645	$ 469	$ 477

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities - Selected Cash Payments, Receipts, and Non-Cash Activities (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Dividends Payable [Line Items]
Cash paid for interest	$ 4,569,000	$ 4,327,000	$ 7,456,000
Income taxes paid	181,000	169,000	208,000
Cash paid for operating leases	1,567,000	1,522,000	1,569,000
Non-cash activities:
Purchases of equipment included in accounts payable	417,000	8,000	1,062,000
Lease right of use asset and liability	(37,000)	2,251,000	1,169,000
Deemed dividends of Series B Preferred Stock		926,000	32,028,000
Fair value of non-cash consideration received for option exercise	0	380,000	922,000
Amendment fee on previous term loan	0	0	722,000
Deferred financing costs	0	0	53,000
Series B Preferred Stock
Non-cash activities:
Deemed dividends of Series B Preferred Stock	0	926,000	32,028,000
Note receivable for sale of property and equipment	$ 0	$ 75,000	$ 0

Commitments and Contingencies - Estimated Annual Lease, Royalty, and Employment Agreement Expenses (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2023	$ 989
2024	394
Total Contractual commitments	$ 1,383

Commitments and Contingencies - Narrative (Details) $ in Thousands				1 Months Ended		7 Months Ended	12 Months Ended
	May 15, 2019 plaintiff	Jan. 16, 2019 class_action	Jan. 20, 2017 plaintiff	Jun. 30, 2022	Apr. 30, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Sep. 15, 2022 USD ($)	Dec. 06, 2018 action
Loss Contingencies [Line Items]
Selling, general and administrative							$ 208,789	$ 198,359	$ 181,022
Litigation liability						$ 200	200
Payments for legal settlements							700	6,700	7,400
Payments for legal settlements through insurance provider									3,500
Number of securities class actions \| class_action		2
Number of shareholder derivative actions \| action											3
Number of plaintiffs \| plaintiff	2		2
Agreed payment on claims filed by former employees					$ 6,500
Platform Intellectual Property License
Loss Contingencies [Line Items]
Contingent consideration							9,600
Licenses
Loss Contingencies [Line Items]
Payments to acquire intangible assets							1,000	0	$ 0
Insurance Providers
Loss Contingencies [Line Items]
Payments for legal settlements							600
Payments for legal settlements through insurance provider								$ 1,100
Nordic Bioscience Clinical Development A/S \| Research and Development Arrangement
Loss Contingencies [Line Items]
Long-term purchase commitment amount						13,300
Termination period (in days)				30 days
Payments made on long-term purchase commitment						2,000	2,000
Expenses on long-term purchase commitment							1,000
Remaining prepaid expenses on long-term purchase commitment						1,000	1,000
Chief Executive Officer \| Separation Agreement
Loss Contingencies [Line Items]
Other commitment						3,100	3,100			$ 3,100
Selling, general and administrative							3,100
Chief Executive Officer \| Separation Agreement \| Accrued Compensation
Loss Contingencies [Line Items]
Other commitment						1,900	1,900
Chief Executive Officer \| Separation Agreement \| Other Liabilities
Loss Contingencies [Line Items]
Other commitment						$ 1,200	$ 1,200

401(k) Plan (Details) - USD ($)	12 Months Ended
401(k) Plan (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Retirement Benefits [Abstract]
Minimum service period required to qualify for 401(k) plan (in months)	1 month
Maximum wages deferred (as percent)	90.00%
Maximum eligible wages deferred by participants per year	$ 20,500
Minimum age for additional contribution beyond normal plan	50 years
Defined benefit plan, contributions by plan participants	$ 6,500
Contributions matched by employer (as percent)	50.00%	50.00%	50.00%
Employer matching contribution of eligible compensation (as percent)	8.00%	8.00%	5.00%
Employer matching contribution	$ 3,300,000	$ 2,700,000	$ 1,500,000

Related Party Transactions (Details) - Chief Scientific Officer $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($)
Related Party - Salary
Related Party Transaction [Line Items]
Related party expenses	$ 0.2
Related Party - Sales Commissions, Equity, Incentive, and Other Compensation
Related Party Transaction [Line Items]
Related party expenses	$ 0.3

Restructuring - Narrative (Details) $ in Thousands		1 Months Ended	12 Months Ended
Restructuring - Narrative (Details) $ in Thousands	Sep. 02, 2022 USD ($)	Dec. 31, 2018 employee	Dec. 31, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2019 USD ($)
Restructuring Cost and Reserve [Line Items]
Number of positions eliminated \| employee		240
Number of positions eliminated, percentage		24.00%
Restructuring expenses			$ 0
Restructuring reserve			$ 0		$ 3,561
One-time Termination Benefits
Restructuring Cost and Reserve [Line Items]
Restructuring expenses	$ 2,000
Restructuring reserve				$ 600

Restructuring - Restructuring Reserve Liability (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2020 USD ($)
Restructuring Reserve [Roll Forward]
Liability balance, beginning	$ 3,561
Expenses	0
Cash distributions	(3,561)
Liability balance, ending	$ 0

Government Assistance (Details) - USD ($) $ in Millions	12 Months Ended
Government Assistance (Details) - USD ($) $ in Millions	Dec. 31, 2022	Dec. 31, 2021
Government Assistance [Line Items]
Government Assistance, Statement of Income or Comprehensive Income [Extensible Enumeration]	Selling, general and administrative	Selling, general and administrative
Government Assistance, Current, Statement of Financial Position [Extensible Enumeration]	Other current assets	Other current assets
Employee Retention Credit (ERC)
Government Assistance [Line Items]
Government assistance, amount received		$ 1.6
Government assistance receivable	$ 1.4	$ 1.6
Proceeds from government assistance	$ 0.2

Subsequent Events (Details) - USD ($) $ in Millions			7 Months Ended	12 Months Ended
Subsequent Events (Details) - USD ($) $ in Millions	Jan. 27, 2023	Jan. 24, 2023	Dec. 31, 2022	Dec. 31, 2022
Subsequent Event [Line Items]
Options granted (in shares)				0
Nordic Bioscience Clinical Development A/S \| Research and Development Arrangement
Subsequent Event [Line Items]
Long-term purchase commitment amount			$ 13.3
Performance stock unit awards
Subsequent Event [Line Items]
Awards granted (in shares)				441,965
Vested (in shares)				0
Subsequent Event \| Nordic Bioscience Clinical Development A/S \| Research and Development Arrangement
Subsequent Event [Line Items]
Long-term purchase commitment amount		$ 10.2
Subsequent Event \| Chief Executive Officer
Subsequent Event [Line Items]
Vested (in shares)	200,000
Subsequent Event \| Performance stock unit awards \| Chief Executive Officer
Subsequent Event [Line Items]
Awards granted (in shares)	3,300,000
Vesting period	4 years
Vesting percentage	200.00%
Subsequent Event \| Non-qualified stock option \| Chief Executive Officer
Subsequent Event [Line Items]
Options granted (in shares)	3,600,000
Vesting period	4 years
Subsequent Event \| Non-qualified stock option \| Chief Executive Officer \| Tranche One
Subsequent Event [Line Items]
Vesting percentage	25.00%
Subsequent Event \| Non-qualified stock option \| Chief Executive Officer \| Tranche Two
Subsequent Event [Line Items]
Vesting percentage	25.00%
Subsequent Event \| Non-qualified stock option \| Chief Executive Officer \| Tranche Three
Subsequent Event [Line Items]
Vesting percentage	25.00%
Subsequent Event \| Non-qualified stock option \| Chief Executive Officer \| Tranche Four
Subsequent Event [Line Items]
Vesting percentage	25.00%

Schedule II Valuation and Qualifying Accounts (Details) - Allowance for product returns - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Year	$ 2,549	$ 2,321	$ 4,115
Additions charged to Expense or Revenue	2,449	2,508	705
Deductions and write-offs	(2,304)	(2,280)	(2,499)
Balance at End of Year	$ 2,694	$ 2,549	$ 2,321