Conformis (CFMS) 10-Q 11 May 20 2020 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	Apr. 30, 2020
Document and Entity Information
Entity Registrant Name	CONFORMIS INC
Entity Central Index Key	0001305773
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Small Business	true
Entity Shell Company	false
Document Type	10-Q
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Amendment Flag	false
Entity Common Stock, Shares Outstanding		71,484,102
Entity Current Reporting Status	Yes

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current Assets
Cash and cash equivalents	$ 21,518	$ 26,394
Accounts receivable, net	8,163	11,066
Royalty receivable	150	165
Inventories, net	11,857	12,074
Prepaid expenses and other current assets	1,863	2,815
Total current assets	43,551	52,514
Property and equipment, net	13,756	13,356
Operating lease right-of-use assets	5,565	5,853
Other Assets
Restricted cash	462	462
Other long-term assets	200	211
Total assets	63,534	72,396
Current liabilities
Accounts payable	6,191	6,920
Accrued expenses	6,285	7,135
Operating lease liabilities	1,479	1,469
Advance on research and development	2,020	2,331
Total current liabilities	15,975	17,855
Other long-term liabilities	1,500	1,500
Contract liability		12,000
Long-term debt, less debt issuance costs	19,787	19,623
Operating lease liabilities	4,757	5,071
Total liabilities	54,019	56,049
Commitments and contingencies
Stockholders’ equity
Preferred stock, $0.00001 par value: Authorized: 5,000,000 shares authorized as of March 31, 2020 and December 31, 2019; no shares issued and outstanding as of March 31, 2020 and December 31, 2019	0	0
Common stock, $0.00001 par value: Authorized: 200,000,000 shares authorized as of March 31, 2020 and December 31, 2019; 71,505,724 and 70,427,400 shares issued and outstanding as of March 31, 2020 and December 31, 2019, respectively	1	1
Additional paid-in capital	523,265	521,356
Accumulated deficit	(513,498)	(504,145)
Accumulated other comprehensive loss	(253)	(865)
Total stockholders’ equity	9,515	16,347
Total liabilities and stockholders’ equity	$ 63,534	$ 72,396

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.00001	$ 0.00001
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)	$ 0.00001	$ 0.00001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	71,505,724	70,427,400
Common stock, shares outstanding	71,505,724	70,427,400

Consolidated Statements of Oper

Consolidated Statements of Operations (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Revenue
Total revenue	$ 16,475	$ 20,644
Cost of revenue	9,261	10,813
Gross profit	7,214	9,831
Operating expenses
Sales and marketing	6,563	8,181
Research and development	2,990	2,912
General and administrative	5,736	5,329
Total operating expenses	15,289	16,422
Loss from operations	(8,075)	(6,591)
Other income and expenses
Interest income	35	107
Interest expense	(574)	(453)
Foreign currency exchange transaction loss	(714)	(653)
Total other expenses	(1,253)	(999)
Loss before income taxes	(9,328)	(7,590)
Income tax provision	25	(9)
Net loss	$ (9,353)	$ (7,581)
Net loss per share - basic and diluted (in dollars per share)	$ (0.14)	$ (0.12)
Weighted average common shares outstanding - basic and diluted (in shares)	67,274,391	62,849,335
Product
Revenue
Total revenue	$ 16,290	$ 20,469
Royalty
Revenue
Total revenue	$ 185	$ 175

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss (unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Statement of Comprehensive Income [Abstract]
Net loss	$ (9,353)	$ (7,581)
Other comprehensive income
Foreign currency translation adjustments	612	620
Comprehensive loss	$ (8,741)	$ (6,961)

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholder's Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Deficit	Accumulated other comprehensive income (loss)	LPC Offering	LPC OfferingCommon Stock	LPC OfferingAdditional Paid-In Capital	At The Market Offering	At The Market OfferingAdditional Paid-In Capital
Beginning balance (in shares) at Dec. 31, 2018		65,290,879
Beginning balance at Dec. 31, 2018	$ 36,200	$ 1	$ 513,336	$ (475,667)	$ (1,470)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		2,589,785
Compensation expense related to issued stock options and restricted stock awards	1,148		1,148
Net loss	(7,581)			(7,581)
Other comprehensive income (loss)	620				620
Ending balance (in shares) at Mar. 31, 2019		67,880,664
Ending balance at Mar. 31, 2019	$ 30,387	$ 1	514,484	(483,248)	(850)
Beginning balance (in shares) at Dec. 31, 2019	70,427,400	70,427,400
Beginning balance at Dec. 31, 2019	$ 16,347	$ 1	521,356	(504,145)	(865)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		78,324
Issuance of common stock—restricted stock	2
Issuance of common stock (in shares)							1,000,000
Issuance of common stock						$ 1,143		$ 1,143	$ (2)	$ (2)
Compensation expense related to issued stock options and restricted stock awards	766		766
Net loss	(9,353)
Other comprehensive income (loss)	$ 612				612
Ending balance (in shares) at Mar. 31, 2020	71,505,724	71,505,724
Ending balance at Mar. 31, 2020	$ 9,515	$ 1	$ 523,265	$ (513,498)	$ (253)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net loss	$ (9,353)	$ (7,581)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization expense	1,077	1,065
Stock-based compensation expense	766	1,148
Unrealized foreign exchange loss	675	639
Non-cash lease expense	288	310
Provision for bad debts on trade receivables	23	0
Non-cash interest expense	175	26
Amortization/accretion on investments	0	(4)
Changes in operating assets and liabilities:
Accounts receivable	2,881	252
Royalty receivable	15	(3)
Inventories	216	(27)
Prepaid expenses and other assets	952	(69)
Accounts payable, accrued expenses and other liabilities	(1,883)	330
Advance on research and development	(310)	(324)
Net cash used in operating activities	(4,478)	(4,238)
Cash flows from investing activities:
Acquisition of property and equipment	(1,477)	(757)
Maturity of investments	0	7,250
Net cash (used in) provided by investing activities	(1,477)	6,493
Cash flows from financing activities:
Net proceeds from issuance of common stock	1,141	0
Net cash provided by financing activities	1,141	0
Foreign exchange effect on cash and cash equivalents	(62)	(19)
(Decrease) increase in cash, cash equivalents and restricted cash	(4,876)	2,236
Cash, cash equivalents and restricted cash beginning of period	26,856	16,842
Cash, cash equivalents and restricted cash end of period	21,980	19,078
Supplemental information:
Cash paid for interest	346	331
Noncash Investing and Financing Items [Abstract]
Operating leases right-of-use assets obtained in exchange for lease obligations	$ 0	$ 6,988

Organization and Basis of Prese

Organization and Basis of Presentation	3 Months Ended
	Mar. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Conformis, Inc., and its subsidiaries (collectively, the “Company”), is a medical technology company that uses its proprietary iFit Image-to-Implant technology platform to develop, manufacture and sell joint replacement implants that are individually sized and shaped, which the Company refers to as personalized, to fit each patient’s unique anatomy. The Company’s proprietary iFit technology platform is potentially applicable to all major joints. The Company offers a broad line of personalized knee implants designed to restore the natural shape of a patient’s knee. The Company was incorporated in Delaware and commenced operations in 2004. The Company introduced its iUni and iDuo in 2007, its iTotal CR in 2011, its iTotal PS in 2015, and its Conformis Hip System in 2018. The Company has its corporate offices in Billerica, Massachusetts. These consolidated financial statements as of March 31, 2020 and for the three months ended March 31, 2020 and 2019 , and related interim information contained within the notes to the Consolidated Financial Statements, have been prepared assuming that the Company will continue as a going concern, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. Liquidity and operations Since the Company’s inception in June 2004, it has financed its operations primarily through private placements of preferred stock, its initial public offering in July 2015, other equity financings, debt and convertible debt financings, equipment purchase loans, patent licensing, and product revenue beginning in 2007. The Company has not yet attained profitability and continues to incur operating losses and negative operating cash flows, which adversely impacts the Company's ability to continue as a going concern. At March 31, 2020 , the Company had an accumulated deficit of $513.5 million and cash and cash equivalents of $21.5 million , and $0.5 million in restricted cash allocated to lease deposits. In December 2019, a human infection originating in China was traced to a novel strain of coronavirus. The virus has subsequently spread to other parts of the world, including the United States and Europe, and has caused unprecedented disruptions in the global economy as efforts to contain the spread of the virus have intensified. In March 2020, the World Health Organization declared this coronavirus outbreak (COVID-19) to be a pandemic. The future progression of the pandemic and its effects on the Company's business and operations are highly uncertain. The Company has experienced significantly decreased demand for its products and expects further unpredictable and potentially significant reductions in demand for its products as healthcare providers and individuals de-prioritize and defer medical procedures that are not deemed to be a high priority, such as joint replacement procedures, which will have a material adverse effect on its business, operations and financial condition. On March 20, 2020, the Company provided notice to its employees of a furlough of approximately 80 employees, effective as of March 23, 2020, to help address decreased demand for its products. The furlough resulted in limited production capacity at the Company's manufacturing facilities, but sufficient to meet expected demand. While the Company does not currently anticipate significant interruptions in its supply chain, extended or additional quarantines, travel restrictions and other measures may significantly impact the ability of employees of its third-party suppliers to get to their places of work to manufacture the key components and materials necessary for our products. The Company has experienced and may experience further shortages of mask and gown consumables used in its clean room processes, which may further limit the production capacity and further delay the joint replacement procedures in which its products are used. The Company's employee furlough and any delay or shortage of such components or materials or delays in delivering its products may result in its inability to satisfy consumer demand for its products in a timely manner or at all, which could harm its reputation, future sales, profitability and financial condition. On April 17, 2020, the Company entered into an approximately $4.7 million promissory note (the “PPP Note”) with East West Bank as the lender under the Paycheck Protection Program (“PPP”) offered by the U.S. Small Business Administration (the "SBA") to mitigate the negative financial and operational impacts of the coronavirus (COVID-19) pandemic. For further information regarding the PPP Note, see "Note L-Subsequent Events" to the consolidated financial statements appearing in this Quarterly Report on Form 10Q. On April 23, 2020, the Company accelerated a plan to return to full-time employment the vast majority of those employees who were furloughed on March 23, 2020. Due to the reductions in demand for its products as a result of the COVID-19 pandemic, the Company does not expect to satisfy the trailing six months' revenue covenant at the end of June 2020, which may be an event of default under the 2019 Secured Loan Agreement unless a new financial plan, which would include the sale and issuance of new securities, is agreed upon between parties within a 60-day cure period after June 30, 2020. If the company fails to meet such revenue covenant as of June 30, 2020 and the parties fail to agree upon a new financial plan within the 60-day cure period after June 30, 2020, Innovatus would be permitted to exercise remedies against the Company and its assets, including charging interest at the rate that is otherwise applicable plus 5.0%, taking control of the Company's cash and commencing foreclosure proceedings on the Company's other assets. The Company is in initial discussions with Innovatus with the goal of adjusting the revenue covenants under the 2019 Secured Loan Agreement, but there can be no guarantee that these discussions will be successful. If the Company is unsuccessful in the discussions with Innovatus, the Company would need to refinance this debt prior to Innovatus exercising remedies against the Company in order to prevent such exercise of remedies. The Company may not be able to obtain additional financing on terms favorable to the Company, or at all. Accordingly, this factor raises substantial doubt about the Company's ability to continue as a going concern. The Company’s consolidated financial statements have been prepared assuming that the Company will continue as a going concern, which contemplates the realization of assets and the settlement of liabilities and commitments in the normal course of business. The financial statements for the three months ended March 31, 2020, do not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or the amounts and classification of liabilities that may result from uncertainty related to the Company’s ability to continue as a going concern. The Company may need to engage in additional equity or debt financings to secure additional funds. The Company may not be able to obtain additional financing on terms favorable to it, or at all. To the extent that the Company raises additional capital through the future sale of equity or debt, the ownership interests of its existing stockholders will be diluted. The terms of these future equity or debt securities may include liquidation or other preferences that adversely affect the rights of the Company's existing common stockholders or involve negative covenants that restrict the Company's ability to take specific actions, such as incurring additional debt or making capital expenditures. In January 2017, the Company filed a shelf registration statement on Form S-3, which was declared effective by the Securities and Exchange Commission ("SEC") on May 9, 2017 (the "Existing Shelf Registration Statement"). The Existing Shelf Registration Statement allows the Company to sell from time to time up to $200 million of common stock, preferred stock, debt securities, warrants, or units comprised of any combination of these securities, for its own account in one or more offerings. On May 10, 2017, the Company filed with the SEC a prospectus supplement, for the sale and issuance of up to $50 million of its common stock and entered into a Distribution Agreement (“Distribution Agreement”) with Canaccord Genuity Inc. ("Canaccord") pursuant to which Canaccord agreed to sell shares of the Company's common stock from time to time, as its agent, in an “at-the-market” ("ATM") offering as defined in Rule 415 promulgated under the U.S. Securities Act of 1933, as amended (the "Securities Act"). The Company is not obligated to sell any shares under the Distribution Agreement. As of March 31, 2020 , the Company had sold 1,870,069 shares under the Distribution Agreement resulting in net proceeds of $3.6 million . On March 23, 2020, the Company filed a new shelf registration statement on Form S-3 (the "New Shelf Registration Statement"). Once the New Shelf Registration Statement is declared effective by the SEC, the Existing Shelf Registration Statement will expire. Under the New Shelf Registration Statement, the Company will be permitted to sell from time to time up to $200 million of common stock, preferred stock, debt securities, warrants, or units comprised of any combination of these securities, for its own account in one or more offerings. The New Shelf Registration Statement is intended to provide the Company flexibility to conduct sales of its registered securities, subject to market conditions and our future capital needs. The terms of any offering under the New Shelf Registration Statement will be established at the time of such offering and will be described in a prospectus supplement filed with the SEC prior to the completion of any such offering. On December 17, 2018, the Company entered into a stock purchase agreement (the "Stock Purchase Agreement") with Lincoln Park Capital ("LPC"). Upon entering into the Stock Purchase Agreement, the Company sold 1,921,968 shares of common stock for $1.0 million to LPC, representing a premium of 110% to the previous day's closing price. As consideration for LPC’s commitment to purchase shares of common stock under the Stock Purchase Agreement, the Company issued 354,430 shares to LPC. The Company has the right at its sole discretion to sell to LPC up to $20.0 million worth of shares over a 36 -month period subject to the terms of the Stock Purchase Agreement. The Company controls the timing of any sales to LPC and LPC will be obligated to make purchases of the Company's common stock upon receipt of requests from the Company in accordance with the terms of the Stock Purchase Agreement. There are no upper limits to the price per share LPC may pay to purchase up to $20.0 million worth of common stock subject to the Stock Purchase Agreement, and the purchase price of the shares will be based on the then prevailing market prices of the Company's shares at the time of each sale to LPC as described in the Stock Purchase Agreement, provided that LPC will not be obligated to make purchases of the Company's common stock pursuant to receipt of a request from the Company on any business day on which the last closing trade price of the Company's common stock on the Nasdaq Capital Market (or alternative national exchange in accordance with the Stock Purchase Agreement) is below a floor price of $0.25 per share. No warrants, derivatives, financial or business covenants are associated with the Stock Purchase Agreement and LPC has agreed not to cause or engage in any manner whatsoever, any direct or indirect short selling or hedging of shares of the Company's common stock. The Stock Purchase Agreement may be terminated by the Company at any time, at the Company's sole discretion, without any cost or penalty. As of March 31, 2020 , the Company has sold 2,921,268 shares under the Stock Purchase Agreement resulting in proceeds of $2.2 million . On June 25, 2019, the Company entered into a Loan and Security Agreement (the "2019 Secured Loan Agreement") with Innovatus Life Sciences Lending Fund I, LP ("Innovatus"), as collateral agent and lender, East West Bank and the other lenders party thereto from time to time (collectively, the "Lenders"), pursuant to which the Lenders agreed to make term loans and revolving credit facility to the Company to repay existing indebtedness, for working capital and general business purposes, in a principal amount of up to $30 million . The Company used the proceeds from the debt financings to pay off its senior secured loan and security agreement (the "2017 Secured Loan Agreement") with Oxford Finance LLC ("Oxford"). In addition, Innovatus purchased approximately $3 million of the Company's common stock at the previous day's closing price (the "Private Placement"). For further information regarding the 2017 Secured Loan Agreement and the 2019 Secured Loan Agreement, see “Note I—Debt and Notes Payable” in the financial statements and related notes appearing elsewhere in this Quarterly Report on Form 10-Q. On September 30, 2019, the Company entered into an Asset Purchase Agreement (the "Asset Purchase Agreement") with Howmedica Osteonics Corp., a subsidiary of Stryker Corporation also known as Stryker Orthopaedics ("Stryker"). In connection with entering into the Asset Purchase Agreement, the Company and Stryker also entered into a Development Agreement (the "Development Agreement"), a License Agreement (the "License Agreement"), a Distribution Agreement (the "Distribution Agreement" and together with the Asset Purchase Agreement, the Development Agreement and the License Agreement (the "Stryker Agreements") and other ancillary agreements contemplated by the Stryker Agreements. Under the terms of the Stryker Agreements, the Company agreed to sell and license to Stryker certain assets relating to the Company's patient-specific instrumentation technology, and to develop, manufacture, and supply patient-specific instrumentation for use in connection with Stryker's "off-the-shelf" non-personalized knee implant offerings. The Company received $14 million upfront and is eligible to receive up to an additional $16 million in milestone payments pursuant to the License Agreement and the Development Agreement. As of March 31, 2020 , the Company completed the first of three milestones set forth in the License Agreement and the Development Agreement and received $2.0 million for achievement of this milestone. Under the long-term Distribution Agreement, the Company will supply patient specific instrumentation to Stryker. The Stryker Agreements contain termination provisions pursuant to which, under certain circumstances, Stryker may be able to terminate the Development Agreement and oblige the Company to repay a portion of the initial payment. In other circumstances, Stryker could terminate and pay an additional fee for the right to use the Company's intellectual property to sell patient-specific instrumentation with their off-the-shelf knee offering, subject to paying the Company a sales-based royalty fee. The Company funds its operations, capital expenditure requirements and debt service with existing cash and cash equivalents as of March 31, 2020 , anticipated revenue from operations, the successful completion of the milestones set forth in the Development Agreement and License Agreement, revenue that may be generated in connection with licensing its intellectual property, available sales of shares under the Distribution Agreement and the Stock Purchase Agreement, and available borrowings under the revolving credit facility. In order for the Company to meet its operating plan, gross margin improvements and operating expense reductions will be necessary to reduce cash used in operations, and the Company will need to successfully complete milestones set forth in the Development Agreement and the License Agreement and successfully renegotiate its debt, none of which can be assured. When the Company needs additional equity or debt financing proceeds to fund its operations, the Company may not be able to obtain additional financing on terms favorable to the Company, or at all. Basis of presentation and use of estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States 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 amounts of revenue and expenses during the reporting periods. The most significant estimates used in these consolidated financial statements include revenue recognition, accounts receivable valuation, inventory reserves, purchase accounting, impairment assessments, equity instruments, stock compensation, income tax reserves and related allowances, and the lives of property and equipment, and valuation of right-of-use lease assets and lease liabilities. Actual results may differ from those estimates. The interim financial statements should be read in conjunction with the audited financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 . Unaudited Interim Financial Information The accompanying Interim Consolidated Financial Statements as of March 31, 2020 and for the three months ended March 31, 2020 and 2019 , and related interim information contained within the notes to the Consolidated Financial Statements are unaudited. These unaudited interim consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States ("U.S. GAAP"). In management’s opinion, the unaudited interim consolidated financial statements have been prepared on the same basis as the audited financial statements and include all adjustments (including normal recurring adjustments) necessary for the fair presentation of the Company’s financial position as of March 31, 2020 , results of operations for and stockholders' equity for the three months ended March 31, 2020 and 2019 , and comprehensive loss, and cash flows for the three months ended March 31, 2020 and 2019 . The results for the three months ended March 31, 2020 are not necessarily indicative of the results expected for the full year or any interim period.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies The Company's financial results are affected by the selection and application of accounting policies and methods. There were no material changes in the three months ended March 31, 2020 to the application of significant accounting policies and estimates as described in its audited consolidated financial statements for the year ended December 31, 2019 . Concentrations of credit risk and other risks and uncertainties Financial instruments that subject the Company to credit risk primarily consist of cash, cash equivalents, and accounts receivable. The Company maintains the majority of its cash with accredited financial institutions. The Company and its contract manufacturers rely on sole source suppliers and service providers for certain components. There can be no assurance that a shortage or stoppage of shipments of the materials or components that the Company purchases will not result in a delay in production or adversely affect the Company’s business. On an ongoing basis, the Company validates alternate suppliers relative to certain key components as needed. For the three months ended March 31, 2020 and 2019 , no customer represented greater than 10% of revenue. There were no customers that represented greater than 10% of the total gross receivable balance as of March 31, 2020 or December 31, 2019 . Principles of consolidation The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries ImaTx, Inc. ("ImaTx"); ConforMIS Europe GmbH; ConforMIS UK Limited; ConforMIS Hong Kong Limited; and Conformis Cares LLC. All intercompany balances and transactions have been eliminated in consolidation. Cash, cash equivalents and restricted cash The Company considers all highly liquid investment instruments with original maturities of 90 days or less when purchased, to be cash equivalents. The Company’s cash equivalents consist of demand deposits , money market accounts, money market funds, and repurchase agreements on deposit with certain financial institutions, in addition to cash deposits in excess of federally insured limits. Demand deposits and money market accounts are carried at cost which approximates their fair value. Money market funds are carried at fair value based upon level 1 inputs. Repurchase agreements are valued using level 2 inputs. The associated risk of concentration is mitigated by banking with credit worthy financial institutions. The Company had $0.4 million as of March 31, 2020 and $0.8 million as of December 31, 2019 held in foreign bank accounts that are not federally insured. In addition, the Company has recorded restricted cash of $0.5 million as of March 31, 2020 and December 31, 2019 . Restricted cash consisted of security provided for lease obligations. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown in the consolidated statements of cash flows. March 31, December 31, Cash and cash equivalents $ 21,518 $ 26,394 Restricted cash 462 462 Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 21,980 $ 26,856 Fair value of financial instruments Certain of the Company’s financial instruments, including cash and cash equivalents (excluding money market funds), accounts receivable, accounts payable, accrued expenses and other liabilities are carried at cost, which approximates their fair value because of the short-term maturity. Based on borrowing rates currently available to the Company for loans with similar terms, the carrying value of the Company’s long-term debt approximates its fair value. Accounts receivable and allowance for doubtful accounts Accounts receivable consist of billed and unbilled amounts due from medical facilities or independent distributors (the "Customer"). Upon completion of a procedure, revenue is recognized and an unbilled receivable is recorded. Under ASC No. 2014-09, Revenue from Contracts with Customers ("Topic 606" or "ASC 606"), an enforceable contract is met either at or prior to the procedure being performed. Upon receipt of a purchase order from the Customer, a billed receivable is recorded and the unbilled receivable is reversed. As a result, the unbilled receivable balance fluctuates based on the timing of the Company's receipt of purchase orders from the medical facilities. In estimating whether accounts receivable can be collected, the Company performs evaluations of customers and continuously monitors collections and payments and estimates an allowance for doubtful accounts based on the aging of the underlying invoices, collections experience to date and any specific collection issues that have been identified. The allowance for doubtful accounts is recorded in the period in which revenue is recorded or when collection risk is identified. Inventories Inventories consist of raw materials, work-in-process components and finished goods. Inventories are stated at the lower of cost, determined using the first-in first-out method, or net realizable value. The Company regularly reviews its inventory quantities on hand and related cost and records a provision for any excess or obsolete inventory based on its estimated forecast of product demand and existing product configurations. The Company also reviews its inventory value to determine if it reflects the lower of cost or market, based on net realizable value. Appropriate consideration is given to inventory items sold at negative gross margin, purchase commitments and other factors in evaluating net realizable value. During the three months ended March 31, 2020 and 2019 , the Company recognized provisions of $1.0 million and $0.5 million , respectively, to adjust its inventory value to the lower of cost or net realizable value for estimated unused product related to known and potential cancelled cases, which is included in cost of revenue. Property and equipment Property and equipment is stated at cost less accumulated depreciation and is depreciated using the straight-line method over the estimated useful lives of the respective assets. Leasehold improvements are amortized over their useful life or the life of the lease, whichever is shorter. Assets capitalized under capital leases are amortized in accordance with the respective class of assets and the amortization is included with depreciation expense. Maintenance and repair costs are expensed as incurred. Long-Lived Assets The Company tests impairment of long-lived assets when events or changes in circumstances indicate that the assets might be impaired. The amount of impairment, if any, is measured based on fair value, which is determined using estimated undiscounted cash flows to be generated from such assets or group of assets. During the three months ended March 31, 2020 , there were changes in circumstances that led the Company to believe that its long-lived assets may be impaired and as such, a Step 2 analysis was performed. The Company evaluated whether the estimated undiscounted cash flows, including estimated residual value, generated from the asset group were sufficient to support the carrying value of the assets. If the cash flow estimates or the significant operating assumptions upon which they are based change in the future, the Company may be required to record impairment charges. During the three months ended March 31, 2020 and 2019, no such impairment charges were recognized. Leases The Company adopted ASU No. 2016-02-Leases ("Topic 842" or "ASC 842"), as of January 1, 2019, in accordance with ASU No. 2018-11-Leases (Topic 842) ("ASU 2018-11"), issued by the FASB in July 2018. ASU 2018-11 allows an entity to elect not to recast its comparative periods in the period of adoption when transitioning to ASC 842 (the “Comparatives Under 840 Option”). Effectively, an entity would be permitted to change its date of initial application to the beginning of the period of adoption of ASC 842. In doing so, the entity would apply ASC 840 in the comparative periods and provide the disclosures required by ASC 840 for all periods that continue to be presented in accordance with ASC 840. Further, the entity would recognize the effects of applying ASC 842 as a cumulative-effect adjustment to retained earnings as of the effective date. Under the Comparatives Under 840 Option, this date would represent the date of initial application. The Company is not required to restate comparative periods for the effects of applying ASC 842, provide the disclosures required by ASC 842 for the comparative periods, nor change how the transition requirements apply, only when the transition requirements apply. The Company elected to report results for periods after January 1, 2019 under ASC 842 and prior period amounts are reported in accordance with ASC 840. The Company has elected not to separate non-lease components from all classes of leases. Non-lease components have been accounted for as part of the single lease component to which they are related. Leases with an initial term of 12 months or less are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. The Company has elected the hindsight practical expedient to determine the lease term for existing leases. This practical expedient enables an entity to use hindsight in determining the lease term when considering options to extend and terminate leases as well as purchase the underlying assets. Adoption of the new standard resulted in the recording of additional right-of-use assets and lease liabilities of $7.0 million and $7.7 million , respectively, as of January 1, 2019. The difference between the additional lease assets and lease liabilities is related to deferred rent, which was previously recorded as deferred rent within Accrued expenses and Other long-term liabilities under ASC 840. The operating lease right-of-use assets are subsequently assessed for impairment in accordance with the Company's accounting policy for long-lived assets. The adoption of the standard did not impact the Company’s consolidated net earnings and had no impact on cash flows. Revenue Recognition Product Revenue Recognition Revenue is recognized when, or as, obligations under the terms of a contract are satisfied, which occurs when control of the promised products or services is transferred to customers. Revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer (“transaction price”). When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying the practical expedient in paragraph 606-10-32-18, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component as of March 31, 2020 . Payment is typically due between 30 - 60 days from invoice. To the extent that the transaction price includes variable consideration, such as prompt-pay discounts or rebates, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value to which the Company expects to be entitled. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Actual amounts of consideration ultimately received may differ from the Company's estimates. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. If the contract contains a single performance obligation, the entire transaction price is allocated to the single performance obligation. Contracts that contain multiple performance obligations require an allocation of the transaction price based on the estimated relative standalone selling prices of the promised products or services underlying each performance obligation. The Company determines standalone selling prices based on observable prices or a cost-plus margin approach when one is not available. Revenue is recognized at the time the related performance obligation is satisfied by transferring control of a promised good or service to a customer. The Company's performance obligations are satisfied at the same time, typically upon surgery, therefore, product revenue is recognized at a point in time upon completion of the surgery. Since the Company does not have contracts that extend beyond a duration of one year, there is no transaction price related to performance obligations that have not been satisfied. Certain customer contracts include terms that allow the Company to bill for orders that are cancelled after the product is manufactured and could result in revenue recognition over time. However, the impact of adopting over time revenue recognition was deemed immaterial. Unconditional rights to consideration are reported as receivables. Incidental items that are immaterial in the context of the contract are recognized as expense. Royalty Revenue Recognition The Company receives ongoing sales-based royalties under its agreement with MicroPort Orthopedics Inc, a wholly owned subsidiary of Microport Scientific Corporation. Royalty revenue is recorded at the expected value of the royalty revenue. On September 30, 2019 the Company entered into the Stryker Agreements. The Company determined that the Asset Purchase Agreement and the License Agreement are within the scope of ASC 606. Under the Asset Purchase Agreement and License Agreement, the Company is required to provide certain assets and the right to use the license for a specific purpose. The assets and the right to use the license are highly interdependent and is considered one performance obligation. The Company bifurcated the total transaction price of $ 30.0 million into two components; $ 5.0 million related to cost reimbursement for other services (development) and $ 25.0 million allocated to royalty revenue determined using the residual approach by deducting the cost reimbursement component from the total transaction price. The arrangement does not contain a significant financing component. The Company records a contract liability when there is an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer. The Company has concluded that Stryker meets the definition of a customer for a portion of the obligations under the Stryker Agreements. At March 31, 2020 , the Company recorded $12.0 million as a long-term contract liability related to consideration received from the customer under the Asset Purchase Agreement and Development Agreement. The Company concluded the license rights under the License Agreement are functional when FDA 510(k) clearance is received as required under Milestone 3 in the License Agreement, or upon termination by Stryker and Stryker's election to purchase the license rights. Disaggregation of Revenue See " Note K—Segment and Geographic Data " for disaggregated product revenue by geography. Variable Consideration Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which reserves are established and which result from rebates that are offered within contracts between the Company and some of its customers. The amount of variable consideration which is included in the transaction price may be constrained, and is included in the net sales price only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in a future period. The following table summarizes activity for rebate allowance reserve (in thousands): March 31, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 48 145 Adjustment related to prior period sales — 20 Payments or credits issued to customer (14 ) (134 ) Ending Balance $ 161 $ 127 Costs to Obtain and Fulfill a Contract The Company currently expenses commissions paid for obtaining product sales. Sales commissions are paid following the manufacture and implementation of the implant. Due to the period being less than one year, the Company will apply the practical expedient, whereby the Company recognizes the incremental costs of obtaining contracts as an expense when incurred if the amortization period of the assets that the Company otherwise would have recognized is one year or less. These costs are included in sales and marketing expense. Further, the Company incurs costs to buy, build, replenish, restock, sterilize and replace the reusable instrumentation trays associated with the sale of its products and services. The reusable instrument trays are not contract specific and are used for multiple contracts and customers, therefore does not meet the criteria to capitalize under ASC 606. Shipping and handling costs Shipping and handling activities prior to the transfer of control to the customer (e.g. when control transfers after delivery) are considered fulfillment activities, and not performance obligations. Amounts invoiced to customers for shipping and handling are classified as revenue. Shipping and handling costs incurred are included in general and administrative expense. Shipping and handling expense was $0.4 million and $0.6 million for the three months ended March 31, 2020 and 2019 , respectively. Taxes collected from customers and remitted to government authorities The Company’s policy is to present taxes collected from customers and remitted to government authorities on a net basis and not to include tax amounts in revenue. Research and development expense The Company’s research and development costs consist of engineering, product development, quality assurance, clinical and regulatory expense. These costs primarily relate to employee compensation, including salary, benefits and stock-based compensation. The Company also incurs costs related to consulting fees, revenue share, materials and supplies, and marketing studies, including data management and associated travel expense. Research and development costs are expensed as incurred. Advertising expense Advertising costs are expensed as incurred, which are included in sales and marketing. Advertising expense was $0.2 million and $0.1 million for the three months ended March 31, 2020 and 2019 , respectively. Segment reporting Operating segments are defined as components of an enterprise about which separate financial information is available and is evaluated on a regular basis by the chief operating decision-maker, or decision-making group, in deciding how to allocate resources to an individual segment and in assessing performance of the segment. The Company’s chief operating decision-maker is its chief executive officer. The Company’s chief executive officer reviews financial information presented on an aggregate basis for purposes of allocating resources and evaluating financial performance. The Company has one business segment and there are no segment managers who are held accountable for operations, operating results and plans for products or components below the aggregate Company level. Accordingly, in light of the Company’s current product offerings, management has determined that the primary form of internal reporting is aligned with the offering of the Conformis personalized joint replacement products and that the Company operates as one segment. See “ Note K—Segment and Geographic Data .” Foreign currency translation and transactions The assets and liabilities of the Company’s foreign operations are translated into U.S. dollars at current exchange rates at the balance sheet date, and income and expense items are translated at average rates of exchange prevailing during the quarter. Net translation gains and losses are recorded in Accumulated other comprehensive (loss) income. Gains and losses from foreign currency transactions denominated in foreign currencies, including intercompany balances not of a long-term investment nature, are included in the Consolidated Statements of Operations. Income taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax bases, operating losses and tax credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized as income in the period that includes the enactment date. In evaluating the need for a valuation allowance, the Company considers all reasonably available positive and negative evidence, including recent earnings, expectations of future taxable income and the character of that income. In estimating future taxable income, the Company relies upon assumptions and estimates of future activity including the reversal of temporary differences. Presently, the Company believes that a full valuation allowance is required to reduce deferred tax assets to the amount expected to be realized. The tax benefit from an uncertain tax position is only recognized if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from these positions are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate resolution. The Company reviews its tax positions on an annual basis and more frequently as facts surrounding tax positions change. Based on these future events, the Company may recognize uncertain tax positions or reverse current uncertain tax positions, the impact of which would affect the consolidated financial statements. The Company has operations in Germany. The operating results of German operations will be permanently reinvested in that jurisdiction. As a result, the Company has only provided for income taxes at local rates when required. In April 2020, new interpretations of a German law related to intellectual property and withholding tax were released. The Company is currently evaluating whether the interpretations will have an impact on its consolidated financial statements. The Company is subject to U.S. federal, state, and foreign income taxes. The Company recorded a provision for income taxes of $25,000 and $(9,000) for the three months ended March 31, 2020 and 2019 , respectively. The Company recognizes interest and penalties related to income taxes as a component of income tax expense. As of March 31, 2020 and 2019 , a cumulative balance of $55,000 and $47,000 of interest and penalties had been accrued, respectively. On March 27, 2020, the U.S government enacted the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") which included modifications to the limitation on business interest expense, net operating loss provisions, and other various U.S. tax law updates. The Company does not expect that these aspects of the CARES Act will have a material impact on its consolidated financial statements. Stock-based compensation The Company accounts for stock-based compensation in accordance with ASC 718, Stock Based Compensation. ASC 718 requires all stock-based payments to employees and consultants, including grants of stock options, to be recognized in the consolidated statements of operations based on their fair values. The Company uses the Black-Scholes option pricing model to determine the weighted-average fair value of options granted and recognizes the compensation expense of stock-based awards on a straight-line basis over the vesting period of the award. The determination of the fair value of stock-based payment awards utilizing the Black-Scholes option pricing model is affected by the stock price, exercise price, and a number of assumptions, including expected volatility of the stock, expected life of the option, risk-free interest rate and expected dividends on the stock. The Company evaluates the assumptions used to value the awards at each grant date and if factors change and different assumptions are utilized, stock-based compensation expense may differ significantly from what has been recorded in the past. If there are any modifications or cancellations of the underlying unvested securities, the Company may be required to accelerate, increase or cancel any remaining unearned stock-based compensation expense. Net loss per share The Company calculates net income (loss) per share in accordance with ASC 260, "Earnings per Share." Basic earnings per share (“EPS”) is calculated by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period, without consideration for common stock equivalents. Diluted EPS is computed by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share attributable to stockholders (in thousands, except share and per share data): Three Months Ended March 31, (in thousands, except share and per share data) 2020 2019 Numerator: Basic and diluted loss per share Net loss $ (9,353 ) $ (7,581 ) Denominator: Basic and diluted weighted average shares 67,274,391 62,849,335 Loss per share attributable to Conformis, Inc. stockholders: Basic and diluted $ (0.14 ) $ (0.12 ) The following table sets forth potential shares of common stock equivalents that are not included in the calculation of diluted net loss per share because to do so would be anti-dilutive as of the end of each period presented: Three Months Ended March 31, 2020 2019 Stock options and restricted stock awards 1,099,413 2,538,495

Accounts Receivable

Accounts Receivable	3 Months Ended
	Mar. 31, 2020
Accounts Receivable, Net, Current [Abstract]
Accounts Receivable	Accounts Receivable Accounts receivable consisted of the following (in thousands): March 31, December 31, Total receivables $ 8,495 $ 11,401 Allowance for doubtful accounts and returns (332 ) (335 ) Accounts receivable, net $ 8,163 $ 11,066 Accounts receivable included unbilled receivable of $0.7 million and $2.1 million at March 31, 2020 and December 31, 2019 , respectively. Write-offs related to accounts receivable were approximately $5,000 and $0 for the three months ended March 31, 2020 and 2019 , respectively. Summary of allowance for doubtful accounts and returns activity was as follows (in thousands): March 31, December 31, Beginning balance $ (335 ) $ (390 ) Provision for bad debts on trade receivables (23 ) (106 ) Other allowances 31 (26 ) Accounts receivable write offs (5 ) 187 Ending balance $ (332 ) $ (335 )

Inventories

Inventories	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventories	Inventories Inventories consisted of the following (in thousands): March 31, December 31, Raw Material $ 5,373 $ 6,171 Work in process 1,498 1,717 Finished goods 4,986 4,186 Total Inventories $ 11,857 $ 12,074

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following (in thousands): Estimated March 31, 2020 December 31, 2019 Equipment 5-7 $ 19,210 $ 19,011 Furniture and fixtures 5-7 864 864 Computer and software 3 9,535 9,561 Leasehold improvements 3-7 2,047 2,008 Reusable instruments 5 4,667 3,402 Total property and equipment 36,323 34,846 Accumulated depreciation (22,567 ) (21,490 ) Property and equipment, net $ 13,756 $ 13,356 Depreciation expense related to property and equipment was $1.1 million and $1.0 million for the three months ended March 31, 2020 and 2019 , respectively.

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2020
Accrued Liabilities and Other Liabilities [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consisted of the following (in thousands): March 31, December 31, Accrued employee compensation $ 2,329 $ 3,198 Accrued legal expense 569 310 Accrued consulting expense 21 21 Accrued vendor charges 1,296 1,037 Accrued revenue share expense 564 1,050 Accrued clinical trial expense 325 394 Accrued other 1,181 1,125 $ 6,285 $ 7,135

Leases

Leases	3 Months Ended
	Mar. 31, 2020
Leases [Abstract]
Leases	Leases The Company maintains its corporate headquarters in a leased building located in Billerica, Massachusetts. The Company maintains its manufacturing facilities in leased buildings located in Wilmington, Massachusetts and Wallingford, Connecticut. The Company's leases have remaining lease terms of approximately one to seven years, some of which include one or more options to extend the leases for up to five years per renewal. The exercise of lease renewal options is at the sole discretion of the Company. The amounts disclosed in the Consolidated Balance Sheet pertaining to right-of-use assets and lease liabilities are measured based on management’s current expectations of exercising its available renewal options. The Company’s existing leases are not subject to any restrictions or covenants which preclude its ability to pay dividends, obtain financing, or enter into additional leases. As of March 31, 2020 , the Company has not entered into any leases which have not yet commenced which would entitle the Company to significant rights or create additional obligations. The Company uses either its incremental borrowing rate or the implicit rate in the lease agreement as the basis to calculate the present value of future lease payments at lease commencement. The incremental borrowing rate represents the rate the Company would have to pay to borrow funds on a collateralized basis over a similar term and in a similar economic environment. The components of lease expense and related cash flows were as follows (in thousands): Three Months Ended March 31, 2020 2019 Rent expense $ 381 $ 381 Variable lease cost (1) 89 101 $ 470 $ 482 (1) Variable operating lease expenses consist primarily of common area maintenance and real estate taxes for the three months ended March 31, 2020 and 2019 , respectively. As of March 31, 2020 , the remaining weighted-average lease term of the operating leases was 4.8 years and the weighted-average discount rate was 6.0% . The future minimum rental payments under these agreements as of March 31, 2020 were as follows (in thousands): Year Minimum Lease Payments 2020 remainder of year 1,218 2021 1,633 2022 1,399 2023 1,053 After 2023 1,885 Total lease payments $ 7,188 Present value adjustment (952 ) Present value of lease liabilities $ 6,236

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note H—Commitments and Contingencies License and revenue share agreements Revenue share agreements The Company is party to revenue share agreements with certain past and present members of its scientific advisory board under which these advisors agreed to participate on a scientific advisory board and to assist with the development of the Company’s personalized implant products and related intellectual property. These agreements provide that the Company will pay the advisor a specified percentage of the Company’s net revenue, ranging from 0.1 % to 1.33% , with respect to the Company’s products on which the advisor made a technical contribution or, in some cases, products covered by one or more claims of one or more Company patents on which the advisor is a named inventor. The specific percentage is determined by reference to product classifications set forth in the agreement and is often tiered based on the level of net revenue collected by the Company on such product sales. The Company’s payment obligations under these agreements typically expire a fixed number of years after expiration or termination of the agreement or a fixed number of years after the first sale of a product, but in some cases expire on a product-by-product basis or expiration of the last to expire of the Company’s patents where the advisor is a named inventor that claims the applicable product. The Company incurred aggregate revenue share expense including all amounts payable under the Company’s scientific advisory board revenue share agreements of $0.5 million during the three months ended March 31, 2020 , representing 3.3% of product revenue and $0.7 million during the three months ended March 31, 2019 , representing 3.5% of product revenue. Revenue share expense is included in research and development. Other obligations In the ordinary course of business, the Company is a party to certain non-cancellable contractual obligations typically related to product royalty and research and development. The Company accrues a liability for such matters when it is probable that future expenditures will be made and such expenditures can be reasonably estimated. There have been no contingent liabilities requiring accrual at March 31, 2020 or December 31, 2019 . Legal proceedings On August 15, 2019, the Company filed a lawsuit against Zimmer Biomet Holdings, Inc. and Zimmer, Inc., (together, “Zimmer Biomet”) in the United States District Court for the District of Delaware seeking damages for Zimmer Biomet’s infringement of certain of the Company’s patents related to patient-specific instrument and implant systems. The complaint alleges that Zimmer Biomet’s multiple lines of patient-specific instruments, as well as the implant components used in conjunction with them, infringe four of the Company’s patents. The accused product lines include Zimmer Biomet patient-specific instrument and implant systems for knee, shoulder, and hip replacement procedures. On November 5, 2019, Zimmer Biomet filed a lawsuit against the Company in the United States District Court for the District of Delaware, alleging that the Company infringes five patents owned by Zimmer Biomet. Zimmer Biomet alleges that the Company’s iTotal CR and iTotal PS products infringe all five asserted patents, that the Company’s iDuo product infringes three of the asserted patents, and that the Company’s iUni product infringes two of the asserted patents. On January 13, 2020, Zimmer Biomet filed a motion to dismiss the Company’s complaint, and the Company filed its answer to Zimmer Biomet’s complaint, denying that the Company’s products infringe Zimmer Biomet’s asserted patents. The Company’s answer also alleges that Zimmer Biomet’s asserted patents are invalid. On March 27, 2020, the court entered a stay in both lawsuits pursuant to a joint motion to stay filed by the Company and Zimmer Biomet, and on April 13, 2020, the court extended the stay through April 30, 2020, pursuant to a joint motion to extend the stay filed by the Company and Zimmer Biomet, and on May 4, 2020, the court extended the stay through May 15, 2020, pursuant to a joint motion to extend the stay filed by Conformis and Zimmer Biomet. On August 29, 2019, the Company filed a lawsuit against Medacta USA, Inc. (“Medacta”), in the United States District Court for the District of Delaware, and the Company amended its complaint on December 23, 2019, seeking damages for Medacta’s infringement of certain of the Company’s patents related to patient-specific instrument and implant systems. The Company alleges in the lawsuit that Medacta’s multiple lines of patient-specific instruments, as well as the implant components used in conjunction with them, infringe four of the Company’s patents. The accused product lines include Medacta patient-specific instrument and implant systems for knee and shoulder replacement procedures. On January 6, 2020, Medacta filed its answer, denying that its patient-specific instrument and implant systems infringe the patents asserted by the Company. Medacta’s answer also alleges the affirmative defense that the Company's asserted patents are invalid. Discovery in the lawsuit has commenced and is ongoing. On March 20, 2020, Osteoplastics LLC ("Osteoplastics"), filed a lawsuit against the Company in the United States District Court for the District of Delaware, and Osteoplastics amended its complaint on April 2, 2020, alleging that the Company infringes seven patents owned by Osteoplastics. Osteoplastics alleges that the Company’s proprietary software, including the Company’s iFit software platform, and the Company’s use of its proprietary software for designing and manufacturing medical devices, including implants, infringes the seven asserted patents. On April 24, 2020, the Company filed a lawsuit against Wright Medical Technology, Inc. and Tornier, Inc. (together, “Wright Medical”), in the United States District Court for the District of Delaware seeking damages for Wright Medical’s infringement of certain of the Company's patents related to patient-specific instrument and implant systems. The complaint alleges that Wright Medical’s multiple lines of patient-specific shoulder instruments, as well as the implant components used in conjunction with them, infringe four of the Company’s patents. The accused product lines include Wright Medical’s Tornier Blueprint™ 3D Planning + PSI shoulder replacement systems. On May 8, 2020, the Company and an individual plaintiff filed a lawsuit against Aetna, Inc. and Aetna Life Insurance Company (together, “Aetna”) in the United States District Court for the District of Massachusetts seeking damages for Aetna’s improper denial of coverage for personalized knee implants under its health plans and the ones it administers. The complaint alleges that Aetna has violated its duties under state and federal law, including the Employee Retirement Income Security Act. Adverse outcomes of these lawsuits could have a material adverse effect on the Company's business, financial condition or results of operations. The Company is presently unable to predict the outcome of these lawsuits or to reasonably estimate a range of potential losses, if any, related to the lawsuits. Legal costs associated with legal proceedings are accrued as incurred. Indemnification In the normal course of business, the Company enters into contracts and agreements that contain a variety of representations and warranties and provide for general indemnifications. The Company’s exposure under these agreements is unknown because it involves claims that may be made against the Company in the future, but have not yet been made. To date, the Company has not paid any claims or been required to defend any action related to its indemnification obligations. However, the Company may record charges in the future as a result of these indemnification obligations. In accordance with its bylaws, the Company has indemnification obligations to its officers and directors for certain events or occurrences, subject to certain limits, while they are serving at the Company’s request in such capacity. There have been no claims to date and the Company has a director and officer insurance policy that enables it to recover a portion of any amounts paid for future claims.

Debt and Notes Payable

Debt and Notes Payable	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Debt and Notes Payable	Note I—Debt and Notes Payable Long-term debt consisted of the following (in thousands): March 31, December 31, Innovatus, Term Loan 20,000 20,000 Innovatus, Term Loan accrued payment-in-kind interest 388 262 Less unamortized debt issuance costs (601 ) (639 ) Long-term debt, less debt issuance costs $ 19,787 $ 19,623 Principal payments, including the Term Loan Basic Interest Rate in-kind (described below), due as of March 31, 2020 consisted of the following (in thousands): Principal Payment 2020 (remainder of the year) — 2021 — 2022 — 2023 8,986 2024 12,580 Total $ 21,566 2017 Secured Loan Agreement On January 6, 2017, the Company entered into the 2017 Secured Loan Agreement with Oxford. Through the 2017 Secured Loan Agreement, the Company accessed $15 million under Term Loan A at closing and an additional $15 million of borrowings under Term Loan B on June 30, 2017. On December 13, 2018, the Company entered into a fifth amendment (the "Fifth Amendment") to the 2017 Secured Loan Agreement, with Oxford, and pursuant to the Fifth Amendment, the Company pre-paid $15 million aggregate principal amount of the $30 million outstanding principal amount, as a pro rata portion of the Term A Loan and Term B Loan, together with accrued and unpaid interest thereon and a pro rata prepayment fee and final payment. Under the Fifth Amendment, the Company's cash collateral requirement was reduced to $5 million . On June 25, 2019, the Company elected to prepay the remainder of the Oxford term loan outstanding (along with accrued interest and applicable final payment and prepayment fee) using the proceeds from the 2019 Secured Loan Agreement. The prepayment of the debt was accounted for as a debt extinguishment and the Company incurred a loss on the extinguishment recognized in interest expense of $1.1 million . 2019 Secured Loan Agreement On June 25, 2019, the Company entered into the 2019 Secured Loan Agreement with Innovatus, as collateral agent and lender, East West Bank and the Lenders, pursuant to which the Lenders agreed to make term loans and revolving credit facility to the Company to repay existing indebtedness, for working capital and general business purposes, in a principal amount of up to $30 million . The term loan facility established under the 2019 Secured Loan Agreement is secured by substantially all of the Company's and its U.S. subsidiaries' properties, rights and assets. The 2019 Secured Loan Agreement includes a trailing six months' revenue test, a liquidity covenant and an additional liquidity covenant that is applicable if there are borrowings under the revolving credit facility. The 2019 Secured Loan Agreement also includes customary representations, affirmative and negative covenants. Additionally, the 2019 Secured Loan Agreement includes events of default, the occurrence and continuation of which could cause interest to be charged at the rate that is otherwise applicable plus 5.0% and would provide Innovatus, as collateral agent, with the right to accelerate all obligations under the 2019 Secured Loan Agreement and to exercise remedies against the Company and the collateral securing the credit facility, including foreclosure against assets securing the credit facilities, including the Company's cash. These events of default include, among other things, the Company’s failure to pay any amounts due under the credit facility, a breach of covenants under the credit facility, the Company’s insolvency, a material adverse change, the occurrence of any default under certain other indebtedness in an amount greater than $250,000 , one or more judgments against the Company in an amount greater than $500,000 , changes with respect to governmental approvals and FDA actions. As of March 31, 2020 , the Company was not in breach of covenants under the 2019 Secured Loan Agreement. Term Loan - Innovatus The term loan under the 2019 Secured Loan Agreement bears interest at a floating annual rate calculated at the greater of the variable rate of interest as most recently announced by East West Bank as prime or 5.50% , plus 3.75% ("Term Loan Basic Interest Rate"), bearing an effective interest rate of 9.25% at March 31, 2020 . The Company is required to make interest only payments in arrears on the term loan for four years ; provided that the Company has elected to pay 2.50% per annum as such Term Loan Basic Interest Rate in-kind by adding an amount equal to 2.50% per annum of the outstanding principal amount to the then outstanding principal balance on a monthly basis until the third anniversary of the 2019 Secured Loan Agreement. Commencing July 1, 2023, and continuing on the payment date of each month thereafter, the Company is required to make consecutive equal monthly payments of principal of the term loan, together with accrued interest, in arrears, to the Lenders. All unpaid principal, accrued and unpaid interest with respect to the term loan, and a final fee in the amount of 5.0% of the term loan commitment, is due and payable in full on the term loan maturity date on June 1, 2024. At the Company’s option, the Company may prepay all, but not less than all, of the term loans advanced by the Lenders under the term loan facility after the first year, subject to a prepayment fee and an amount equal to the sum of all outstanding principal of the term loans plus accrued and unpaid interest thereon through the prepayment date, a final fee, plus all other amounts that are due and payable, including the Lenders' expenses and interest at the default rate with respect to any past due amounts. Revolving Credit Facility - East West Bank Under the 2019 Secured Loan Agreement, East West Bank will make loans of up to $10 million from time to time outstanding, subject to availability based on a borrowing base equal to (i) 85.00% of eligible customer accounts, subject to a maximum of 2.50% dilution based upon collections, minus (ii) the Company’s foreign accounts receivable credit insurance’s outstanding co-payment and minimum annual deductible (that has not been used at the applicable time). Advances under the revolving credit facility bear interest at a rate of 0.50% above the greater of East West Bank’s prime rate or 5.50% . Interest on the revolving advances is payable monthly in arrears. The revolving credit facility terminates and the principal and all amounts are due in full on June 25, 2024, provided that if an optional or mandatory prepayment (other than regularly scheduled payments) is made under the term loan, the Company must satisfy in full the obligations under the revolving credit line. The revolving credit facility requires a lockbox arrangement, which provides for all receipts to be swept daily to reduce the borrowings outstanding under the revolving credit facility. There were no amounts outstanding under the revolving credit facility at March 31, 2020 .

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2020
Stockholders' Equity Note [Abstract]
Shareholders' Equity	Stockholders’ Equity Common stock Common stockholders are entitled to dividends as and when declared by the board of directors, subject to the rights of holders of all classes of stock outstanding having priority rights as to dividends. There have been no dividends declared to date. Preferred stock The Company’s Restated Certificate of Incorporation authorizes the Company to issue 5,000,000 shares of preferred stock, $0.00001 par value, all of which is undesignated. No shares were issued and outstanding at March 31, 2020 and December 31, 2019 . Demand registration rights In conjunction with the Private Placement, on June 25, 2019, the Company entered into a registration rights agreement (the "Registration Rights Agreement"), with Innovatus, Innovatus Life Science Offshore Fund I, LP and Innovatus Life Sciences Offshore Fund I-A, LP (collectively, the "Innovatus Investors"), pursuant to which the Company agreed to register for resale the shares held by the Innovatus Investors (the “Shares”) under certain circumstances. Under the Registration Rights Agreement, in the event that the Company receives a written request from the Innovatus Investors that the Company file with the SEC a registration statement covering the resale of all of the Shares, the Company shall promptly but no later than 120 days after the date of such request prepare and file with the SEC such registration statement. The Innovatus Investors have agreed to use best efforts not to make such a request, including by effecting any planned sales of Shares under Rule 144 under the Securities Act. The Company has agreed to use commercially reasonable efforts to cause such registration statement to become effective and to keep such registration statement effective until the date the Shares covered by such registration statement have been sold or may be resold pursuant to Rule 144 without restriction. The Company has agreed to be responsible for all fees and expenses incurred in connection with the registration of the Shares. The Company has granted the Innovatus Investors customary indemnification rights in connection with the registration statement. The Innovatus Investors have also granted the Company customary indemnification rights in connection with the registration statement. Warrants The Company also issued warrants to certain investors and consultants to purchase shares of the Company’s preferred stock and common stock. Based on the Company’s assessment of the warrants granted in 2013 and 2014 relative to ASC 480, Distinguishing Liabilities from Equity , the warrants are classified as equity. No warrants were issued in the three months ended March 31, 2020 . According to ASC 480, an entity shall classify as a liability any financial instrument, other than an outstanding share, that, at inception, both a) embodies an obligation to repurchase the issuer’s equity shares, or is indexed to such obligation and b) requires or may require the issuer to settle the obligation by transferring assets. The warrants do not contain any provision that requires the Company to repurchase the shares and are not indexed to such an obligation. The warrants also do not require the Company to settle by transferring assets. All warrants were exercisable immediately upon issuance. Common stock warrants The Company also issued warrants to certain investors and consultants to purchase shares of common stock. Warrants to purchase 28,926 shares of common stock were outstanding as of March 31, 2020 and December 31, 2019 . Outstanding warrants are currently exercisable with varying exercise expiration dates from 2020 through 2024 . At March 31, 2020 and December 31, 2019 , the weighted average warrant exercise price per share for common stock underlying warrants and the weighted average contractual life was as follows: Number of Weighted Weighted Average Remaining Contractual Life Number of Weighted Outstanding December 31, 2019 28,926 $ 9.80 3.66 28,926 $ 9.80 Outstanding March 31, 2020 28,926 $ 9.80 3.41 28,926 $ 9.80 Stock option plans As of March 31, 2020 , 3,906,242 shares of common stock were available for future issuance under the 2015 Stock Incentive Plan ("2015 Plan"). The 2015 Plan provides for an annual increase, to be added on the first day of each fiscal year, beginning with the fiscal year ending December 31, 2016 and continuing until, and including, the fiscal year ending December 31, 2025, equal to the lesser of (a) 3,000,000 shares of the Company's common stock, (b) 3% of the number of share of its common stock outstanding on the first day of such fiscal year and (c) an amount determined by the Board. Effective January 1, 2020, an additional 2,112,822 shares of the Company's common stock were added to the 2015 Plan under the terms of this provision. On April 29, 2019, the stockholders approved the Conformis, Inc. 2019 Sales Team Performance-Based Equity Incentive Plan ("2019 Sales Team Plan") for up to 3,000,000 shares of common stock available to grant to certain sales representatives or independent sales agents. The 2019 Sales Team Plan provides for the grant of performance-based equity, including incentive stock options, nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock units and other stock-based awards. Shares covered by awards under the 2019 Sales Team Plan that expire or are terminated, surrendered, or cancelled without having been fully exercised or are forfeited in whole or in part (including as the result of shares subject to such award being repurchased by us at the original issuance price pursuant to a contractual repurchase right) or that result in any shares not being issued, will again be available for the grant of awards under the 2019 Sales Team Plan. Equity granted under the 2019 Sales Team Plan will expire ten years from the date of grant. As of March 31, 2020 , 2,775,000 shares of common stock were available for future issuance under the 2019 Sales Team Plan. Activity under all stock option plans was as follows: Number of Options Weighted Average Exercise Price per Share Aggregate Intrinsic Value (in Thousands) Outstanding December 31, 2019 1,802,463 $ 6.75 Granted 191,667 0.98 Expired (317,992 ) 8.19 Outstanding March 31, 2020 1,676,138 $ 5.81 $ — Total vested and exercisable 1,266,859 $ 6.72 $ — The total fair value of stock options that vested during the three months ended March 31, 2020 was $0.1 million . The weighted average remaining contractual term for the total stock options outstanding was 5.17 years as of March 31, 2020 . The weighted average remaining contractual term for the total stock options vested and exercisable was 4.02 years as of March 31, 2020 . Restricted common stock award activity under the plan was as follows: Number of Shares Weighted Average Fair Value Unvested December 31, 2019 4,436,928 $ 1.54 Granted 225,000 1.39 Vested (593,644 ) 0.69 Forfeited (146,676 ) 1.30 Unvested March 31, 2020 3,921,608 $ 1.67 The total fair value of restricted common stock awards that vested during the three months ended March 31, 2020 was $0.4 million . Inducement Awards In February 2020, the Company granted an inducement award outside of the prior plans to the Company's Chief Financial Officer in the form of an option to purchase 125,000 shares of the Company's common stock with an exercise price per share equal to $0.98 and 125,000 restricted stock units. The option and restricted stock unit awards were granted as inducements material to his commencement of employment with the Company in accordance with Nasdaq Listing Rule 5635(c)(4). In addition, in February 2020, the Company granted an inducement award outside of the prior plans to the Company's Senior Vice President, Operations in the form of an option to purchase 66,667 shares of the Company's common stock with an exercise price per share equal to $0.98 and 61,350 restricted stock units. The option and restricted stock unit awards were granted as inducements material to his commencement of employment with the Company in accordance with Nasdaq Listing Rule 5635(c)(4). Stock-based compensation The Company uses the Black-Scholes option pricing model to determine the fair value of stock options. The determination of the fair value of stock-based payment awards on the date of grant using a pricing model is affected by the value of the Company’s common stock as well as assumptions regarding a number of complex and subjective variables. The valuation of the Company’s common stock prior to the IPO was performed with the assistance of an independent third-party valuation firm using a methodology that includes various inputs including the Company’s historical and projected financial results, peer company public data and market metrics, such as risk-free interest and discount rates. As the valuations included unobservable inputs that were primarily based on the Company’s own assumptions, the inputs were considered level 3 inputs within the fair value hierarchy. The fair value of options at date of grant was estimated using the Black-Scholes option pricing model, based on the following assumptions: Three Months Ended March 31, 2020 2019 Risk-free interest rate 1.49% - 1.63% N/A Expected term (in years) 6.25 N/A Dividend yield —% N/A Expected volatility 55.92% N/A Risk-free interest rate . The risk-free interest rate is based on U.S. Treasury zero-coupon issues with remaining terms similar to the expected term on the options. Expected term. The expected term of stock options represents the period the stock options are expected to remain outstanding and is based on the “SEC Shortcut Approach” as defined in “Share-Based Payment” (SAB 107) ASC 718-10-S99, “Compensation-Stock Compensation-Overall-SEC Materials,” which is the midpoint between the vesting date and the end of the contractual term. With certain stock option grants, the exercise price may exceed the fair value of the common stock. In these instances, the Company adjusts the expected term accordingly. Dividend yield. The Company has never declared or paid any cash dividends and does not plan to pay cash dividends in the foreseeable future, and, therefore, used an expected dividend yield of zero in the valuation model. Expected volatility. Expected volatility measures the amount that a stock price has fluctuated or is expected to fluctuate during a period. The Company does not have sufficient history of market prices of its common stock as it is a newly public company. Therefore, the Company estimates volatility using historical volatilities of similar public entities. Forfeitures. The Company recognizes forfeitures as they occur. Stock-based compensation expense was $0.8 million and $1.1 million for the three months ended March 31, 2020 and 2019 , respectively. Stock-based compensation expense was calculated based on awards ultimately expected to vest. To date, the amount of stock-based compensation capitalized as part of inventory was not material. The following is a summary of stock-based compensation expense (in thousands): Three Months Ended March 31, 2020 2019 Cost of revenues $ 11 $ 166 Sales and marketing 112 81 Research and development 134 257 General and administrative 509 644 $ 766 $ 1,148 As of March 31, 2020 , the Company had $0.6 million of total unrecognized compensation expense for options that will be recognized over a weighted average period of 2.57 years . As of March 31, 2020 , the Company had $4.7 million of total unrecognized compensation expense for restricted awards that will be recognized over a weighted average period of 2.11 years.

Segment and Geographic Data

Segment and Geographic Data	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Segment and Geographic Data	Note K—Segment and Geographic Data The Company operates as one reportable segment as described in Note B to the Consolidated Financial Statements. The countries in which the Company has local revenue generating operations have been combined into the following geographic areas: the United States (including Puerto Rico), Germany and the rest of world, which consists of Europe predominately (including the United Kingdom) and other foreign countries. Sales are attributable to a geographic area based upon the customer’s country of domicile. Net property, plant and equipment are based upon physical location of the assets. Geographic information consisted of the following (in thousands): Three Months Ended March 31, 2020 2019 Product revenue United States $ 13,827 $ 17,601 Germany 1,970 2,464 Rest of world 493 404 $ 16,290 $ 20,469 March 31, 2020 December 31, 2019 Property and equipment, net United States $ 13,707 $ 13,303 Germany 49 53 $ 13,756 $ 13,356

Subsequent Events Subsequent Ev

Subsequent Events Subsequent Events	3 Months Ended
	Mar. 31, 2020
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On April 17, 2020, the Company entered into an approximately $4.7 million promissory note (the “PPP Note”) with East West Bank under the Paycheck Protection Program (“PPP”) offered by the U.S. Small Business Administration (the "SBA") to mitigate the negative financial and operational impacts of the coronavirus (COVID-19) pandemic. The interest rate on the PPP Note is a fixed rate of 1% per annum. The Company is required to make one payment of all outstanding principal plus all accrued unpaid interest on April 9, 2022 (the “Maturity Date”). The Company will pay regular monthly payments in an amount equal to one month’s accrued interest commencing on November 9, 2020, with all subsequent interest payments to be due on the same day of each month after that. All interest which accrues during the initial six months of the loan period will be deferred to and payable on the Maturity Date. According to the terms of the PPP, all or a portion of the loan may be fully forgiven if the funds are used for payroll costs (and at least 75% of the forgiven amount must have been used for payroll), interest on certain other outstanding debt, rent, and utilities. In accordance with the CARES Act, the Company intends to use the proceeds of the loan primarily for payroll costs.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Basis of presentation and use of estimates	Basis of presentation and use of estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the United States 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 amounts of revenue and expenses during the reporting periods. The most significant estimates used in these consolidated financial statements include revenue recognition, accounts receivable valuation, inventory reserves, purchase accounting, impairment assessments, equity instruments, stock compensation, income tax reserves and related allowances, and the lives of property and equipment, and valuation of right-of-use lease assets and lease liabilities. Actual results may differ from those estimates. The interim financial statements should be read in conjunction with the audited financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 .
Concentrations of credit risk and other risks and uncertainties	Concentrations of credit risk and other risks and uncertainties Financial instruments that subject the Company to credit risk primarily consist of cash, cash equivalents, and accounts receivable. The Company maintains the majority of its cash with accredited financial institutions. The Company and its contract manufacturers rely on sole source suppliers and service providers for certain components. There can be no assurance that a shortage or stoppage of shipments of the materials or components that the Company purchases will not result in a delay in production or adversely affect the Company’s business. On an ongoing basis, the Company validates alternate suppliers relative to certain key components as needed.
Principles of consolidation	Principles of consolidation The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries ImaTx, Inc. ("ImaTx"); ConforMIS Europe GmbH; ConforMIS UK Limited; ConforMIS Hong Kong Limited; and Conformis Cares LLC. All intercompany balances and transactions have been eliminated in consolidation.
Cash and cash equivalents	Cash, cash equivalents and restricted cash The Company considers all highly liquid investment instruments with original maturities of 90 days or less when purchased, to be cash equivalents. The Company’s cash equivalents consist of demand deposits , money market accounts, money market funds, and repurchase agreements on deposit with certain financial institutions, in addition to cash deposits in excess of federally insured limits. Demand deposits and money market accounts are carried at cost which approximates their fair value. Money market funds are carried at fair value based upon level 1 inputs. Repurchase agreements are valued using level 2 inputs. The associated risk of concentration is mitigated by banking with credit worthy financial institutions.
Fair value of financial instruments	Fair value of financial instruments Certain of the Company’s financial instruments, including cash and cash equivalents (excluding money market funds), accounts receivable, accounts payable, accrued expenses and other liabilities are carried at cost, which approximates their fair value because of the short-term maturity. Based on borrowing rates currently available to the Company for loans with similar terms, the carrying value of the Company’s long-term debt approximates its fair value.
Accounts receivable and allowance for doubtful accounts	Accounts receivable and allowance for doubtful accounts Accounts receivable consist of billed and unbilled amounts due from medical facilities or independent distributors (the "Customer"). Upon completion of a procedure, revenue is recognized and an unbilled receivable is recorded. Under ASC No. 2014-09, Revenue from Contracts with Customers ("Topic 606" or "ASC 606"), an enforceable contract is met either at or prior to the procedure being performed. Upon receipt of a purchase order from the Customer, a billed receivable is recorded and the unbilled receivable is reversed. As a result, the unbilled receivable balance fluctuates based on the timing of the Company's receipt of purchase orders from the medical facilities. In estimating whether accounts receivable can be collected, the Company performs evaluations of customers and continuously monitors collections and payments and estimates an allowance for doubtful accounts based on the aging of the underlying invoices, collections experience to date and any specific collection issues that have been identified. The allowance for doubtful accounts is recorded in the period in which revenue is recorded or when collection risk is identified.
Inventories	Inventories Inventories consist of raw materials, work-in-process components and finished goods. Inventories are stated at the lower of cost, determined using the first-in first-out method, or net realizable value. The Company regularly reviews its inventory quantities on hand and related cost and records a provision for any excess or obsolete inventory based on its estimated forecast of product demand and existing product configurations. The Company also reviews its inventory value to determine if it reflects the lower of cost or market, based on net realizable value. Appropriate consideration is given to inventory items sold at negative gross margin, purchase commitments and other factors in evaluating net realizable value.
Property and equipment	Property and equipment Property and equipment is stated at cost less accumulated depreciation and is depreciated using the straight-line method over the estimated useful lives of the respective assets. Leasehold improvements are amortized over their useful life or the life of the lease, whichever is shorter. Assets capitalized under capital leases are amortized in accordance with the respective class of assets and the amortization is included with depreciation expense. Maintenance and repair costs are expensed as incurred.
Intangibles and other long-lived assets	Long-Lived Assets The Company tests impairment of long-lived assets when events or changes in circumstances indicate that the assets might be impaired. The amount of impairment, if any, is measured based on fair value, which is determined using estimated undiscounted cash flows to be generated from such assets or group of assets. During the three months ended March 31, 2020 , there were changes in circumstances that led the Company to believe that its long-lived assets may be impaired and as such, a Step 2 analysis was performed. The Company evaluated whether the estimated undiscounted cash flows, including estimated residual value, generated from the asset group were sufficient to support the carrying value of the assets. If the cash flow estimates or the significant operating assumptions upon which they are based change in the future, the Company may be required to record impairment charges. During the three months ended March 31, 2020 and 2019, no such impairment charges were recognized.
Leases	Leases The Company adopted ASU No. 2016-02-Leases ("Topic 842" or "ASC 842"), as of January 1, 2019, in accordance with ASU No. 2018-11-Leases (Topic 842) ("ASU 2018-11"), issued by the FASB in July 2018. ASU 2018-11 allows an entity to elect not to recast its comparative periods in the period of adoption when transitioning to ASC 842 (the “Comparatives Under 840 Option”). Effectively, an entity would be permitted to change its date of initial application to the beginning of the period of adoption of ASC 842. In doing so, the entity would apply ASC 840 in the comparative periods and provide the disclosures required by ASC 840 for all periods that continue to be presented in accordance with ASC 840. Further, the entity would recognize the effects of applying ASC 842 as a cumulative-effect adjustment to retained earnings as of the effective date. Under the Comparatives Under 840 Option, this date would represent the date of initial application. The Company is not required to restate comparative periods for the effects of applying ASC 842, provide the disclosures required by ASC 842 for the comparative periods, nor change how the transition requirements apply, only when the transition requirements apply. The Company elected to report results for periods after January 1, 2019 under ASC 842 and prior period amounts are reported in accordance with ASC 840. The Company has elected not to separate non-lease components from all classes of leases. Non-lease components have been accounted for as part of the single lease component to which they are related. Leases with an initial term of 12 months or less are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. The Company has elected the hindsight practical expedient to determine the lease term for existing leases. This practical expedient enables an entity to use hindsight in determining the lease term when considering options to extend and terminate leases as well as purchase the underlying assets. Adoption of the new standard resulted in the recording of additional right-of-use assets and lease liabilities of $7.0 million and $7.7 million , respectively, as of January 1, 2019. The difference between the additional lease assets and lease liabilities is related to deferred rent, which was previously recorded as deferred rent within Accrued expenses and Other long-term liabilities under ASC 840. The operating lease right-of-use assets are subsequently assessed for impairment in accordance with the Company's accounting policy for long-lived assets. The adoption of the standard did not impact the Company’s consolidated net earnings and had no impact on cash flows.
Revenue recognition	Revenue Recognition Product Revenue Recognition Revenue is recognized when, or as, obligations under the terms of a contract are satisfied, which occurs when control of the promised products or services is transferred to customers. Revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer (“transaction price”). When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying the practical expedient in paragraph 606-10-32-18, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component as of March 31, 2020 . Payment is typically due between 30 - 60 days from invoice. To the extent that the transaction price includes variable consideration, such as prompt-pay discounts or rebates, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value to which the Company expects to be entitled. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Actual amounts of consideration ultimately received may differ from the Company's estimates. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. If the contract contains a single performance obligation, the entire transaction price is allocated to the single performance obligation. Contracts that contain multiple performance obligations require an allocation of the transaction price based on the estimated relative standalone selling prices of the promised products or services underlying each performance obligation. The Company determines standalone selling prices based on observable prices or a cost-plus margin approach when one is not available. Revenue is recognized at the time the related performance obligation is satisfied by transferring control of a promised good or service to a customer. The Company's performance obligations are satisfied at the same time, typically upon surgery, therefore, product revenue is recognized at a point in time upon completion of the surgery. Since the Company does not have contracts that extend beyond a duration of one year, there is no transaction price related to performance obligations that have not been satisfied. Certain customer contracts include terms that allow the Company to bill for orders that are cancelled after the product is manufactured and could result in revenue recognition over time. However, the impact of adopting over time revenue recognition was deemed immaterial. Unconditional rights to consideration are reported as receivables. Incidental items that are immaterial in the context of the contract are recognized as expense. Royalty Revenue Recognition The Company receives ongoing sales-based royalties under its agreement with MicroPort Orthopedics Inc, a wholly owned subsidiary of Microport Scientific Corporation. Royalty revenue is recorded at the expected value of the royalty revenue. On September 30, 2019 the Company entered into the Stryker Agreements. The Company determined that the Asset Purchase Agreement and the License Agreement are within the scope of ASC 606. Under the Asset Purchase Agreement and License Agreement, the Company is required to provide certain assets and the right to use the license for a specific purpose. The assets and the right to use the license are highly interdependent and is considered one performance obligation. The Company bifurcated the total transaction price of $ 30.0 million into two components; $ 5.0 million related to cost reimbursement for other services (development) and $ 25.0 million allocated to royalty revenue determined using the residual approach by deducting the cost reimbursement component from the total transaction price. The arrangement does not contain a significant financing component. The Company records a contract liability when there is an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer. The Company has concluded that Stryker meets the definition of a customer for a portion of the obligations under the Stryker Agreements. At March 31, 2020 , the Company recorded $12.0 million as a long-term contract liability related to consideration received from the customer under the Asset Purchase Agreement and Development Agreement. The Company concluded the license rights under the License Agreement are functional when FDA 510(k) clearance is received as required under Milestone 3 in the License Agreement, or upon termination by Stryker and Stryker's election to purchase the license rights. Disaggregation of Revenue See " Note K—Segment and Geographic Data " for disaggregated product revenue by geography. Variable Consideration Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which reserves are established and which result from rebates that are offered within contracts between the Company and some of its customers. The amount of variable consideration which is included in the transaction price may be constrained, and is included in the net sales price only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in a future period. The following table summarizes activity for rebate allowance reserve (in thousands): March 31, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 48 145 Adjustment related to prior period sales — 20 Payments or credits issued to customer (14 ) (134 ) Ending Balance $ 161 $ 127 Costs to Obtain and Fulfill a Contract The Company currently expenses commissions paid for obtaining product sales. Sales commissions are paid following the manufacture and implementation of the implant. Due to the period being less than one year, the Company will apply the practical expedient, whereby the Company recognizes the incremental costs of obtaining contracts as an expense when incurred if the amortization period of the assets that the Company otherwise would have recognized is one year or less. These costs are included in sales and marketing expense. Further, the Company incurs costs to buy, build, replenish, restock, sterilize and replace the reusable instrumentation trays associated with the sale of its products and services. The reusable instrument trays are not contract specific and are used for multiple contracts and customers, therefore does not meet the criteria to capitalize under ASC 606. Shipping and handling costs Shipping and handling activities prior to the transfer of control to the customer (e.g. when control transfers after delivery) are considered fulfillment activities, and not performance obligations. Amounts invoiced to customers for shipping and handling are classified as revenue. Shipping and handling costs incurred are included in general and administrative expense. Shipping and handling expense was $0.4 million and $0.6 million for the three months ended March 31, 2020 and 2019 , respectively. Taxes collected from customers and remitted to government authorities The Company’s policy is to present taxes collected from customers and remitted to government authorities on a net basis and not to include tax amounts in revenue.
Research and development expense	Research and development expense The Company’s research and development costs consist of engineering, product development, quality assurance, clinical and regulatory expense. These costs primarily relate to employee compensation, including salary, benefits and stock-based compensation. The Company also incurs costs related to consulting fees, revenue share, materials and supplies, and marketing studies, including data management and associated travel expense. Research and development costs are expensed as incurred.
Advertising expense	Advertising expense Advertising costs are expensed as incurred, which are included in sales and marketing.
Segment reporting	Segment reporting Operating segments are defined as components of an enterprise about which separate financial information is available and is evaluated on a regular basis by the chief operating decision-maker, or decision-making group, in deciding how to allocate resources to an individual segment and in assessing performance of the segment. The Company’s chief operating decision-maker is its chief executive officer. The Company’s chief executive officer reviews financial information presented on an aggregate basis for purposes of allocating resources and evaluating financial performance. The Company has one business segment and there are no segment managers who are held accountable for operations, operating results and plans for products or components below the aggregate Company level. Accordingly, in light of the Company’s current product offerings, management has determined that the primary form of internal reporting is aligned with the offering of the Conformis personalized joint replacement products and that the Company operates as one segment. See “ Note K—Segment and Geographic Data .”
Foreign currency translation and transactions	Foreign currency translation and transactions The assets and liabilities of the Company’s foreign operations are translated into U.S. dollars at current exchange rates at the balance sheet date, and income and expense items are translated at average rates of exchange prevailing during the quarter. Net translation gains and losses are recorded in Accumulated other comprehensive (loss) income. Gains and losses from foreign currency transactions denominated in foreign currencies, including intercompany balances not of a long-term investment nature, are included in the Consolidated Statements of Operations.
Income taxes	Income taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax bases, operating losses and tax credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized as income in the period that includes the enactment date. In evaluating the need for a valuation allowance, the Company considers all reasonably available positive and negative evidence, including recent earnings, expectations of future taxable income and the character of that income. In estimating future taxable income, the Company relies upon assumptions and estimates of future activity including the reversal of temporary differences. Presently, the Company believes that a full valuation allowance is required to reduce deferred tax assets to the amount expected to be realized. The tax benefit from an uncertain tax position is only recognized if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from these positions are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate resolution. The Company reviews its tax positions on an annual basis and more frequently as facts surrounding tax positions change. Based on these future events, the Company may recognize uncertain tax positions or reverse current uncertain tax positions, the impact of which would affect the consolidated financial statements. The Company has operations in Germany. The operating results of German operations will be permanently reinvested in that jurisdiction. As a result, the Company has only provided for income taxes at local rates when required. In April 2020, new interpretations of a German law related to intellectual property and withholding tax were released. The Company is currently evaluating whether the interpretations will have an impact on its consolidated financial statements. The Company is subject to U.S. federal, state, and foreign income taxes. The Company recorded a provision for income taxes of $25,000 and $(9,000) for the three months ended March 31, 2020 and 2019 , respectively. The Company recognizes interest and penalties related to income taxes as a component of income tax expense. As of March 31, 2020 and 2019 , a cumulative balance of $55,000 and $47,000 of interest and penalties had been accrued, respectively.
Stock-based compensation	Stock-based compensation The Company accounts for stock-based compensation in accordance with ASC 718, Stock Based Compensation. ASC 718 requires all stock-based payments to employees and consultants, including grants of stock options, to be recognized in the consolidated statements of operations based on their fair values. The Company uses the Black-Scholes option pricing model to determine the weighted-average fair value of options granted and recognizes the compensation expense of stock-based awards on a straight-line basis over the vesting period of the award. The determination of the fair value of stock-based payment awards utilizing the Black-Scholes option pricing model is affected by the stock price, exercise price, and a number of assumptions, including expected volatility of the stock, expected life of the option, risk-free interest rate and expected dividends on the stock. The Company evaluates the assumptions used to value the awards at each grant date and if factors change and different assumptions are utilized, stock-based compensation expense may differ significantly from what has been recorded in the past. If there are any modifications or cancellations of the underlying unvested securities, the Company may be required to accelerate, increase or cancel any remaining unearned stock-based compensation expense.
Net loss per share	Net loss per share The Company calculates net income (loss) per share in accordance with ASC 260, "Earnings per Share." Basic earnings per share (“EPS”) is calculated by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period, without consideration for common stock equivalents. Diluted EPS is computed by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury stock method.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown in the consolidated statements of cash flows. March 31, December 31, Cash and cash equivalents $ 21,518 $ 26,394 Restricted cash 462 462 Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 21,980 $ 26,856
Contract with Customer, Asset and Liability	The following table summarizes activity for rebate allowance reserve (in thousands): March 31, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 48 145 Adjustment related to prior period sales — 20 Payments or credits issued to customer (14 ) (134 ) Ending Balance $ 161 $ 127
Schedule of computation of basic and diluted earnings per share attributable to stockholders	The following table sets forth the computation of basic and diluted earnings per share attributable to stockholders (in thousands, except share and per share data): Three Months Ended March 31, (in thousands, except share and per share data) 2020 2019 Numerator: Basic and diluted loss per share Net loss $ (9,353 ) $ (7,581 ) Denominator: Basic and diluted weighted average shares 67,274,391 62,849,335 Loss per share attributable to Conformis, Inc. stockholders: Basic and diluted $ (0.14 ) $ (0.12 )
Schedule of potential shares of common stock equivalents that are antidilutive and not included in the calculation of diluted net loss per share	The following table sets forth potential shares of common stock equivalents that are not included in the calculation of diluted net loss per share because to do so would be anti-dilutive as of the end of each period presented: Three Months Ended March 31, 2020 2019 Stock options and restricted stock awards 1,099,413 2,538,495

Accounts Receivable (Tables)

Accounts Receivable (Tables)	3 Months Ended
	Mar. 31, 2020
Accounts Receivable, Net, Current [Abstract]
Schedule of accounts receivable	Accounts receivable consisted of the following (in thousands): March 31, December 31, Total receivables $ 8,495 $ 11,401 Allowance for doubtful accounts and returns (332 ) (335 ) Accounts receivable, net $ 8,163 $ 11,066
Allowance for doubtful accounts receivable	Summary of allowance for doubtful accounts and returns activity was as follows (in thousands): March 31, December 31, Beginning balance $ (335 ) $ (390 ) Provision for bad debts on trade receivables (23 ) (106 ) Other allowances 31 (26 ) Accounts receivable write offs (5 ) 187 Ending balance $ (332 ) $ (335 )

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Schedule of inventories	Inventories consisted of the following (in thousands): March 31, December 31, Raw Material $ 5,373 $ 6,171 Work in process 1,498 1,717 Finished goods 4,986 4,186 Total Inventories $ 11,857 $ 12,074

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Schedule of property and equipment	Property and equipment consisted of the following (in thousands): Estimated March 31, 2020 December 31, 2019 Equipment 5-7 $ 19,210 $ 19,011 Furniture and fixtures 5-7 864 864 Computer and software 3 9,535 9,561 Leasehold improvements 3-7 2,047 2,008 Reusable instruments 5 4,667 3,402 Total property and equipment 36,323 34,846 Accumulated depreciation (22,567 ) (21,490 ) Property and equipment, net $ 13,756 $ 13,356

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2020
Accrued Liabilities and Other Liabilities [Abstract]
Schedule of accrued expenses	Accrued expenses consisted of the following (in thousands): March 31, December 31, Accrued employee compensation $ 2,329 $ 3,198 Accrued legal expense 569 310 Accrued consulting expense 21 21 Accrued vendor charges 1,296 1,037 Accrued revenue share expense 564 1,050 Accrued clinical trial expense 325 394 Accrued other 1,181 1,125 $ 6,285 $ 7,135

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2020
Leases [Abstract]
Lease, Cost	The components of lease expense and related cash flows were as follows (in thousands): Three Months Ended March 31, 2020 2019 Rent expense $ 381 $ 381 Variable lease cost (1) 89 101 $ 470 $ 482 (1) Variable operating lease expenses consist primarily of common area maintenance and real estate taxes for the three months ended March 31, 2020 and 2019 , respectively.
Lessee, Operating Lease, Liability, Maturity	The future minimum rental payments under these agreements as of March 31, 2020 were as follows (in thousands): Year Minimum Lease Payments 2020 remainder of year 1,218 2021 1,633 2022 1,399 2023 1,053 After 2023 1,885 Total lease payments $ 7,188 Present value adjustment (952 ) Present value of lease liabilities $ 6,236

Debt and Notes Payable (Tables)

Debt and Notes Payable (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Schedule of long term debt	Long-term debt consisted of the following (in thousands): March 31, December 31, Innovatus, Term Loan 20,000 20,000 Innovatus, Term Loan accrued payment-in-kind interest 388 262 Less unamortized debt issuance costs (601 ) (639 ) Long-term debt, less debt issuance costs $ 19,787 $ 19,623
Schedule of principal payments due	Principal payments, including the Term Loan Basic Interest Rate in-kind (described below), due as of March 31, 2020 consisted of the following (in thousands): Principal Payment 2020 (remainder of the year) — 2021 — 2022 — 2023 8,986 2024 12,580 Total $ 21,566

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	3 Months Ended
	Mar. 31, 2020
Stockholders' Equity Note [Abstract]
Range of warrant prices per share for shares under warrants and the weighted average contractual life	At March 31, 2020 and December 31, 2019 , the weighted average warrant exercise price per share for common stock underlying warrants and the weighted average contractual life was as follows: Number of Weighted Weighted Average Remaining Contractual Life Number of Weighted Outstanding December 31, 2019 28,926 $ 9.80 3.66 28,926 $ 9.80 Outstanding March 31, 2020 28,926 $ 9.80 3.41 28,926 $ 9.80
Schedule of activity under all stock option plans	Activity under all stock option plans was as follows: Number of Options Weighted Average Exercise Price per Share Aggregate Intrinsic Value (in Thousands) Outstanding December 31, 2019 1,802,463 $ 6.75 Granted 191,667 0.98 Expired (317,992 ) 8.19 Outstanding March 31, 2020 1,676,138 $ 5.81 $ — Total vested and exercisable 1,266,859 $ 6.72 $ —
Schedule of restricted stock award activity under the plan	Restricted common stock award activity under the plan was as follows: Number of Shares Weighted Average Fair Value Unvested December 31, 2019 4,436,928 $ 1.54 Granted 225,000 1.39 Vested (593,644 ) 0.69 Forfeited (146,676 ) 1.30 Unvested March 31, 2020 3,921,608 $ 1.67
Assumptions used to estimate the fair value of options at date of grant	The fair value of options at date of grant was estimated using the Black-Scholes option pricing model, based on the following assumptions: Three Months Ended March 31, 2020 2019 Risk-free interest rate 1.49% - 1.63% N/A Expected term (in years) 6.25 N/A Dividend yield —% N/A Expected volatility 55.92% N/A
Summary of stock-based compensation	The following is a summary of stock-based compensation expense (in thousands): Three Months Ended March 31, 2020 2019 Cost of revenues $ 11 $ 166 Sales and marketing 112 81 Research and development 134 257 General and administrative 509 644 $ 766 $ 1,148

Segment and Geographic Data (Ta

Segment and Geographic Data (Tables)	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Schedule of revenue by geographic information	Geographic information consisted of the following (in thousands): Three Months Ended March 31, 2020 2019 Product revenue United States $ 13,827 $ 17,601 Germany 1,970 2,464 Rest of world 493 404 $ 16,290 $ 20,469
Schedule of property, plant and equipment by geographic information	March 31, 2020 December 31, 2019 Property and equipment, net United States $ 13,707 $ 13,303 Germany 49 53 $ 13,756 $ 13,356

Organization and Basis of Pre_2

Organization and Basis of Presentation (Details)

May 11, 2020USD ($)

Mar. 23, 2020USD ($)

Mar. 20, 2020employee

Sep. 30, 2019USD ($)milestone

Jun. 25, 2019USD ($)

Dec. 17, 2018USD ($)$ / sharesshares

May 10, 2017USD ($)

Jan. 31, 2017USD ($)

Mar. 31, 2020USD ($)shares

Mar. 31, 2019USD ($)

Mar. 31, 2020USD ($)shares

Apr. 17, 2020USD ($)

Dec. 31, 2019USD ($)

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Accumulated deficit

$ (513,498,000)

$ (513,498,000)

$ (504,145,000)

Cash and cash equivalents and investments

21,500,000

21,500,000

Restricted cash

500,000

$ 500,000

$ 500,000

Line of Credit Facility [Line Items]

Amount of equity able to raise

$ 200,000,000

$ 200,000,000

Maximum offering price

$ 50,000,000

Net proceeds from issuance of common stock

$ 1,141,000

$ 0

Number of employees furloughed | employee

80

Equity Distribution Agreement

Line of Credit Facility [Line Items]

Number of shares sold (in shares) | shares

1,870,069

Net proceeds from issuance of common stock

$ 3,600,000

Innovatus

Line of Credit Facility [Line Items]

Issuance of common stock

$ 3,000,000

LPC Agreements

Line of Credit Facility [Line Items]

Number of shares sold (in shares) | shares

2,921,268

Net proceeds from issuance of common stock

$ 2,200,000

Number of shares issued in transaction (in shares) | shares

1,921,968

Proceeds received from sale of stock

$ 1,000,000

Premium on previous day's closing price

110.00%

Purchase period

36 months

LPC Agreements, Consideration For Commitment To Purchase Shares

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

354,430

Term loan | 2019 Secured Loan Agreement

Line of Credit Facility [Line Items]

Maximum borrowing capacity

$ 30,000,000

Instrumentation Technology | Howmedica Osteonics Corp

Line of Credit Facility [Line Items]

Installment payment

$ 14,000,000

$ 2,000,000

Potential milestone payment

$ 16,000,000

Number of potential milestones | milestone

3

Maximum | LPC Agreements

Line of Credit Facility [Line Items]

Value of stock to be sold

$ 20,000,000

Minimum | LPC Agreements

Line of Credit Facility [Line Items]

Sale of stock (in usd per share) | $ / shares

$ 0.25

Subsequent Event

Line of Credit Facility [Line Items]

Maximum offering price

$ 50,000,000

Subsequent Event | Paycheck Protection Program Note

Line of Credit Facility [Line Items]

Debt instrument principal

$ 4,700,000

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Concentration Risk) (Details) - customer	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2020	Mar. 31, 2019
Customer Concentration Risk, Revenue
Concentration Risk [Line Items]
Concentration risk, number of customers			0	0
Credit Concentration Risk, Accounts Receivable
Concentration Risk [Line Items]
Concentration risk, number of customers	0	0

Summary of Significant Accoun_5

Summary of Significant Accounting Policies (Cash and Cash Equivalents, Inventories, Intangibles and Other Long-Lived Assets, and Goodwill) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Cash and cash equivalents
Cash held in foreign bank accounts	$ 400		$ 800
Restricted cash	500		$ 500
Cost of revenue	9,261	$ 10,813
Improper Classification of Cost of Revenue
Cash and cash equivalents
Cost of revenue	$ 1,000	$ 500

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Schedule of Cash and Cash Equivalents (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Cash and cash equivalents	$ 21,518	$ 26,394
Restricted cash	462	462
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows	$ 21,980	$ 26,856	$ 19,078	$ 16,842

Summary of Significant Accoun_7

Summary of Significant Accounting Policies (Leases) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019	Jan. 01, 2019
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets	$ 5,565	$ 5,853
Operating lease liabilities	$ 6,236
Accounting Standards Update 2016-02
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets			$ 7,000
Operating lease liabilities			$ 7,700

Summary of Significant Accoun_8

Summary of Significant Accounting Policies (Revenue Recognition) (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Contract liability				$ 12,000
Minimum
Disaggregation of Revenue [Line Items]
Contract with customer payment period		30 days
Maximum
Disaggregation of Revenue [Line Items]
Contract with customer payment period		60 days
Shipping and Handling
Disaggregation of Revenue [Line Items]
Shipping and handling expense		$ 400	$ 600
Howmedica Osteonics Corp | Instrumentation Technology
Disaggregation of Revenue [Line Items]
Contract liability				12,000
Consideration	$ 30,000
Howmedica Osteonics Corp | Cost Reimbursement
Disaggregation of Revenue [Line Items]
Contract with customer asset, net				5,000
Howmedica Osteonics Corp | Royalty
Disaggregation of Revenue [Line Items]
Contract with customer asset, net				$ 25,000

Summary of Significant Accoun_9

Summary of Significant Accounting Policies Summary of Significant Accounting Policies (Effects of Topic 606 on Financial Statements) (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Change in Contract Liabilities
Beginning Balance	$ 127	$ 96
Provision related to current period sales	48	145
Adjustment related to prior period sales	0	20
Payments or credits issued to customer	(14)	(134)
Ending Balance	$ 161	$ 127

Summary of Significant Accou_10

Summary of Significant Accounting Policies (Expenses and Net Loss Per Share) (Details) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)segment$ / sharesshares	Mar. 31, 2019USD ($)$ / sharesshares	Dec. 31, 2019USD ($)
Advertising expense
Advertising expense	$ 200	$ 100
Segment reporting
Number of operating segments | segment	1
Income taxes
Income tax provision	$ 25	(9)
Interest and penalties accrued	55		$ 47
Numerator for basic and diluted loss per share:
Net loss	$ (9,353)	$ (7,581)
Denominator for basic loss per share:
Basic and diluted weighted average shares | shares	67,274,391	62,849,335
Basic loss per share attributable to ConforMIS, Inc. stockholders (in dollars per share) | $ / shares	$ (0.14)	$ (0.12)

Summary of Significant Accou_11

Summary of Significant Accounting Policies (Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share) (Details) - shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Equity options
Antidilutive Securities Excluded from Computation of Earnings Per Share
Anti-dilutive shares not included in the calculation of diluted net loss per share (in shares)	1,099,413	2,538,495

Accounts Receivable (Schedule o

Accounts Receivable (Schedule of Accounts Receivable) (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Accounts Receivable, Net, Current [Abstract]
Total receivables	$ 8,495		$ 11,401
Allowance for doubtful accounts and returns	(332)		(335)
Accounts receivable, net	8,163		11,066
Unbilled receivable	700		2,100
Accounts receivable write offs	$ 5	$ 0	$ 187

Accounts Receivable (Allowance

Accounts Receivable (Allowance For Doubtful Accounts Receivable) (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Allowance for Doubtful Accounts Receivable [Roll Forward]
Beginning balance	$ (335)	$ (390)	$ (390)
Provision for bad debts on trade receivables	(23)		(106)
Other allowances	31		(26)
Accounts receivable write offs	(5)
Accounts receivable write offs	5	$ 0	187
Ending balance	$ (332)		$ (335)

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw Material	$ 5,373	$ 6,171
Work in process	1,498	1,717
Finished goods	4,986	4,186
Total Inventories, net	$ 11,857	$ 12,074

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Property and equipment
Total property and equipment	$ 36,323	$ 34,846
Accumulated depreciation	(22,567)	(21,490)
Property and equipment, net	13,756	13,356
Depreciation expense	1,100	1,000
Equipment
Property and equipment
Total property and equipment	$ 19,210	19,011
Equipment | Minimum
Property and equipment
Estimated useful life	5 years
Equipment | Maximum
Property and equipment
Estimated useful life	7 years
Furniture and fixtures
Property and equipment
Total property and equipment	$ 864	864
Furniture and fixtures | Minimum
Property and equipment
Estimated useful life	5 years
Furniture and fixtures | Maximum
Property and equipment
Estimated useful life	7 years
Computer and software
Property and equipment
Estimated useful life	3 years
Total property and equipment	$ 9,535	9,561
Leasehold improvements
Property and equipment
Total property and equipment	$ 2,047	2,008
Leasehold improvements | Minimum
Property and equipment
Estimated useful life	3 years
Leasehold improvements | Maximum
Property and equipment
Estimated useful life	7 years
Reusable instruments
Property and equipment
Estimated useful life	5 years
Total property and equipment	$ 4,667	$ 3,402

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Accrued Liabilities and Other Liabilities [Abstract]
Accrued employee compensation	$ 2,329	$ 3,198
Accrued legal expense	569	310
Accrued consulting expense	21	21
Accrued vendor charges	1,296	1,037
Accrued revenue share expense	564	1,050
Accrued clinical trial expense	325	394
Accrued other	1,181	1,125
Total	$ 6,285	$ 7,135

Leases - Narrative (Details)

Leases - Narrative (Details)	3 Months Ended
	Mar. 31, 2020extension
Lessee, Lease, Description [Line Items]
Number of renewal options	1
Weighted average remaining lease term	4 years 9 months 18 days
Weighted average discount rate	6.00%
Billerica Facility
Lessee, Lease, Description [Line Items]
Renewal term	5 years
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	7 years

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Leases [Abstract]
Rent expense	$ 381	$ 381
Variable lease cost	89	101
Total lease cost	$ 470	$ 482

Leases - Schedule of Lease Matu

Leases - Schedule of Lease Maturities (Details) $ in Thousands	Mar. 31, 2020USD ($)
Leases [Abstract]
2020 remainder of year	$ 1,218
2021	1,633
2022	1,399
2023	1,053
After 2023	1,885
Total lease payments	7,188
Present value adjustment	(952)
Present value of lease liabilities	$ 6,236

Commitments and Contingencies (

Commitments and Contingencies (Details) - Revenue share agreements - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
License and revenue share agreements
Revenue share expense	$ 0.5	$ 0.7
Revenue share expense as a percentage of product revenues	3.30%	3.50%
Members of scientific advisory board | Minimum
License and revenue share agreements
Required payment to related party from net revenues of current and planned products (as a percent)	0.10%
Members of scientific advisory board | Maximum
License and revenue share agreements
Required payment to related party from net revenues of current and planned products (as a percent)	1.33%

Debt and Notes Payable (Schedul

Debt and Notes Payable (Schedule of Long Term Debt) (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt and Notes Payable
Innovatus, Term Loan accrued payment-in-kind interest	$ 388	$ 262
Less unamortized debt issuance costs	(601)	(639)
Long-term debt, less debt issuance costs	19,787	19,623
Principal payments due
2020 (remainder of the year)	0
2021	0
2022	0
2023	8,986
2024	12,580
Total	21,566
Innovatus | Term loan
Debt and Notes Payable
Term Loan principal	$ 20,000	$ 20,000

Debt and Notes Payable (Details

Debt and Notes Payable (Details) - USD ($)	Jun. 25, 2019	Jun. 30, 2017	Mar. 31, 2020	Dec. 13, 2018	Dec. 31, 2017
2017 Secured Loan Agreement | Term loan
Credit facility
Principal amount				$ 30,000,000
Final payment, percent of amount of loans advanced	5.00%
Additional interest rate if event of default occurs (as a percent)	5.00%
2017 Secured Loan Agreement | Term loan | Oxford Term Loan
Credit facility
Amount drawn down		$ 15,000,000
Loss on extinguishment of debt	$ (1,100,000)
2017 Secured Loan Agreement | Term loan | Oxford Term Loan B
Credit facility
Maximum borrowing capacity					$ 15,000,000
2019 Secured Loan Agreement | Term loan
Credit facility
Maximum borrowing capacity	$ 30,000,000
Margin rate (as a percent)	3.75%
Effective interest rate			9.25%
Credit facility term	4 years
Interest rate stated percentage	2.50%
Event of default, threshold amount	$ 500,000
2019 Secured Loan Agreement | Term loan | Prime Rate
Credit facility
Margin rate (as a percent)	5.50%
2019 Secured Loan Agreement | Revolving Credit Facility
Credit facility
Maximum borrowing capacity	$ 10,000,000
Principal amount			$ 0
Margin rate (as a percent)	0.50%
Percent of eligible accounts subject to maximum 2.50% dilution	85.00%
2019 Secured Loan Agreement | Revolving Credit Facility | Prime Rate
Credit facility
Margin rate (as a percent)	5.50%
Minimum | 2017 Secured Loan Agreement | Term loan | Oxford Term Loan
Credit facility
Cash collateral requirement				$ 5,000,000
Minimum | 2019 Secured Loan Agreement | Term loan
Credit facility
Event of default, threshold amount	$ 250,000

Stockholders' Equity (Common St

Stockholders' Equity (Common Stock) (Details)	Mar. 31, 2020USD ($)
Stockholders' Equity Note [Abstract]
Common stock dividends declared to date	$ 0

Stockholders' Equity (Preferred

Stockholders' Equity (Preferred Stock) (Details) - $ / shares	Jun. 25, 2019	Mar. 31, 2020	Dec. 31, 2019
Stockholders' Equity Note [Abstract]
Preferred stock, shares authorized		5,000,000	5,000,000
Preferred stock, par value (in dollars per share)		$ 0.00001	$ 0.00001
Preferred stock, shares issued		0	0
Preferred stock, shares outstanding		0	0
2019 Rights Agreement
Class of Stock [Line Items]
Maximum days to register for resale shares held by investors	120 days

Stockholders' Equity (Warrants

Stockholders' Equity (Warrants and Common Stock Warrants) (Details) - Common stock warrants - $ / shares	3 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Warrants
Number of warrants, outstanding (in shares)	28,926	28,926
Number of Warrants
Outstanding at beginning of period (in shares)	28,926
Outstanding at end of period (in shares)	28,926	28,926
Weighted Average Exercise Price Per Share
Outstanding at beginning of period (in dollars per share)	$ 9.80
Outstanding at end of period (in dollars per share)	$ 9.80	$ 9.80
Weighted Average Remaining Contractual Life
Weighted average remaining contractual life, outstanding (in years)	3 years 4 months 28 days	3 years 7 months 28 days
Number of Warrants Exercisable
Outstanding at beginning of period (in shares)	28,926
Outstanding at end of period (in shares)	28,926	28,926
Weighted Average Price Per Share
Outstanding at beginning of period (in dollars per share)	$ 9.80	$ 9.80
Outstanding at end of period (in dollars per share)	$ 9.80	$ 9.80

Stockholders' Equity (Stock Opt

Stockholders' Equity (Stock Option Plans) (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 29, 2019	Feb. 29, 2020	Mar. 31, 2020	Jan. 01, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested and Expected to Vest [Abstract]
Weighted average grant date fair value, vested			$ 100
Weighted average remaining contractual term, outstanding			5 years 2 months 1 day
Weighted average remaining contractual term, vested and exercisable			4 years 7 days
Stock options
Number of Options
Balance outstanding at the beginning of the period (in shares)			1,802,463
Granted (in shares)			191,667
Expired (in shares)			(317,992)
Balance outstanding at the end of the period (in shares)			1,676,138
Total vested and exercisable (in shares)			1,266,859
Weighted Average Exercise Price per Share
Balance at the beginning of the period (in dollars per share)			$ 6.75
Granted (in dollars per share)			0.98
Expired (in dollars per share)			8.19
Balance at the end of the period (in dollars per share)			5.81
Total vested and exercisable (in dollars per share)			$ 6.72
Aggregate Intrinsic Value (in Thousands)
Outstanding at end of the period			$ 0
Total vested and exercisable			0
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested and Expected to Vest [Abstract]
Weighted average grant date fair value, vested			$ 400
Number of Shares
Unvested beginning of period (in shares)			4,436,928
Granted (in shares)			225,000
Vested (in shares)			(593,644)
Forfeited (in shares)			(146,676)
Unvested end of period (in shares)			3,921,608
Weighted Average Fair Value
Unvested beginning of period (in dollars per share)			$ 1.54
Granted (in dollars per share)			1.39
Vested (in dollars per share)			0.69
Forfeited (in dollars per share)			1.30
Unvested end of period (in dollars per share)			$ 1.67
2015 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock available for future issuance (in shares)			3,906,242
Additional shares authorized, maximum annual amount (in shares)			3,000,000	2,112,822
Additional shares authorized, maximum annual percentage			3.00%
2019 Sales Team Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)	3,000,000
Award expiration period	10 years
Number of Shares
Unvested end of period (in shares)			2,775,000
Chief Financial Officer | Restricted stock awards
Number of Shares
Granted (in shares)		125,000
Chief Financial Officer | Inducement Award [Member]
Number of Options
Granted (in shares)		125,000
Weighted Average Exercise Price per Share
Granted (in dollars per share)		$ 0.98
Senior Vice President, Operations | Restricted stock awards
Number of Shares
Granted (in shares)		61,350
Senior Vice President, Operations | Inducement Award [Member]
Number of Options
Granted (in shares)		66,667
Weighted Average Exercise Price per Share
Granted (in dollars per share)		$ 0.98

Stockholders' Equity (Stock-bas

Stockholders' Equity (Stock-based Compensation) (Details)	3 Months Ended
	Mar. 31, 2020
Assumptions used to estimate the fair value of options at date of grant
Risk-free interest rate minimum	1.49%
Risk-free interest rate maximum	1.63%
Expected term (in years)	6 years 3 months
Dividend yield	0.00%
Expected volatility	55.92%

Stockholders' Equity (Stock-b_2

Stockholders' Equity (Stock-based Compensation Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based compensation
Stock-based compensation expense	$ 766	$ 1,148
Stock options
Share-based compensation
Unrecognized compensation expense	$ 600
Period for unrecognized compensation expense to be recognized	2 years 6 months 26 days
Restricted stock awards
Share-based compensation
Unrecognized compensation expense	$ 4,700
Period for unrecognized compensation expense to be recognized	2 years 1 month 10 days

Stockholders' Equity (Summary o

Stockholders' Equity (Summary of Stock-based Compensation) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based compensation
Stock-based compensation expense	$ 766	$ 1,148
Cost of revenues
Share-based compensation
Stock-based compensation expense	11	166
Sales and marketing
Share-based compensation
Stock-based compensation expense	112	81
Research and development
Share-based compensation
Stock-based compensation expense	134	257
General and administrative
Share-based compensation
Stock-based compensation expense	$ 509	$ 644

Segment and Geographic Data (De

Segment and Geographic Data (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)segment	Mar. 31, 2019USD ($)	Dec. 31, 2019USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment	1
Geographic information for Product Revenue and Property and equipment, net
Revenue	$ 16,475	$ 20,644
Property and equipment, net	13,756		$ 13,356
United States
Geographic information for Product Revenue and Property and equipment, net
Property and equipment, net	13,707		13,303
Germany
Geographic information for Product Revenue and Property and equipment, net
Property and equipment, net	49		$ 53
Product
Geographic information for Product Revenue and Property and equipment, net
Revenue	16,290	20,469
Product | United States
Geographic information for Product Revenue and Property and equipment, net
Revenue	13,827	17,601
Product | Germany
Geographic information for Product Revenue and Property and equipment, net
Revenue	1,970	2,464
Product | Rest of World
Geographic information for Product Revenue and Property and equipment, net
Revenue	$ 493	$ 404

Subsequent Events - Narrative

Subsequent Events - Narrative (Details) - Paycheck Protection Program Note - Subsequent Event	Apr. 17, 2020USD ($)payment
Subsequent Event [Line Items]
Debt instrument principal | $	$ 4,700,000
Interest rate stated percentage	1.00%
Number of payments | payment	1
Interest accrual period	6 months
Minimum
Subsequent Event [Line Items]
Percent of forgiven funds that must be used for payroll	75.00%