Document and Entity Information
Document and Entity Information - shares | 9 Months Ended | |
Sep. 30, 2020 | Oct. 27, 2020 | |
Cover [Abstract] | ||
Entity Registrant Name | Xtant Medical Holdings, Inc. | |
Entity Central Index Key | 0001453593 | |
Document Type | 10-Q | |
Document Period End Date | Sep. 30, 2020 | |
Amendment Flag | false | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Non-accelerated Filer | |
Entity Small Business Flag | true | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 72,061,034 | |
Document Fiscal Period Focus | Q3 | |
Document Fiscal Year Focus | 2020 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Current Assets: | ||
Cash and cash equivalents | $ 2,741 | $ 5,237 |
Trade accounts receivable, net of allowance for credit losses of $746 and doubtful accounts of $500, respectively | 7,317 | 10,124 |
Inventories | 20,671 | 16,101 |
Prepaid and other current assets | 1,656 | 784 |
Total current assets | 32,385 | 32,246 |
Property and equipment, net | 4,122 | 4,695 |
Right-of-use asset, net | 1,799 | 2,100 |
Goodwill | 3,205 | 3,205 |
Intangible assets, net | 471 | 515 |
Other assets | 412 | 394 |
Total Assets | 42,394 | 43,155 |
Current Liabilities: | ||
Accounts payable | 2,814 | 2,188 |
Accrued liabilities | 6,043 | 6,632 |
Current portion of lease liability | 415 | 394 |
Current portion of financing lease obligations | 59 | 176 |
Total current liabilities | 9,331 | 9,390 |
Long-term Liabilities: | ||
Lease liability, less current portion | 1,417 | 1,726 |
Long-term debt, plus premium and less issuance costs | 79,627 | 76,244 |
Total Liabilities | 90,375 | 87,360 |
Commitments and Contingencies (note 11) | ||
Stockholders' Equity (Deficit): | ||
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding | ||
Common stock, $0.000001 par value; 75,000,000 shares authorized; 13,240,831 shares issued and outstanding as of September 30, 2020 and 13,161,762 shares issued and outstanding as of December 31, 2019 | ||
Additional paid-in capital | 181,649 | 179,061 |
Accumulated deficit | (229,630) | (223,266) |
Total Stockholders' Equity (Deficit) | (47,981) | (44,205) |
Total Liabilities & Stockholders' Equity (Deficit) | $ 42,394 | $ 43,155 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Statement of Financial Position [Abstract] | ||
Trade accounts receivable, allowance for doubtful accounts | $ 746 | $ 500 |
Preferred stock, par value | $ 0.000001 | $ 0.000001 |
Preferred stock, shares authorized | 10,000,000 | 10,000,000 |
Preferred stock, shares issued | ||
Preferred stock, shares outstanding | ||
Common stock, par value | $ 0.000001 | $ 0.000001 |
Common stock, shares authorized | 75,000,000 | 75,000,000 |
Common stock, shares issued | 13,240,831 | 13,161,762 |
Common Stock, shares outstanding | 13,240,831 | 13,161,762 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
Revenue | ||||
Orthopedic product sales | $ 13,980 | $ 15,691 | $ 39,207 | $ 47,574 |
Other revenue | 36 | 30 | 115 | 144 |
Total Revenue | 14,016 | 15,721 | 39,322 | 47,718 |
Cost of sales | 4,768 | 5,310 | 13,913 | 16,613 |
Gross Profit | 9,248 | 10,411 | 25,409 | 31,105 |
Operating Expenses | ||||
General and administrative | 3,042 | 4,228 | 10,293 | 12,866 |
Sales and marketing | 5,270 | 6,685 | 15,578 | 19,499 |
Research and development | 176 | 203 | 529 | 675 |
Total Operating Expenses | 8,488 | 11,116 | 26,400 | 33,040 |
Income (Loss) from Operations | 760 | (705) | (991) | (1,935) |
Other (Expense) Income | ||||
Interest expense | (2,097) | (1,185) | (5,258) | (4,504) |
Other (expense) income | 34 | (109) | ||
Total Other Expense | (2,097) | (1,151) | (5,258) | (4,613) |
Net Loss Before Provision for Income Taxes | (1,337) | (1,856) | (6,249) | (6,548) |
Provision for income taxes | (23) | (23) | (68) | (68) |
Net Loss | $ (1,360) | $ (1,879) | $ (6,317) | $ (6,616) |
Net loss per share: | ||||
Basic | $ (0.10) | $ (0.14) | $ (0.48) | $ (0.50) |
Dilutive | $ (0.10) | $ (0.14) | $ (0.48) | $ (0.50) |
Shares used in the computation: | ||||
Basic | 13,231,823 | 13,161,762 | 13,210,386 | 13,164,694 |
Dilutive | 13,231,823 | 13,161,762 | 13,210,386 | 13,164,694 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands | Common Stock [Member] | Additional Paid-In Capital [Member] | Retained Deficit [Member] | Total |
Beginning Balance at Dec. 31, 2018 | $ 171,273 | $ (215,045) | $ (43,772) | |
Beginning Balance, Shares at Dec. 31, 2018 | 13,172,179 | |||
Stock-based compensation | 256 | 256 | ||
Forfeiture of restricted stock | ||||
Forfeiture of restricted stock, shares | (10,417) | |||
Debt extinguishment | 7,264 | 7,264 | ||
Issuance of warrant | 9 | 9 | ||
Net loss | (6,616) | (6,616) | ||
Ending Balance at Sep. 30, 2019 | 178,802 | (221,661) | (42,859) | |
Ending Balance, Shares at Sep. 30, 2019 | 13,161,762 | |||
Beginning Balance at Jun. 30, 2019 | 178,707 | (219,782) | (41,075) | |
Beginning Balance, Shares at Jun. 30, 2019 | 13,161,762 | |||
Stock-based compensation | 95 | 95 | ||
Net loss | (1,879) | (1,879) | ||
Ending Balance at Sep. 30, 2019 | 178,802 | (221,661) | (42,859) | |
Ending Balance, Shares at Sep. 30, 2019 | 13,161,762 | |||
Beginning Balance at Dec. 31, 2019 | 179,061 | (223,266) | (44,205) | |
Beginning Balance, Shares at Dec. 31, 2019 | 13,161,762 | |||
Stock-based compensation | 726 | 726 | ||
Issuance of warrant | 1,862 | 1,862 | ||
ASU 2016-13 cumulative effect adjustment | (47) | (47) | ||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 79,069 | |||
Net loss | (6,317) | (6,317) | ||
Ending Balance at Sep. 30, 2020 | 181,649 | (229,630) | (47,981) | |
Ending Balance, Shares at Sep. 30, 2020 | 13,240,831 | |||
Beginning Balance at Jun. 30, 2020 | 181,412 | (228,270) | (46,858) | |
Beginning Balance, Shares at Jun. 30, 2020 | 13,223,565 | |||
Stock-based compensation | 237 | 237 | ||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 17,266 | |||
Net loss | (1,360) | (1,360) | ||
Ending Balance at Sep. 30, 2020 | $ 181,649 | $ (229,630) | $ (47,981) | |
Ending Balance, Shares at Sep. 30, 2020 | 13,240,831 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2020 | Sep. 30, 2019 | |
Operating activities: | ||
Net loss | $ (6,317) | $ (6,616) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Depreciation and amortization | 1,658 | 2,338 |
Gain on disposal of fixed assets | (307) | (27) |
Non-cash interest | 5,245 | 4,467 |
Non-cash rent | 12 | 16 |
Stock-based compensation | 726 | 256 |
Provision for reserve on accounts receivable | 296 | 453 |
Provision for excess and obsolete inventory | 429 | 517 |
Changes in operating assets and liabilities: | ||
Accounts receivable | 2,463 | 417 |
Inventories | (4,999) | 760 |
Prepaid and other assets | (890) | 240 |
Accounts payable | 626 | (4,216) |
Accrued liabilities | (589) | 1,053 |
Net cash (used in) provided by operating activities | (1,647) | (342) |
Investing activities: | ||
Purchases of property and equipment and intangible assets | (907) | (403) |
Proceeds from sale of fixed assets | 173 | 241 |
Net cash used in investing activities | (734) | (162) |
Financing activities: | ||
Payments on financing leases | (115) | (395) |
Costs associated with Second Amended and Restated Credit Agreement | (149) | |
Net cash used in financing activities | (115) | (544) |
Net change in cash and cash equivalents | (2,496) | (1,048) |
Cash and cash equivalents at beginning of period | 5,237 | 6,797 |
Cash and cash equivalents at end of period | $ 2,741 | $ 5,749 |
Business Description, Basis of
Business Description, Basis of Presentation and Summary of Significant Accounting Policies | 9 Months Ended |
Sep. 30, 2020 | |
Accounting Policies [Abstract] | |
Business Description, Basis of Presentation and Summary of Significant Accounting Policies | (1) Business Description, Basis of Presentation and Summary of Significant Accounting Policies Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we,” “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. Since March 2020, the COVID-19 pandemic has caused business closures, severe travel restrictions and implementation of social distancing measures. At the onset of the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Because of the COVID-19 pandemic, surgeons and their patients have been, and may continue to be, required, or are choosing, to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and will likely continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2019, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2020. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2019. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. Reclassifications Certain prior year amounts have been reclassified to conform with current year presentation. Recent Accounting Pronouncements In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments–Credit Losses: Measurement of Credit Losses on Financial Instruments Receivables Although there are several other new accounting pronouncements issued or proposed by the FASB, which the Company has adopted or will adopt, as applicable, the Company does not believe any of these accounting pronouncements has had or will have a material impact on the Company’s consolidated financial position or operating results. Use of Estimates The preparation of the consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term right-of-use asset, evaluation of ability to continue as a going concern and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. The Company looks primarily to estimated undiscounted future cash flows in its assessment of whether or not long-lived assets are recoverable. As a result of the revenue decline related to the COVID-19 pandemic, the Company evaluated whether the carrying values of the long-lived assets were recoverable. Based on these evaluations, the Company determined that the long-lived assets were still recoverable. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2020 and 2019. Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually and whenever events or circumstances indicate that the carrying amount of the asset may not be recoverable. As a result of the COVID-19 pandemic and its impact on the Company’s projected cash flows, the Company evaluated goodwill for impairment at the end of the third quarter of 2020. No impairments of goodwill were recorded for the three months and nine months ended September 30, 2020 and 2019. Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three and nine months ended September 30, 2020 and 2019, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported, as the effects of including 7,083,922 and 3,313,953 outstanding stock options, restricted stock units and warrants for the three and nine months ended September 30, 2020 and 2019, respectively, are anti-dilutive. Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2020 and December 31, 2019. |
Revenue
Revenue | 9 Months Ended |
Sep. 30, 2020 | |
Revenue from Contract with Customer [Abstract] | |
Revenue | (2) Revenue In the United States, we generate most of our revenue from independent commissioned sales agents. We consign our orthobiologics products to hospitals and consign or loan our spinal implant sets to the independent sales agents. The spinal implant sets typically contain the instruments, disposables, and spinal implants required to complete a surgery. Consigned sets are managed by the sales agent to service hospitals that are high volume users for multiple procedures. We ship replacement inventory to independent sales agents to replace the consigned inventory used in surgeries. Loaned sets are returned to the Company’s distribution center, replenished, and made available to sales agents for the next surgical procedure. For each surgical procedure, the sales agent reports use of the product by the hospital and, as soon as practicable thereafter, ensures that the hospital provides a purchase order to the Company. Upon receipt of the hospital purchase order, the Company invoices the hospital, and revenue is recognized in the proper period. Additionally, the Company sells product directly to domestic and international stocking resellers and private label resellers. Upon receipt and acceptance of a purchase order from a stocking reseller, the Company ships product and invoices the reseller. The Company recognizes revenue when control of the promised goods is transferred to the customer, in an amount that reflects the consideration we expect to collect in exchange for those goods or services. There is generally no customer acceptance or other condition that prevents the Company from recognizing revenue in accordance with the delivery terms for these sales transactions. The Company operates in one reportable segment with our net revenue derived primarily from the sale of orthobiologics and spinal implant products across North America, Europe, Asia Pacific, and Latin America. Sales are reported net of returns. The following table presents revenues from these product lines for the three and nine months ended September 30, 2020 and 2019 (in thousands): Three Months Ended Percentage of Three Months Ended Percentage of September 30, 2020 Total September 30, 2019 Total Orthobiologics $ 10,542 75 % $ 11,342 72 % Spinal implant 3,438 25 % 4,349 28 % Other revenue 36 0 % 30 0 % Total revenue $ 14,016 100 % $ 15,721 100 % Nine Months Ended Percentage of Nine Months Ended Percentage of September 30, 2020 Total September 30, 2019 Total Orthobiologics $ 28,613 73 % $ 34,374 72 % Spinal implant 10,594 27 % 13,200 28 % Other revenue 115 0 % 144 0 % Total revenue $ 39,322 100 % $ 47,718 100 % |
Receivables
Receivables | 9 Months Ended |
Sep. 30, 2020 | |
Credit Loss [Abstract] | |
Receivables | (3) Receivables Concurrent with the adoption of ASU 2016-13, the Company’s allowance for doubtful accounts was expanded to include provision for current expected credit loss (“CECL”). The Company’s provision for CECL is determined based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for credit losses are charged to expense. Activity within the allowance for credit losses was as follows for the three months ended September 30, 2020 (in thousands): Balance at January 1, 2020 $ 547 Provision for expected credit losses 138 Write-offs charged against allowance (17 ) Balance at March 31, 2020 668 Provision for expected credit losses 66 Write-offs charged against allowance (6 ) Balance at June 30, 2020 728 Provision for expected credit losses 92 Write-offs charged against allowance (74 ) Balance at September 30, 2020 $ 746 |
Inventories
Inventories | 9 Months Ended |
Sep. 30, 2020 | |
Inventory Disclosure [Abstract] | |
Inventories | (4) Inventories Inventories consist of the following (in thousands): September 30, 2020 December 31, 2019 Raw materials $ 4,461 $ 3,805 Work in process 2,332 1,603 Finished goods 25,307 22,135 Gross inventories 32,100 27,543 Reserve for obsolescence (11,429 ) (11,442 ) Total $ 20,671 $ 16,101 |
Property and Equipment, Net
Property and Equipment, Net | 9 Months Ended |
Sep. 30, 2020 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment, Net | (5) Property and Equipment, Net Property and equipment, net are as follows (in thousands): September 30, 2020 December 31, 2019 Equipment $ 4,682 $ 4,250 Computer equipment 461 455 Computer software 570 570 Furniture and fixtures 133 124 Leasehold improvements 3,987 3,980 Vehicles 10 10 Surgical instruments 11,147 10,897 Total cost 20,990 20,286 Less: accumulated depreciation (16,868 ) (15,591 ) Property and equipment, net $ 4,122 $ 4,695 The Company leases certain equipment under finance leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of September 30, 2020, the Company has recorded $0.5 million of gross assets in equipment and $0.4 million of accumulated depreciation for assets subject to finance leases. |
Intangible Assets
Intangible Assets | 9 Months Ended |
Sep. 30, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangible Assets | (6) Intangible Assets The following table sets forth information regarding intangible assets (in thousands): September 30, 2020 December 31, 2019 Patents $ 847 $ 847 Accumulated amortization (376 ) (332 ) Intangible assets, net $ 471 $ 515 |
Accrued Liabilities
Accrued Liabilities | 9 Months Ended |
Sep. 30, 2020 | |
Payables and Accruals [Abstract] | |
Accrued Liabilities | (7) Accrued Liabilities Accrued liabilities consist of the following (in thousands): September 30, 2020 December 31, 2019 Wages/commissions payable $ 3,788 $ 3,902 Other accrued liabilities 2,255 2,730 Accrued liabilities $ 6,043 $ 6,632 |
Debt
Debt | 9 Months Ended |
Sep. 30, 2020 | |
Debt Disclosure [Abstract] | |
Debt | (8) Debt On March 29, 2019, we entered into a Second Amended and Restated Credit Agreement (the “Second Amended and Restated Credit Agreement”) with OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”) and ROS Acquisition Offshore LP (“ROS” and together with Royalty Opportunities the “Lenders”), which amended and restated the prior credit agreement with the Lenders (the “Prior Credit Agreement”). On May 6, 2020, we entered into a First Amendment to the Second Amended and Restated Credit Agreement (the “First Amendment”) with the Lenders, which among other things, provided that: ● No interest will accrue on the outstanding loans under the Second Amended and Restated Credit Agreement (the “Loans”) from and after March 31, 2020 until September 30, 2020; ● Beginning October 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Second Amended and Restated Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%; ● The maturity date of the Loans is December 31, 2021; ● The Revenue Base (as such term is defined in the Second Amended and Restated Credit Agreement) financial covenant was revised through December 31, 2021; and ● The key person event default provision was revised to refer specifically to Sean Browne in lieu of a former executive. On May 6, 2020, we issued warrants to purchase an aggregate of 2.4 million shares of our common stock to the Lenders, with an exercise price of $0.01 per share and an expiration date of May 6, 2030 (collectively, the “2020 Warrants”). The issuance of the 2020 Warrants was a condition to the effectiveness of the First Amendment. The First Amendment was accounted for as a debt modification whereby the recorded debt balance was discounted for the fair value of the 2020 Warrants issued and interest expense is accrued through the maturity date of the Loans at the post-amendment effective interest rate of 10.02%. As of September 30, 2020, the Company had availability for additional delayed draw loan advances of $2.2 million, subject to Lenders’ discretion, and in addition, as of such date, the Company could request additional term loans from the Lenders in an aggregate amount up to $10.0 million, subject to Lenders’ discretion. Long-term debt consists of the following (in thousands): September 30, 2020 December 31, 2019 Amounts due under the Second Amended and Restated Credit Agreement $ 76,886 $ 72,657 PIK interest payable related to Second Amended and Restated Credit Agreement — 3,280 Plus: 2% exit fee 820 399 Gross long-term debt 77,706 76,336 Premium related to First Amendment 1,974 — Less: total debt issuance costs on Credit Agreements (53 ) (92 ) Long-term debt, plus premium and less issuance costs $ 79,627 $ 76,244 Subsequent to the end of the quarter ended September 30, 2020, in connection with the restructuring transactions described in Note 16, “ Subsequent Events ● Extinguishment by the Lenders of approximately $61.9 million of principal and paid-in-kind interest outstanding on the Loans in exchange for approximately 57.8 million shares of our common stock and the addition of a principal amount equal to prepayment fees associated with the Loans not paid in cash or exchanged for shares of our common stock; ● Exchange of approximately $0.9 million of prepayment fees associated with the Loans for approximately 0.9 million shares of our common stock (the “Prepayment Fee Shares”); ● Elimination of the availability of additional draw loan advances and reduction of available additional term loans to $5.0 million; ● Accrual of interest payable in cash for the remaining term of the Second Amended and Restated Credit Agreement at a rate per annum equal to the sum of (i) 7.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 1.00%; and ● Elimination of certain financial covenants. The Lenders, which were the sole holders of the Company’s outstanding debt as of September 30, 2020, collectively owned approximately 70% of the Company’s outstanding common stock, and beneficially owned, with their warrants, approximately 78% of the Company’s common stock as of such date. As a result of the execution of the Second Amendment and the completion of the restructuring transactions described in Note 16, “ Subsequent Events |
Stock-Based Compensation
Stock-Based Compensation | 9 Months Ended |
Sep. 30, 2020 | |
Share-based Payment Arrangement [Abstract] | |
Stock-Based Compensation | (9) Stock-Based Compensation Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan, was as follows for the nine months ended: 2020 2019 Shares Weighted Average Exercise Price Per Share Weighted Average Fair Value at Grant Date Per Share Shares Weighted Average Exercise Price Per Share Weighted Average Fair Value at Grant Date Per Share Outstanding at January 1 602,966 $ 6.07 $ 3.99 496,958 $ 9.90 $ 6.62 Granted 239,884 $ 1.13 $ 0.90 100,000 $ 2.24 $ 1.95 Cancelled or expired (120,738 ) $ 6.42 $ 4.05 (448,053 ) $ 4.64 $ 3.69 Outstanding at September 30 722,112 $ 4.37 $ 2.96 148,905 $ 9.12 $ 6.53 Exercisable at September 30 49,979 $ 33.70 $ 19.67 18,135 $ 52.04 $ 33.67 Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended: 2020 2019 Shares Weighted Average Fair Value at Grant Date Per Share Shares Weighted Average Fair Value at Grant Date Per Share Outstanding at January 1 499,914 $ 2.93 40,000 $ 6.20 Granted 679,803 $ 1.36 89,204 $ 2.74 Vested (79,069 ) $ 2.37 - $ - Outstanding at September 30 1,100,648 $ 2.00 129,204 $ 3.81 |
Warrants
Warrants | 9 Months Ended |
Sep. 30, 2020 | |
Warrants and Rights Note Disclosure [Abstract] | |
Warrants | (10) Warrants 2020 Warrants As noted in Note 8, “ Debt 2019 Warrants On April 1, 2019, the Company issued warrants to purchase an aggregate of 1.2 million shares of Company common stock to the Lenders with an exercise price of $0.01 per share and an expiration date of April 1, 2029. The issuance of the 2019 Warrants was a condition to the effectiveness of the Second Amended and Restated Credit Agreement. The fair value of the 2019 Warrants upon issuance was determined to be $9 thousand. The 2019 Warrants meet all the requirements to be classified as equity awards in accordance with ASC No. 815-40. The number of shares of Company common stock issuable upon exercise of the 2019 Warrants is subject to standard and customary anti-dilution provisions for stock splits, stock dividends, or similar transactions. Common Stock Warrants Weighted Average Exercise Price Outstanding at January 1, 2020 2,908,874 $ 4.16 Issued 2,400,000 0.01 Expired (47,712 ) 85.44 Outstanding at September 30, 2020 5,261,162 $ 1.53 The estimated fair value of warrants issued was derived using a valuation model with the following weighted-average assumptions: Nine Months Ended September 30, 2020 2019 Risk free interest rate 2.0 % 1.7 % Expected term in years 10.0 3.0 Volatility 105.0 % 85.0 % Dividend yield 0.0 % 0.0 % |
Commitments and Contingencies
Commitments and Contingencies | 9 Months Ended |
Sep. 30, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | (11) Commitments and Contingencies Operating Leases We lease three office facilities as of September 30, 2020 in Belgrade, Montana under non-cancelable operating lease agreements with expiration dates between 2023 and 2025. We have the option to extend certain leases to five or ten-year term(s), and we have the right of first refusal on any sale. Present Value of Long-term Leases (in thousands): September 30, 2020 Right-of-use assets, net $ 1,795 Current portion of lease liability 415 Lease liability, less current portion 1,412 Total lease liability $ 1,827 As of September 30, 2020, the weighted-average remaining lease term was 4.1 years. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, as of September 30, 2020, the Company estimates the weighted-average discount rate for its operating leases to be 5.2% of present value based on the incremental borrowing rate. Future minimum payments for the next five years and thereafter as of September 30, 2020 under these long-term operating leases are as follows (in thousands): Remainder of 2020 $ 126 2021 507 2022 521 2023 489 2024 224 Thereafter 179 Total future minimum lease payments 2,046 Less amount representing interest (219 ) Present value of obligations under operating leases 1,827 Less current portion (415 ) Long-term operating lease obligations $ 1,412 Rent expense was $0.1 million for the three months ended September 30, 2020 and 2019 and $0.4 million for the nine months ended September 30, 2020 and 2019. We have no contingent rent agreements. Financing Leases Future minimum payments under finance leases are as follows as of September 30, 2020 (in thousands): Remainder of 2020 $ 59 Less amount representing interest - Present value of obligations under financing leases $ 59 Litigation On December 13, 2018, a complaint was filed by RSB Spine, LLC against Xtant Medical Holdings, Inc., which claimed that some of our products, including the Irix-A Lumbar Integrated Fusion System and the Irix-C Cervical Integrated Fusion System, infringe certain of RSB Spine’s patents. On February 28, 2020, we entered into a confidential settlement and patent license agreement with RSB Spine pursuant to which we agreed to make an undisclosed settlement payment to RSB Spine and pay royalties on future sales of the two products through the expiration of the asserted patents. The settlement payment was included in accrued expenses as of December 31, 2019. In addition, we are subject to potential liabilities under government regulations and various claims and legal actions that are pending or may be asserted from time to time. These matters arise in the ordinary course and conduct of our business and may include, for example, commercial, product liability, intellectual property, and employment matters. We intend to continue to defend the Company vigorously in such matters and, when warranted, take legal action against others. Furthermore, we regularly assess contingencies to determine the degree of probability and range of possible loss for potential accrual in our financial statements. An estimated loss contingency is accrued in our financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Based on our assessment, we have adequately accrued an amount for contingent liabilities currently in existence. We do not accrue amounts for liabilities that we do not believe are probable or that we consider immaterial to our overall financial position. Litigation is inherently unpredictable, and unfavorable resolutions could occur. As a result, assessing contingencies is highly subjective and requires judgment about future events. The amount of ultimate loss may exceed the Company’s current accruals, and it is possible that its cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of one or more of these contingencies. Indemnifications Our indemnification arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party’s intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying condensed consolidated financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines, and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person’s service as a director or officer, including any action by us, arising out of that person’s services as our director or officer or that person’s services provided to any other company or enterprise at our request. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2020 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | (12) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The Company did not recognize any interest or penalties related to income taxes for the three and nine months ended September 30, 2020 and 2019. |
Supplemental Disclosure of Cash
Supplemental Disclosure of Cash Flow Information | 9 Months Ended |
Sep. 30, 2020 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Disclosure of Cash Flow Information | (13) Supplemental Disclosure of Cash Flow Information Supplemental cash flow information is as follows (in thousands): Nine Months Ended September, 2020 2019 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 13 $ 47 Non-cash activities: ASU 2016-13 cumulative effect adjustment $ 47 $ — Recognition of 2020 Warrants $ 1,862 $ — Lease liability from right-of-use assets $ — $ 2,296 Extinguishment of the Company’s Prior Credit Agreement (including debt issuance costs) $ — $ 79,624 Recognition of Second Amended and Restated Credit Agreement $ — $ 72,657 Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees $ — $ 307 Recognition of 2019 Warrants $ — $ 9 |
Related Party Transactions
Related Party Transactions | 9 Months Ended |
Sep. 30, 2020 | |
Related Party Transactions [Abstract] | |
Related Party Transactions | (14) Related Party Transactions Royalty Opportunities and ROS, which were the sole holders of the Company’s outstanding debt as of September 30, 2020, collectively owned approximately 70% of the Company’s outstanding common stock, and beneficially owned, with their warrants, approximately 78% of the Company’s common stock as of such date. As a result of the completion of the restructuring transactions described in Note 16, “ Subsequent Events In addition, as described in more detail under Note 1, “ Business Description and Summary of Significant Accounting Policies Subsequent Events On January 22, 2020, the Company amended its Sublease Agreement with Cardialen, Inc., reducing monthly rent to $1,350 per month. Because Jeffrey Peters is both a member of our Board and the Chief Executive Officer, President, and a Director of Cardialen, this transaction qualifies as a related party transaction. All related party transactions are reviewed and approved by the Audit Committee or the disinterested members of the full Board. |
Segment and Geographic Informat
Segment and Geographic Information | 9 Months Ended |
Sep. 30, 2020 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | (15) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture, and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately 98% and 96% of sales were in the United States for the three months ended September 30, 2020 and 2019, respectively, and 98% and 96% for the nine months ended September 30, 2020 and 2019, respectively. Total revenue by major geographic area is as follows (in thousands): Three Months Ended September 30, 2020 2019 United States $ 13,773 $ 15,097 Rest of world 243 624 Total revenue $ 14,016 $ 15,721 Nine Months Ended September 30, 2020 2019 United States $ 38,340 $ 45,781 Rest of world 982 1,937 Total revenue $ 39,322 $ 47,718 |
Subsequent Events
Subsequent Events | 9 Months Ended |
Sep. 30, 2020 | |
Subsequent Events [Abstract] | |
Subsequent events | (16) Subsequent Events Debt Restructuring On August 7, 2020, we entered into a Restructuring and Exchange Agreement (the “Restructuring Agreement”) with Royalty Opportunities and ROS, pursuant to which the parties thereto agreed, subject to the terms and conditions set forth therein, to take certain actions as set forth therein and as described below (collectively, the “Restructuring Transactions”) in furtherance of a restructuring of the Company’s outstanding indebtedness under Second Amended and Restated Credit Agreement. The Restructuring Transactions included, among others: ● an amendment to the Company’s Amended and Restated Certificate of Incorporation, as amended, to increase the number of authorized shares of common stock, par value $0.000001 per share, of the Company from 75 million to 300 million (the “Charter Amendment”), which occurred on October 1, 2020; ● the exchange by the Company of shares of common stock for approximately $40.8 million of the aggregate outstanding principal amount of the Loans (as defined in the Second Amended and Restated Credit Agreement) outstanding under the Second Amended and Restated Credit Agreement, as well as, without duplication, approximately $21.1 million of the outstanding amount of PIK Interest (as defined in the Second Amended and Restated Credit Agreement) (such loans and PIK Interest, the “Exchanging Loans”), plus all other accrued and unpaid interest on the Exchanging Loans outstanding as of the closing date, at an exchange price of $1.07 per share, representing the average closing price of the common stock over the 10 trading days immediately prior to the parties entering into the Restructuring Agreement, and resulting in the issuance of approximately 57.8 million shares of common stock (the “Share Issuance”), which occurred on October 1, 2020; ● the execution of the Second Amendment, as described in more detail above under Note 8, “Debt” ● the launch by the Company of a rights offering to allow stockholders of the Company to purchase up to an aggregate of $15 million of common stock at the same price per share as the $1.07 per share exchange price used to exchange the Exchanging Loans into common stock as part of the Share Issuance (the “Rights Offering”), the details of which the Company announced publicly on October 22, 2020 and are described in more detail below. As a result of the completion of these Restructuring Transactions, Royalty Opportunities and ROS own, in the aggregate, approximately 94.5% of the outstanding common stock and all other existing stockholders of the Company own approximately 5.5% of the outstanding common stock. Following completion of these Restructuring Transactions the remaining principal balance of our outstanding debt totals $15.6 million. Also on October 1, 2020, in connection with and as a condition to the closing of the Restructuring Transactions, the Company entered into a Registration Rights Agreement with the Lenders, which requires the Company to, among other things, file with the SEC a shelf registration statement covering the resale, from time to time, of the common stock issuable upon exchange of the Exchanging Loans and the Prepayment Fee Shares no later than the 90th day after the closing date and use its best efforts to cause the shelf registration statement to become effective under the Securities Act of 1933, as amended, no later than the 180th day after the closing date of the Restructuring Transactions. Rights Offering Pursuant to the terms of the Restructuring Agreement, on October 22, 2020, we announced that the Board of Directors has set November 5, 2020 as the record date for the Rights Offering. Subject to the registration statement on Form S-1 relating to the Rights Offering becoming effective on or about November 3, 2020, we intend to distribute to holders of our common stock, at no charge, 0.194539 non-transferable subscription rights for each share of common stock held on the record date. Each whole subscription right will entitle the holder to purchase one share of our common stock for $1.07 in cash. No fractional shares will be issued in the Rights Offering. Any fractional shares of common stock created by the exercise of rights will be rounded down to the nearest whole share. In addition, holders as of the record date will have an over-subscription privilege, pursuant to which they may be able to purchase additional shares at the subscription price, to the extent that not all subscription rights are exercised, subject to certain limitations. We expect that subscription materials for the Rights Offering will be mailed on or about November 6, 2020 to holders of our common stock as of the record date, and that the Rights Offering will close as soon as practicable after the anticipated December 4, 2020 expiration date. The Board of Directors may extend the rights offering for additional periods of time in its sole discretion. Xtant Medical Holdings, Inc. Amended and Restated Equity Incentive Plan On October 27, 2020, at the 2020 Annual Meeting of Stockholders of the Company (the “2020 Annual Meeting”), the Company’s stockholders approved and adopted, upon recommendation of the Board of Directors, an amended and restated version of the 2018 Plan, which incorporates certain amendments, including an amendment to increase the number of shares of our common stock available for issuance under the 2018 Plan by an additional 5,550,308 shares and a new limit on overall non-employee director compensation of $400,000 per year or $600,000 in the case of a non-employee chairman, lead independent director, or non-employee director in the first year of service on the Board (the “Amended 2018 Plan”). Equity Grants to President and Chief Executive Officer On October 27, 2020, immediately after completion of the 2020 Annual Meeting and adoption of the Amended 2018 Plan, the Board of Directors granted, effective as of November 15, 2020, the Company’s President and Chief Executive Officer, an option to purchase 1,468,859 shares of our common stock and a restricted stock unit award covering 1,468,859 shares of our common stock pursuant to the terms of his employment agreement with the Company which entitles him to receive an additional equity grant, 50% in the form of stock options and 50% in the form of restricted stock units, in the event OrbiMed Advisors LLC (including its affiliates) converted any of its remaining outstanding indebtedness of the Company into equity of the Company prior to October 7, 2024. |
Business Description, Basis o_2
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Policies) | 9 Months Ended |
Sep. 30, 2020 | |
Accounting Policies [Abstract] | |
Business Description and Basis of Presentation | Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we,” “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. Since March 2020, the COVID-19 pandemic has caused business closures, severe travel restrictions and implementation of social distancing measures. At the onset of the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Because of the COVID-19 pandemic, surgeons and their patients have been, and may continue to be, required, or are choosing, to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and will likely continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2019, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2020. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2019. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform with current year presentation. |
Recent Accounting Pronouncements | Recent Accounting Pronouncements In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments–Credit Losses: Measurement of Credit Losses on Financial Instruments Receivables Although there are several other new accounting pronouncements issued or proposed by the FASB, which the Company has adopted or will adopt, as applicable, the Company does not believe any of these accounting pronouncements has had or will have a material impact on the Company’s consolidated financial position or operating results. |
Use of Estimates | Use of Estimates The preparation of the consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term right-of-use asset, evaluation of ability to continue as a going concern and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. |
Long-Lived Assets | Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. The Company looks primarily to estimated undiscounted future cash flows in its assessment of whether or not long-lived assets are recoverable. As a result of the revenue decline related to the COVID-19 pandemic, the Company evaluated whether the carrying values of the long-lived assets were recoverable. Based on these evaluations, the Company determined that the long-lived assets were still recoverable. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2020 and 2019. |
Goodwill | Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually and whenever events or circumstances indicate that the carrying amount of the asset may not be recoverable. As a result of the COVID-19 pandemic and its impact on the Company’s projected cash flows, the Company evaluated goodwill for impairment at the end of the third quarter of 2020. No impairments of goodwill were recorded for the three months and nine months ended September 30, 2020 and 2019. |
Net Loss Per Share | Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three and nine months ended September 30, 2020 and 2019, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported, as the effects of including 7,083,922 and 3,313,953 outstanding stock options, restricted stock units and warrants for the three and nine months ended September 30, 2020 and 2019, respectively, are anti-dilutive. |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2020 and December 31, 2019. |
Revenue (Tables)
Revenue (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Revenue from Contract with Customer [Abstract] | |
Summary of Revenues from Product Lines | The following table presents revenues from these product lines for the three and nine months ended September 30, 2020 and 2019 (in thousands): Three Months Ended Percentage of Three Months Ended Percentage of September 30, 2020 Total September 30, 2019 Total Orthobiologics $ 10,542 75 % $ 11,342 72 % Spinal implant 3,438 25 % 4,349 28 % Other revenue 36 0 % 30 0 % Total revenue $ 14,016 100 % $ 15,721 100 % Nine Months Ended Percentage of Nine Months Ended Percentage of September 30, 2020 Total September 30, 2019 Total Orthobiologics $ 28,613 73 % $ 34,374 72 % Spinal implant 10,594 27 % 13,200 28 % Other revenue 115 0 % 144 0 % Total revenue $ 39,322 100 % $ 47,718 100 % |
Receivables (Tables)
Receivables (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Credit Loss [Abstract] | |
Schedule of Allowance for Credit Losses | Activity within the allowance for credit losses was as follows for the three months ended September 30, 2020 (in thousands): Balance at January 1, 2020 $ 547 Provision for expected credit losses 138 Write-offs charged against allowance (17 ) Balance at March 31, 2020 668 Provision for expected credit losses 66 Write-offs charged against allowance (6 ) Balance at June 30, 2020 728 Provision for expected credit losses 92 Write-offs charged against allowance (74 ) Balance at September 30, 2020 $ 746 |
Inventories (Tables)
Inventories (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Inventory Disclosure [Abstract] | |
Schedule of Inventories | Inventories consist of the following (in thousands): September 30, 2020 December 31, 2019 Raw materials $ 4,461 $ 3,805 Work in process 2,332 1,603 Finished goods 25,307 22,135 Gross inventories 32,100 27,543 Reserve for obsolescence (11,429 ) (11,442 ) Total $ 20,671 $ 16,101 |
Property and Equipment, Net (Ta
Property and Equipment, Net (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment, Net | Property and equipment, net are as follows (in thousands): September 30, 2020 December 31, 2019 Equipment $ 4,682 $ 4,250 Computer equipment 461 455 Computer software 570 570 Furniture and fixtures 133 124 Leasehold improvements 3,987 3,980 Vehicles 10 10 Surgical instruments 11,147 10,897 Total cost 20,990 20,286 Less: accumulated depreciation (16,868 ) (15,591 ) Property and equipment, net $ 4,122 $ 4,695 |
Intangible Assets (Tables)
Intangible Assets (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets | The following table sets forth information regarding intangible assets (in thousands): September 30, 2020 December 31, 2019 Patents $ 847 $ 847 Accumulated amortization (376 ) (332 ) Intangible assets, net $ 471 $ 515 |
Accrued Liabilities (Tables)
Accrued Liabilities (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Payables and Accruals [Abstract] | |
Schedule of Accrued Liabilities | Accrued liabilities consist of the following (in thousands): September 30, 2020 December 31, 2019 Wages/commissions payable $ 3,788 $ 3,902 Other accrued liabilities 2,255 2,730 Accrued liabilities $ 6,043 $ 6,632 |
Debt (Tables)
Debt (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt | Long-term debt consists of the following (in thousands): September 30, 2020 December 31, 2019 Amounts due under the Second Amended and Restated Credit Agreement $ 76,886 $ 72,657 PIK interest payable related to Second Amended and Restated Credit Agreement — 3,280 Plus: 2% exit fee 820 399 Gross long-term debt 77,706 76,336 Premium related to First Amendment 1,974 — Less: total debt issuance costs on Credit Agreements (53 ) (92 ) Long-term debt, plus premium and less issuance costs $ 79,627 $ 76,244 |
Stock-Based Compensation (Table
Stock-Based Compensation (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Share-based Payment Arrangement [Abstract] | |
Schedule of Share-based Compensation, Stock Options, Activity | Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan, was as follows for the nine months ended: 2020 2019 Shares Weighted Average Exercise Price Per Share Weighted Average Fair Value at Grant Date Per Share Shares Weighted Average Exercise Price Per Share Weighted Average Fair Value at Grant Date Per Share Outstanding at January 1 602,966 $ 6.07 $ 3.99 496,958 $ 9.90 $ 6.62 Granted 239,884 $ 1.13 $ 0.90 100,000 $ 2.24 $ 1.95 Cancelled or expired (120,738 ) $ 6.42 $ 4.05 (448,053 ) $ 4.64 $ 3.69 Outstanding at September 30 722,112 $ 4.37 $ 2.96 148,905 $ 9.12 $ 6.53 Exercisable at September 30 49,979 $ 33.70 $ 19.67 18,135 $ 52.04 $ 33.67 |
Schedule of Restricted Stock Activity | Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended: 2020 2019 Shares Weighted Average Fair Value at Grant Date Per Share Shares Weighted Average Fair Value at Grant Date Per Share Outstanding at January 1 499,914 $ 2.93 40,000 $ 6.20 Granted 679,803 $ 1.36 89,204 $ 2.74 Vested (79,069 ) $ 2.37 - $ - Outstanding at September 30 1,100,648 $ 2.00 129,204 $ 3.81 |
Warrants (Tables)
Warrants (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Warrants and Rights Note Disclosure [Abstract] | |
Schedule of Warrant Activity | Common Stock Warrants Weighted Average Exercise Price Outstanding at January 1, 2020 2,908,874 $ 4.16 Issued 2,400,000 0.01 Expired (47,712 ) 85.44 Outstanding at September 30, 2020 5,261,162 $ 1.53 |
Schedule of Warrant Valuation Assumptions | The estimated fair value of warrants issued was derived using a valuation model with the following weighted-average assumptions: Nine Months Ended September 30, 2020 2019 Risk free interest rate 2.0 % 1.7 % Expected term in years 10.0 3.0 Volatility 105.0 % 85.0 % Dividend yield 0.0 % 0.0 % |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
Schedule of Right-of-use Assets and Lease Liability | Present Value of Long-term Leases (in thousands): September 30, 2020 Right-of-use assets, net $ 1,795 Current portion of lease liability 415 Lease liability, less current portion 1,412 Total lease liability $ 1,827 |
Schedule of Future Minimum Rental Payments for Operating Leases | Future minimum payments for the next five years and thereafter as of September 30, 2020 under these long-term operating leases are as follows (in thousands): Remainder of 2020 $ 126 2021 507 2022 521 2023 489 2024 224 Thereafter 179 Total future minimum lease payments 2,046 Less amount representing interest (219 ) Present value of obligations under operating leases 1,827 Less current portion (415 ) Long-term operating lease obligations $ 1,412 |
Schedule of Future Minimum Lease Payments for Financing Leases | Future minimum payments under finance leases are as follows as of September 30, 2020 (in thousands): Remainder of 2020 $ 59 Less amount representing interest - Present value of obligations under financing leases $ 59 |
Supplemental Disclosure of Ca_2
Supplemental Disclosure of Cash Flow Information (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Supplemental Cash Flow Elements [Abstract] | |
Schedule of Supplemental Cash Flow Information | Supplemental cash flow information is as follows (in thousands): Nine Months Ended September, 2020 2019 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 13 $ 47 Non-cash activities: ASU 2016-13 cumulative effect adjustment $ 47 $ — Recognition of 2020 Warrants $ 1,862 $ — Lease liability from right-of-use assets $ — $ 2,296 Extinguishment of the Company’s Prior Credit Agreement (including debt issuance costs) $ — $ 79,624 Recognition of Second Amended and Restated Credit Agreement $ — $ 72,657 Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees $ — $ 307 Recognition of 2019 Warrants $ — $ 9 |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 9 Months Ended |
Sep. 30, 2020 | |
Segment Reporting [Abstract] | |
Schedule of Revenues by Geographic Region | Total revenue by major geographic area is as follows (in thousands): Three Months Ended September 30, 2020 2019 United States $ 13,773 $ 15,097 Rest of world 243 624 Total revenue $ 14,016 $ 15,721 Nine Months Ended September 30, 2020 2019 United States $ 38,340 $ 45,781 Rest of world 982 1,937 Total revenue $ 39,322 $ 47,718 |
Business Description, Basis o_3
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Details Narrative) - USD ($) $ in Thousands | Jan. 02, 2020 | Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 |
Cumulative effect adjustment | $ (47) | ||||
Impairment of long lived assets | |||||
Impairment of goodwill | |||||
Antidilutive securities excluded from computation of earnings per share, amount | 7,083,922 | 3,313,953 | 7,083,922 | 3,313,953 | |
Accounting Standards Update 2016-13 [Member] | |||||
Cumulative effect adjustment | $ 47 |
Revenue - Summary of Revenues f
Revenue - Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
Total revenue | $ 14,016 | $ 15,721 | $ 39,322 | $ 47,718 |
Percentage of total revenue | 100.00% | 100.00% | 100.00% | 100.00% |
Orthobiologics [Member] | ||||
Total revenue | $ 10,542 | $ 11,342 | $ 28,613 | $ 34,374 |
Percentage of total revenue | 75.00% | 72.00% | 73.00% | 72.00% |
Spinal Implant [Member] | ||||
Total revenue | $ 3,438 | $ 4,349 | $ 10,594 | $ 13,200 |
Percentage of total revenue | 25.00% | 28.00% | 27.00% | 28.00% |
Other Revenue [Member] | ||||
Total revenue | $ 36 | $ 30 | $ 115 | $ 144 |
Percentage of total revenue | 0.00% | 0.00% | 0.00% | 0.00% |
Receivables -Schedule of allowa
Receivables -Schedule of allowance for credit losses (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2020 | Jun. 30, 2020 | Mar. 31, 2020 | Sep. 30, 2020 | Sep. 30, 2019 | |
Credit Loss [Abstract] | |||||
Beginning balance | $ 728 | $ 668 | $ 547 | $ 547 | |
Provision for expected credit losses | 92 | 66 | 138 | 296 | $ 453 |
Write-offs charged against allowance | (74) | (6) | (17) | ||
Ending balance | $ 746 | $ 728 | $ 668 | $ 746 |
Inventories - Schedule of Inven
Inventories - Schedule of Inventories (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Inventory Disclosure [Abstract] | ||
Raw materials | $ 4,461 | $ 3,805 |
Work in process | 2,332 | 1,603 |
Finished goods | 25,307 | 22,135 |
Gross inventories | 32,100 | 27,543 |
Reserve for obsolescence | (11,429) | (11,442) |
Total | $ 20,671 | $ 16,101 |
Property and Equipment, Net (De
Property and Equipment, Net (Details Narrative) $ in Thousands | Sep. 30, 2020USD ($) |
Property, Plant and Equipment [Abstract] | |
Gross assets | $ 500 |
Accumulated depreciation | $ 400 |
Property and Equipment, Net - S
Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 20,990 | $ 20,286 |
Less: accumulated depreciation | (16,868) | (15,591) |
Property and equipment, net | 4,122 | 4,695 |
Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 4,682 | 4,250 |
Computer Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 461 | 455 |
Computer Software [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 570 | 570 |
Furniture and Fixtures [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 133 | 124 |
Leasehold Improvements [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 3,987 | 3,980 |
Vehicles [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 10 | 10 |
Surgical Instruments [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 11,147 | $ 10,897 |
Intangible Assets - Schedule of
Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Patents | $ 847 | $ 847 |
Accumulated amortization | (376) | (332) |
Intangible assets, net | $ 471 | $ 515 |
Accrued Liabilities - Schedule
Accrued Liabilities - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Payables and Accruals [Abstract] | ||
Wages/commissions payable | $ 3,788 | $ 3,902 |
Other accrued liabilities | 2,255 | 2,730 |
Accrued liabilities | $ 6,043 | $ 6,632 |
Debt (Details Narrative)
Debt (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands | Oct. 02, 2020 | May 06, 2020 | May 06, 2020 | Sep. 30, 2020 |
Sole Holders [Member] | ||||
Beneficially owned percentage | 78.00% | |||
Lenders [Member] | ||||
Beneficially owned percentage | 70.00% | |||
Royalty Opportunities and ROS [Member] | Subsequent Event [Member] | ||||
Beneficially owned percentage | 94.50% | |||
Other Existing Stockholders [Member] | Subsequent Event [Member] | ||||
Beneficially owned percentage | 5.50% | |||
2020 Warrants [Member] | Lenders [Member] | ||||
Debt instrument maturity date | May 6, 2030 | |||
Issuance of warrants to purchase a common stock | 2,400,000 | 2,400,000 | ||
Exercise price of warrants | $ 0.01 | $ 0.01 | ||
Second Amended and Restated Credit Agreement [Member] | ||||
Debt instrument description | Beginning October 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Second Amended and Restated Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%; | |||
Debt instrument maturity date | Dec. 31, 2021 | |||
Second Amended and Restated Credit Agreement [Member] | Lenders [Member] | ||||
Draw of loan advances | $ 2,200 | |||
Debt aggregate amount | $ 10,000 | |||
Second Amended and Restated Credit Agreement [Member] | Lenders [Member] | Subsequent Event [Member] | ||||
Shares issued in exchange of principal and paid-in-kind interest outstanding | $ 61,900 | |||
Shares issued in exchange of loans outstanding | 57,800,000 | |||
Prepayment fees | $ 900 | |||
Available additional term loans | $ 5,000 | |||
Interest rate | 7.00% | |||
Basis spread on variable rate | 1.00% | |||
Second Amended and Restated Credit Agreement [Member] | Lenders [Member] | Subsequent Event [Member] | Prepayment Fee Shares [Member] | ||||
Shares issued in exchange of loans outstanding | 900,000 | |||
Post Amendment [Member] | ||||
Warrants issued and interest expense | 10.02% | 10.02% |
Debt - Schedule of Long-term De
Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Debt Disclosure [Abstract] | ||
Amounts due under the Second Amended and Restated Credit Agreement | $ 76,886 | $ 72,657 |
PIK interest payable related to Second Amended and Restated Credit Agreement | 3,280 | |
Plus: 2% exit fee | 820 | 399 |
Gross long-term debt | 77,706 | 76,336 |
Premium related to First Amendment | 1,974 | |
Less: total debt issuance costs on Credit Agreements | (53) | (92) |
Long-term debt, less issuance costs | $ 79,627 | $ 76,244 |
Stock-Based Compensation - Sche
Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - $ / shares | 9 Months Ended | |
Sep. 30, 2020 | Sep. 30, 2019 | |
Shares Outstanding, Beginning Balance | 602,966 | 496,958 |
Shares Granted | 239,884 | 100,000 |
Shares Cancelled or expired | (120,738) | (448,053) |
Shares Outstanding, Ending Balance | 722,112 | 148,905 |
Shares Exercisable, Ending Balance | 49,979 | 18,135 |
Weighted Average Exercise Price, Outstanding Beginning Balance | $ 6.07 | $ 9.90 |
Weighted Average Exercise Price, Granted | 1.13 | 2.24 |
Weighted Average Exercise Price, Cancelled or expired | 6.42 | 4.64 |
Weighted Average Exercise Price, Outstanding Ending Balance | 4.37 | 9.12 |
Weighted Average Exercise Price, Exercisable Ending Balance | 33.70 | 52.04 |
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance | 3.99 | 6.62 |
Weighted Average Fair Value at Grant Date, Granted | 0.90 | 1.95 |
Weighted Average Fair Value at Grant Date, Cancelled or expired | 4.05 | 3.69 |
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance | 2.96 | 6.53 |
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance | $ 19.67 | $ 33.67 |
Stock-Based Compensation - Sc_2
Stock-Based Compensation - Schedule of Restricted Stock Activity (Details) - Restricted Stock Units (RSUs) [Member] - $ / shares | 9 Months Ended | |
Sep. 30, 2020 | Sep. 30, 2019 | |
Shares Outstanding, Beginning Balance | 499,914 | 40,000 |
Shares Granted | 679,803 | 89,204 |
Shares Vested | (79,069) | |
Shares Outstanding, Ending Balance | 1,100,648 | 129,204 |
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance | $ 2.93 | $ 6.20 |
Weighted Average Fair Value at Grant Date, Granted | 1.36 | 2.74 |
Weighted Average Fair Value at Grant Date, Vested | 2.37 | |
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance | $ 2 | $ 3.81 |
Warrants (Details Narrative)
Warrants (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands | May 06, 2020 | Apr. 02, 2019 |
2020 Warrant [Member] | ||
Class of Warrant or Right [Line Items] | ||
Fair value of warrants | $ 1,900 | $ 9 |
2019 Warrant [Member] | ||
Class of Warrant or Right [Line Items] | ||
Issuance of warrants to purchase a common stock | 1,200,000 | |
Exercise price of warrants | $ 0.01 | |
Warrants expiration date | Apr. 1, 2029 |
Warrants - Schedule of Warrant
Warrants - Schedule of Warrant Activity (Details) | 9 Months Ended |
Sep. 30, 2020$ / sharesshares | |
Warrants and Rights Note Disclosure [Abstract] | |
Common Stock Warrants Outstanding, Beginning Balance | shares | 2,908,874 |
Common Stock Warrants, Issued | shares | 2,400,000 |
Common Stock Warrants, Expired | shares | (47,712) |
Common Stock Warrants Outstanding, Ending Balance | shares | 5,261,162 |
Weighted Average Exercise Price Outstanding Beginning Balance | $ / shares | $ 4.16 |
Weighted Average Exercise Price, Issued | $ / shares | 0.01 |
Weighted Average Exercise Price, Expired | $ / shares | 85.44 |
Weighted Average Exercise Price Outstanding Ending Balance | $ / shares | $ 1.53 |
Warrants - Schedule of Warran_2
Warrants - Schedule of Warrant Valuation Assumptions (Details) - Warrant [Member] | Sep. 30, 2020 | Sep. 30, 2019 |
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Warrants and rights outstanding, measurement Input, expected term (In years) | 10 years | 3 years |
Risk Free Interest Rate [Member] | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Warrants and rights outstanding, measurement Input | 2 | 1.7 |
Volatility [Member] | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Warrants and rights outstanding, measurement Input | 105 | 85 |
Dividend Yield [Member] | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Warrants and rights outstanding, measurement Input | 0 | 0 |
Commitments and Contingencies_2
Commitments and Contingencies (Details Narrative) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
Commitments and Contingencies Disclosure [Abstract] | ||||
Operating lease expiration description | Expiration dates between 2023 and 2025 | |||
Operating lease weighted-average remaining lease term | 4 years 1 month 6 days | 4 years 1 month 6 days | ||
Operating lease weighted-average discount rate | 5.20% | 5.20% | ||
Rent expense | $ 100 | $ 100 | $ 400 | $ 400 |
Commitments and Contingencies -
Commitments and Contingencies - Schedule of Right-of-use Assets and Lease Liability (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Commitments and Contingencies Disclosure [Abstract] | ||
Right-of-use assets, net | $ 1,799 | $ 2,100 |
Current portion of lease liability | 415 | 394 |
Lease liability, less current portion | 1,417 | $ 1,726 |
Total lease liability | $ 1,827 |
Commitments and Contingencies_3
Commitments and Contingencies - Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands | Sep. 30, 2020 | Dec. 31, 2019 |
Commitments and Contingencies Disclosure [Abstract] | ||
Remainder of 2020 | $ 126 | |
2021 | 507 | |
2022 | 521 | |
2023 | 489 | |
2024 | 224 | |
Thereafter | 179 | |
Total future minimum lease payments | 2,046 | |
Less amount representing interest | (219) | |
Present value of obligations under operating leases | 1,827 | |
Less current portion | (415) | $ (394) |
Long-term operating lease obligations | $ 1,417 | $ 1,726 |
Commitments and Contingencies_4
Commitments and Contingencies - Schedule of Future Minimum Lease Payments for Financing Leases (Details) $ in Thousands | Sep. 30, 2020USD ($) |
Commitments and Contingencies Disclosure [Abstract] | |
Remainder of 2020 | $ 59 |
Less amount representing interest | |
Present value of obligations under financing leases | $ 59 |
Income Taxes (Details Narrative
Income Taxes (Details Narrative) - USD ($) | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
Income Tax Disclosure [Abstract] | ||||
Interest or penalties related to income taxes |
Supplemental Disclosure of Ca_3
Supplemental Disclosure of Cash Flow Information - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2020 | Sep. 30, 2019 | |
Supplemental Cash Flow Elements [Abstract] | ||
Interest | $ 13 | $ 47 |
ASU 2016-13 cumulative effect adjustment | 47 | |
Recognition of 2020 Warrants | 1,862 | |
Lease liability from right-of-use assets | 2,296 | |
Extinguishment of the Company's Prior Credit Agreement (including debt issuance costs) | 79,624 | |
Recognition of Second Amended and Restated Credit Agreement | 72,657 | |
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees | 307 | |
Recognition of 2019 Warrants | $ 9 |
Related Party Transactions (Det
Related Party Transactions (Details Narrative) - USD ($) | Jan. 22, 2020 | Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | Oct. 02, 2020 |
Related Party Transaction [Line Items] | ||||||
Rent expense | $ 100,000 | $ 100,000 | $ 400,000 | $ 400,000 | ||
Sole Holders [Member] | ||||||
Related Party Transaction [Line Items] | ||||||
Beneficially owned percentage | 78.00% | 78.00% | ||||
Lenders [Member] | ||||||
Related Party Transaction [Line Items] | ||||||
Beneficially owned percentage | 70.00% | 70.00% | ||||
Royalty Opportunities and ROS [Member] | Subsequent Event [Member] | ||||||
Related Party Transaction [Line Items] | ||||||
Beneficially owned percentage | 94.50% | |||||
Other Existing Stockholders [Member] | Subsequent Event [Member] | ||||||
Related Party Transaction [Line Items] | ||||||
Beneficially owned percentage | 5.50% | |||||
Sublease Agreement [Member] | Cardialen, Inc., [Member] | ||||||
Related Party Transaction [Line Items] | ||||||
Rent expense | $ 1,350 |
Segment and Geographic Inform_3
Segment and Geographic Information (Details Narrative) | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
United States [Member] | Revenue [Member] | Geographic Concentration Risk [Member] | ||||
Concentration risk, percentage | 98.00% | 96.00% | 98.00% | 96.00% |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2020 | Sep. 30, 2019 | Sep. 30, 2020 | Sep. 30, 2019 | |
Total revenue | $ 14,016 | $ 15,721 | $ 39,322 | $ 47,718 |
United States [Member] | ||||
Total revenue | 13,773 | 15,097 | 38,340 | 45,781 |
Rest of World [Member] | ||||
Total revenue | $ 243 | $ 624 | $ 982 | $ 1,937 |
Subsequent Events (Details Narr
Subsequent Events (Details Narrative) $ / shares in Units, $ in Thousands | Oct. 27, 2020USD ($)shares | Oct. 02, 2020USD ($)days$ / sharesshares | Oct. 22, 2020$ / sharesshares | Sep. 30, 2020USD ($)$ / sharesshares | Dec. 31, 2019USD ($)$ / sharesshares |
Common stock, par value | $ / shares | $ 0.000001 | $ 0.000001 | |||
Common stock, shares authorized | shares | 75,000,000 | 75,000,000 | |||
Outstanding debt | $ | $ 79,627 | $ 76,244 | |||
Subsequent Event [Member] | |||||
Common stock, par value | $ / shares | $ 0.000001 | ||||
Common stock, shares authorized | shares | 300,000,000 | ||||
Subsequent Event [Member] | 2018 Equity Incentive Plan [Member] | |||||
Number of shares available for issuance | shares | 5,550,308 | ||||
Subsequent Event [Member] | 2018 Equity Incentive Plan [Member] | Minimum [Member] | |||||
Limit on overall compensation | $ | $ 400,000 | ||||
Subsequent Event [Member] | 2018 Equity Incentive Plan [Member] | Maximum [Member] | |||||
Limit on overall compensation | $ | $ 600,000 | ||||
Subsequent Event [Member] | 2018 Equity Incentive Plan [Member] | President and Chief Executive Officer [Member] | Stock Option [Member] | |||||
Option to purchase common stock | shares | 1,468,859 | ||||
Percentage of additional equity grant in event of debt conversion | 50.00% | ||||
Subsequent Event [Member] | 2018 Equity Incentive Plan [Member] | President and Chief Executive Officer [Member] | Restricted Stock Units (RSUs) [Member] | |||||
Option to purchase common stock | shares | 1,468,859 | ||||
Percentage of additional equity grant in event of debt conversion | 50.00% | ||||
Subsequent Event [Member] | Royalty Opportunities and ROS [Member] | |||||
Beneficially owned percentage | 94.50% | ||||
Subsequent Event [Member] | Other Existing Stockholders [Member] | |||||
Beneficially owned percentage | 5.50% | ||||
Subsequent Event [Member] | Restructuring Agreement [Member] | Rights Offering [Member] | |||||
Shares issued in exchange of principal and paid-in-kind interest outstanding | $ | $ 15,000 | ||||
Exchange price per share | $ / shares | $ 1.07 | ||||
Number of non transferable subscription right for each share of common stock | shares | 0.194539 | ||||
Shares issued price per share | $ / shares | $ 1.07 | ||||
Subsequent Event [Member] | Restructuring Agreement [Member] | Royalty Opportunities and ROS [Member] | |||||
Exchange price per share | $ / shares | $ 1.07 | ||||
Trading days | days | 10 | ||||
Shares issued in exchange of loans outstanding | shares | 57,800,000 | ||||
Outstanding debt | $ | $ 15,600 | ||||
Subsequent Event [Member] | Restructuring Agreement [Member] | Royalty Opportunities and ROS [Member] | Loans Payable [Member] | |||||
Shares issued in exchange of principal and paid-in-kind interest outstanding | $ | 40,800 | ||||
Subsequent Event [Member] | Restructuring Agreement [Member] | Royalty Opportunities and ROS [Member] | PIK Interest [Member] | |||||
Shares issued in exchange of principal and paid-in-kind interest outstanding | $ | $ 21,100 |