Owens & Minor (OMI) 10-Q 4 Aug 23 2023 Q2 Quarterly report Financial data

Cover page

Cover page - shares	6 Months Ended
	Jun. 30, 2023	Jul. 31, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2023
Document Transition Report	false
Entity File Number	1-9810
Entity Registrant Name	Owens & Minor, Inc.
Entity Incorporation, State or Country Code	VA
Entity Tax Identification Number	54-1701843
Entity Address, Address Line One	9120 Lockwood Boulevard
Entity Address, City or Town	Mechanicsville
Entity Address, State or Province	VA
Entity Address, Postal Zip Code	23116
City Area Code	804
Local Phone Number	723-7000
Title of 12(b) Security	Common Stock, $2 par value per share
Trading Symbol	OMI
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Smaller Reporting Entity	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		76,530,724
Entity Central Index Key	0000075252
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
Amendment Flag	false

Consolidated Statements of Oper

Consolidated Statements of Operations (unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Statement [Abstract]
Net revenue	$ 2,563,226	$ 2,500,015	$ 5,086,075	$ 4,906,967
Cost of goods sold	2,043,794	1,967,510	4,069,336	4,001,014
Gross margin	519,432	532,505	1,016,739	905,953
Distribution, selling and administrative expenses	455,030	421,925	903,752	691,397
Acquisition-related charges and intangible amortization	22,203	37,276	44,392	79,410
Exit and realignment charges	28,963	1,214	44,637	2,896
Other operating expense (income), net	2,397	(2,995)	3,312	(3,894)
Operating income	10,839	75,085	20,646	136,144
Interest expense, net	40,728	35,839	82,926	47,858
Other expense, net	1,072	783	2,458	1,565
(Loss) income before income taxes	(30,961)	38,463	(64,738)	86,721
Income tax (benefit) provision	(2,720)	9,859	(12,079)	18,837
Net (loss) income	$ (28,241)	$ 28,604	$ (52,659)	$ 67,884
Net (loss) income per common share:
Basic (in usd per share)	$ (0.37)	$ 0.38	$ (0.70)	$ 0.92
Diluted (in usd per share)	$ (0.37)	$ 0.37	$ (0.70)	$ 0.89

Consolidated Statements of Comp

Consolidated Statements of Comprehensive (Loss) Income (unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Statement of Comprehensive Income [Abstract]
Net (loss) income	$ (28,241)	$ 28,604	$ (52,659)	$ 67,884
Other comprehensive income (loss) net of tax:
Currency translation adjustments	(5,167)	(18,831)	(49)	(19,618)
Change in unrecognized net periodic pension costs	136	297	(11)	486
Change in gains and losses on derivative instruments	3,299	2,764	(78)	2,764
Total other comprehensive loss, net of tax	(1,732)	(15,770)	(138)	(16,368)
Comprehensive (loss) income	$ (29,973)	$ 12,834	$ (52,797)	$ 51,516

Consolidated Balance Sheets (un

Consolidated Balance Sheets (unaudited) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 286,307	$ 69,467
Accounts receivable, net of allowances of $9,270 and $9,063	672,511	763,497
Merchandise inventories	1,168,227	1,333,585
Other current assets	135,409	128,636
Total current assets	2,262,454	2,295,185
Property and equipment, net of accumulated depreciation of $510,394 and $450,286	559,508	578,269
Operating lease assets	292,809	280,665
Goodwill	1,637,149	1,636,705
Intangible assets, net	403,020	445,042
Other assets, net	133,060	150,417
Total assets	5,288,000	5,386,283
Current liabilities
Accounts payable	1,194,173	1,147,414
Accrued payroll and related liabilities	92,264	93,296
Other current liabilities	405,204	325,756
Total current liabilities	1,691,641	1,566,466
Long-term debt, excluding current portion	2,309,853	2,482,968
Operating lease liabilities, excluding current portion of $86,437 and $76,805	214,905	215,469
Deferred income taxes	55,354	60,833
Other liabilities	120,018	114,943
Total liabilities	4,391,771	4,440,679
Commitments and contingencies
Equity
Common stock, par value $2 per share; authorized - 200,000 shares; issued and outstanding - 76,440 shares and 76,279 shares as of June 30, 2023 and December 31, 2022	152,880	152,557
Paid-in capital	421,993	418,894
Retained earnings	357,349	410,008
Accumulated other comprehensive loss	(35,993)	(35,855)
Total equity	896,229	945,604
Total liabilities and equity	$ 5,288,000	$ 5,386,283

Consolidated Balance Sheets (_2

Consolidated Balance Sheets (unaudited) (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 9,270	$ 9,063
Property and equipment, accumulated depreciation	510,394	450,286
Current operating lease liabilities	$ 86,437	$ 76,805
Common stock, par value (in usd per share)	$ 2	$ 2
Common stock, authorized (shares)	200,000	200,000
Common stock, issued (shares)	76,440	76,279
Common stock, outstanding (shares)	76,440	76,279

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Operating activities:
Net (loss) income	$ (52,659)	$ 67,884
Adjustments to reconcile net (loss) income to cash provided by operating activities:
Depreciation and amortization	142,988	97,286
Share-based compensation expense	11,675	11,210
(Benefit) provision for losses on accounts receivable	(900)	4,512
Loss on extinguishment of debt	843	0
Deferred income tax (benefit) provision	(6,758)	1,601
Changes in operating lease right-of-use assets and lease liabilities	(3,077)	606
(Gain) loss on sale and dispositions of property and equipment	(18,563)	226
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable	90,203	16,275
Merchandise inventories	165,651	(24,438)
Accounts payable	52,159	12,349
Net change in other assets and liabilities	82,954	(23,945)
Other, net	6,994	5,958
Cash provided by operating activities	471,510	169,524
Investing activities:
Acquisition, net of cash acquired	0	(1,684,607)
Additions to property and equipment	(92,750)	(62,236)
Additions to computer software	(8,229)	(3,463)
Proceeds from sale of property and equipment	35,729	5,846
Other, net	(418)	(839)
Cash used for investing activities	(65,668)	(1,745,299)
Financing activities:
Borrowings under amended Receivables Financing Agreement	348,200	347,800
Repayments under amended Receivables Financing Agreement	(444,200)	(402,800)
Repayments of debt	(78,301)	(1,500)
Proceeds from issuance of debt	0	1,691,000
Borrowings under revolving credit facility, net and Receivables Financing Agreement	0	30,000
Financing costs paid	0	(41,479)
Other, net	(8,819)	(42,388)
Cash (used for) provided by financing activities	(183,120)	1,580,633
Effect of exchange rate changes on cash, cash equivalents and restricted cash	196	(3,864)
Net increase in cash, cash equivalents and restricted cash	222,918	994
Cash, cash equivalents and restricted cash at beginning of period	86,185	72,035
Cash, cash equivalents and restricted cash at end of period	309,103	73,029
Supplemental disclosure of cash flow information:
Income taxes (received) paid, net	(10,506)	25,782
Interest paid	78,625	32,417
Noncash investing activity:
Unpaid purchases of property and equipment and computer software at end of period	$ 65,808	$ 56,429

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity (unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Paid-In Capital	Retained Earnings	Accumulated Other Comprehensive Loss
Beginning Balance (in shares) at Dec. 31, 2021		75,433
Beginning Balance at Dec. 31, 2021	$ 938,501	$ 150,865	$ 440,608	$ 387,619	$ (40,591)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	39,279			39,279
Other comprehensive income (loss)	(598)				(598)
Share-based compensation expense, exercises and other (in shares)		653
Share-based compensation expense, exercises and other	(29,560)	$ 1,307	(30,867)
Ending Balance (in shares) at Mar. 31, 2022		76,086
Ending Balance at Mar. 31, 2022	947,622	$ 152,172	409,741	426,898	(41,189)
Beginning Balance (in shares) at Dec. 31, 2021		75,433
Beginning Balance at Dec. 31, 2021	938,501	$ 150,865	440,608	387,619	(40,591)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	67,884
Other comprehensive income (loss)	(16,368)
Ending Balance (in shares) at Jun. 30, 2022		76,171
Ending Balance at Jun. 30, 2022	958,659	$ 152,343	407,773	455,502	(56,959)
Beginning Balance (in shares) at Mar. 31, 2022		76,086
Beginning Balance at Mar. 31, 2022	947,622	$ 152,172	409,741	426,898	(41,189)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	28,604			28,604
Other comprehensive income (loss)	(15,770)				(15,770)
Share-based compensation expense, exercises and other (in shares)		85
Share-based compensation expense, exercises and other	(1,797)	$ 171	(1,968)
Ending Balance (in shares) at Jun. 30, 2022		76,171
Ending Balance at Jun. 30, 2022	$ 958,659	$ 152,343	407,773	455,502	(56,959)
Beginning Balance (in shares) at Dec. 31, 2022	76,279	76,279
Beginning Balance at Dec. 31, 2022	$ 945,604	$ 152,557	418,894	410,008	(35,855)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(24,418)			(24,418)
Other comprehensive income (loss)	1,594				1,594
Share-based compensation expense, exercises and other (in shares)		(83)
Share-based compensation expense, exercises and other	1,620	$ (166)	1,786
Ending Balance (in shares) at Mar. 31, 2023		76,196
Ending Balance at Mar. 31, 2023	$ 924,400	$ 152,391	420,680	385,590	(34,261)
Beginning Balance (in shares) at Dec. 31, 2022	76,279	76,279
Beginning Balance at Dec. 31, 2022	$ 945,604	$ 152,557	418,894	410,008	(35,855)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(52,659)
Other comprehensive income (loss)	$ (138)
Ending Balance (in shares) at Jun. 30, 2023	76,440	76,440
Ending Balance at Jun. 30, 2023	$ 896,229	$ 152,880	421,993	357,349	(35,993)
Beginning Balance (in shares) at Mar. 31, 2023		76,196
Beginning Balance at Mar. 31, 2023	924,400	$ 152,391	420,680	385,590	(34,261)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(28,241)			(28,241)
Other comprehensive income (loss)	(1,732)				(1,732)
Share-based compensation expense, exercises and other (in shares)		244
Share-based compensation expense, exercises and other	$ 1,802	$ 489	1,313
Ending Balance (in shares) at Jun. 30, 2023	76,440	76,440
Ending Balance at Jun. 30, 2023	$ 896,229	$ 152,880	$ 421,993	$ 357,349	$ (35,993)

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Equity (unaudited) (Parenthetical) - $ / shares	Jun. 30, 2023	Dec. 31, 2022	Jun. 30, 2022
Statement of Stockholders' Equity [Abstract]
Common stock, par value (in usd per share)	$ 2	$ 2	$ 2

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, or our) and contain all adjustments (which are comprised only of normal recurring accruals and use of estimates) necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year. Our business has two distinct segments: Products & Healthcare Services and Patient Direct. Products & Healthcare Services provides distribution, outsourced logistics and value-added services, and manufactures and sources medical surgical products through our production and kitting operations. Patient Direct expands our business along the continuum of care through delivery of disposable medical supplies sold directly to patients and home health agencies and is a leading provider of integrated home healthcare equipment and related services in the United States. Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates. Cash, Cash Equivalents and Restricted Cash Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash as of June 30, 2023 and December 31, 2022 primarily represents cash held in an escrow account as required by the Centers for Medicare & Medicaid Services in conjunction with the Bundled Payments for Care Improvement initiatives related to wind-down costs of Fusion5. Restricted cash as of June 30, 2023 also includes $6.4 million of cash deposits received subject to limitations on use until remitted to a third-party financial institution (the Purchaser), pursuant to the Master Receivables Purchase Agreement (RPA). The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. June 30, 2023 December 31, 2022 Cash and cash equivalents $ 286,307 $ 69,467 Restricted cash included in Other current assets 22,796 — Restricted cash included in Other assets, net — 16,718 Total cash, cash equivalents, and restricted cash $ 309,103 $ 86,185 Rental Revenue Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is generated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental re venue, less estimated a djustments, is recognized as earned on a straight-line basis over the noncancellable lease term. We recorded $175 million and $144 million for the three months ended June 30, 2023 and 2022 and $346 million and $151 million for the six months ended June 30, 2023 and 2022 in revenue related to equipment we rent to patients. Sales of Accounts Receivable On March 14, 2023, we entered into the RPA, pursuant to which accounts receivable with an aggregate outstanding amount not to exceed $200 million are sold, on a limited-recourse basis, to the Purchaser in exchange for cash. As of June 30, 2023 there were a total of $115 million of uncollected accounts receivable, that had been sold and removed from our consolidated balance sheet. We account for these transactions as sales in accordance with ASC 860, Transfers and Servicing, with the sold receivables removed from our consolidated balance sheets. Under the RPA, we provide certain servicing and collection actions on behalf of the Purchaser; however, we do not maintain any beneficial interest in the accounts receivable sold. Proceeds from the sale of accounts receivable are recorded as an increase to cash and cash equivalents and a reduction to accounts receivable, net of allowances in the consolidated balance sheets. Cash received from the sale of accounts receivable is reflected as cash provided by operating activities in the consolidated statements of cash flows. Total accounts receivable sold under the RPA were $412 million for the three and six months ended June 30, 2023. During the three and six months ended June 30, 2023, we received net cash proceeds of $409 million from the sale of accounts receivable under the RPA and collected $297 million of the sold accounts receivable. The losses on sale of accounts receivable, inclusive of professional fees incurred to establish the agreement, recorded in other operating expense (income), net in the consolidated statements of operations were $2.9 million and $3.6 million for the three and six months ended June 30, 2023. The RPA is separate and distinct from the accounts receivable securitization program (the Receivables Financing Agreement) .

Fair Value

Fair Value	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value	Fair Value Fair value is determined based on assumptions that a market participant would use in pricing an asset or liability. The assumptions used are in accordance with a three-tier hierarchy, defined by GAAP, that draws a distinction between market participant assumptions based on (i) observable inputs such as quoted prices in active markets (Level 1), (ii) inputs other than quoted prices in active markets that are observable either directly or indirectly (Level 2) and (iii) unobservable inputs that require the use of present value and other valuation techniques in the determination of fair value (Level 3). The carrying amounts of cash and cash equivalents, restricted cash, accounts receivable, accounts payable, and accrued payroll and related liabilities reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 6 for the fair value of debt. The fair value of our derivative contracts is determined based on the present value of expected future cash flows considering the risks involved, including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 8 for the fair value of derivatives. Our acquisitions may include contingent consideration as part of the purchase price. The fair value of contingent consideration is estimated as of the acquisition date and at the end of each subsequent reporting period based on the present value of the contingent payments to be made using a weighted probability of possible payments (Level 3). Subsequent changes in fair value are recorded as adjustments to acquisition-related charges and intangible amortization within the consolidated statements of operations.

Acquisition

Acquisition	6 Months Ended
	Jun. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisition	Acquisition On March 29, 2022 (the Acquisition Date), we completed the acquisition (the Apria Acquisition) of 100% of Apria Inc. (Apria) pursuant to the Agreement and Plan of Merger dated January 7, 2022, in exchange for approximately $1.7 billion, net of $144 million of cash acquired. The purchase was funded with a combination of debt and cash on hand. Apria is a leading provider of integrated home healthcare equipment and related services in the United States. This division is reported as part of the Patient Direct segment. The following table presents the final fair value of the assets acquired and liabilities assumed recognized as of the Acquisition Date. The fair value and useful lives of tangible and intangible assets acquired were determined based on various valuation methods, including the income and cost approach, using several significant unobservable inputs including, but not limited to projected cash flows and a discount rate. These inputs are considered Level 3 inputs. Fair Value as of Acquisition Date Assets acquired: Current assets $ 139,560 Goodwill 1,251,347 Intangible assets 315,300 Other non-current assets 354,237 Total assets $ 2,060,444 Liabilities assumed: Current liabilities $ 247,276 Noncurrent liabilities 128,561 Total liabilities 375,837 Fair value of net assets acquired, net of cash $ 1,684,607 Current assets acquired include $88.7 million in fair value of receivables, which reflects the approximate amount contractually owed. We are amortizing the fair value of acquired intangible assets, primarily customer relationships, including payor and capitated relationships, and trade names over their estimated weighted average useful lives of one Goodwill of $1.3 billion, which we assigned to our Patient Direct segment, consists largely of expected opportunities to expand into new markets and further develop a presence in the home healthcare business. Approximately $33 million of the goodwill is deductible for income tax purposes. The following table provides pro forma results of net revenue and net loss for the three and six months ended June 30, 2022 as if Apria was acquired on January 1, 2022, based on the final purchase price allocation. The pro forma results below are not necessarily indicative of the results that would have been if the acquisition had occurred on the dates indicated, nor are the pro forma results indicative of results which may occur in the future. Three Months Ended June 30, 2022 Six Months Ended June 30, 2022 Net revenue $ 2,500,015 $ 5,184,080 Net income (loss) $ 34,408 $ (44,454) Pro forma net income of $34.4 million for the three months ended June 30, 2022 includes a pro forma adjustment for amortization of intangible assets, net of tax of ($5.8) million. Pro forma net loss of $44.5 million for the six months ended June 30, 2022 includes pro forma adjustments for interest expense of $15.4 million, net of tax and amortization of intangible assets, net of tax of $3.1 million. The pro forma net loss also includes $39.4 million in seller transaction expenses and stock compensation expense associated with $108 million owed to the holders of Apria stock awards in connection with the Apria Acquisition. Acquisition-related charges within acquisition-related charges and intangible amortization presented in our consolidated statements of operations were $1.3 million and $6.4 million for the three months ended June 30, 2023 and 2022 and $2.5 million and $38.3 million for the six months ended June 30, 2023 and 2022.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill through June 30, 2023: Patient Direct Products & Healthcare Services Consolidated Carrying amount of goodwill, December 31, 2022 $ 1,533,670 $ 103,035 $ 1,636,705 Acquisition adjustment 1,582 — 1,582 Currency translation adjustments — (1,138) (1,138) Carrying amount of goodwill, June 30, 2023 $ 1,535,252 $ 101,897 $ 1,637,149 Intangible assets subject to amortization at June 30, 2023 and December 31, 2022 were as follows: June 30, 2023 December 31, 2022 Customer Tradenames Other Customer Tradenames Other Gross intangible assets $ 446,344 $ 202,000 $ 73,184 $ 447,107 $ 202,000 $ 73,181 Accumulated amortization (224,154) (59,874) (34,480) (197,540) (50,094) (29,612) Net intangible assets $ 222,190 $ 142,126 $ 38,704 $ 249,567 $ 151,906 $ 43,569 Weighted average useful life 13 years 10 years 6 years 13 years 10 years 6 years At June 30, 2023 and December 31, 2022, $279 million and $308 million in net intangible assets were held in the Patient Direct segment and $124 million and $137 million were held in the Products & Healthcare Services segment. Amortization expense for intangible assets was $20.9 million and $30.9 million for the three months ended June 30, 2023 and 2022 and $41.8 million and $41.2 million for the six months ended June 30, 2023 and 2022. As of June 30, 2023, based on the current carrying value of intangible assets subject to amortization, estimated amortization expense were as follows: Year 2023 (remainder) $ 41,489 2024 65,285 2025 55,157 2026 53,721 2027 46,878 2028 28,867

Exit and Realignment Costs

Exit and Realignment Costs	6 Months Ended
	Jun. 30, 2023
Restructuring and Related Activities [Abstract]
Exit and Realignment Costs	Exit and Realignment Costs We periodically incur exit and realignment and other charges associated with optimizing our operations which includes the consolidation of certain facilities and IT restructuring charges. These charges also include costs associated with our Operating Model Realignment Program, which include professional fees, severance and other costs to streamline functions and processes. Exit and realignment charges were $29.0 million and $1.2 million for the three months ended June 30, 2023 and 2022 and $44.6 million and $2.9 million for six months ended June 30, 2023 and 2022. These amounts are excluded from our segments operating income. We expect material additional costs in 2023 associated with the Operating Model Realignment Program and IT restructuring charges. The following table summarizes the activity related to exit and realignment cost accruals through June 30, 2023 and 2022: Total Accrued exit and realignment costs, December 31, 2022 $ 969 Provision for exit and realignment activities: Severance 4,127 Professional fees 9,012 Vendor contract and lease termination costs 1,824 Other 711 Cash payments (5,546) Accrued exit and realignment costs, March 31, 2023 11,097 Provision for exit and realignment activities: Severance 505 Professional fees 22,953 Vendor contract and lease termination costs 1,707 Other 3,798 Cash payments (20,196) Accrued exit and realignment costs, June 30, 2023 $ 19,864 Accrued exit and realignment costs, December 31, 2021 $ 8,306 Provision for exit and realignment activities: Severance 811 Other 871 Cash payments (6,903) Accrued exit and realignment costs, March 31, 2022 3,085 Provision for exit and realignment activities: Severance 246 Other 968 Cash payments (3,477) Accrued exit and realignment costs, June 30, 2022 $ 822

Debt

Debt	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Debt	Debt Debt, net of unamortized deferred financing costs, consists of the following: June 30, 2023 December 31, 2022 Carrying Estimated Carrying Estimated 4.375% Senior Notes, due December 2024 $ 245,659 $ 240,032 $ 245,510 $ 237,772 Receivables Securitization Program — — 93,142 96,000 Term Loan A 454,349 452,060 490,816 485,000 4.500% Senior Notes, due March 2029 492,703 417,752 492,762 396,625 Term Loan B 546,014 563,203 576,587 597,733 6.625% Senior Notes, due April 2030 579,023 538,085 585,180 516,060 Finance leases and other 16,508 16,508 16,877 16,877 Total debt 2,334,256 2,227,640 2,500,874 2,346,067 Less current maturities (24,403) (24,403) (17,906) (17,906) Long-term debt $ 2,309,853 $ 2,203,237 $ 2,482,968 $ 2,328,161 We have $246 million of 4.375% senior notes due in December 2024 (the 2024 Notes), with interest payable semi-annually. The 2024 Notes were sold at 99.6% of the principal amount with an effective yield of 4.422%. We have the option to redeem the 2024 Notes in part or in whole prior to maturity at a redemption price equal to the greater of 100% of the principal amount or the present value of the remaining scheduled payments discounted at the applicable Benchmark Treasury Rate (as defined) plus 30 basis points. On March 29, 2022, we entered into a Security Agreement Supplement pursuant to which the Security and Pledge Agreement (the Security Agreement), dated March 10, 2021 was supplemented to grant collateral on behalf of the holders of the 2024 Notes, and the parties secured under the credit agreements (the Secured Parties) including first priority liens and security interests in (a) all present and future shares of capital stock owned by the Grantors (as defined in the Security Agreement) in the Grantors’ present and future subsidiaries, subject to certain customary exceptions, and (b) all present and future personal property and assets of the Grantors, subject to certain exceptions. On March 29, 2022, we entered into an amendment to our Receivables Financing Agreement. The amended Receivables Financing Agreement has a maximum borrowing capacity of $450 million. The interest rate under the Receivables Financing Agreement is based on a spread over a benchmark SOFR rate (as described in the Fourth Amendment to the Receivables Financing Agreement, as further amended by the Fifth Amendment to the Receivables Financing Agreement). Under the Receivables Financing Agreement, certain of our accounts receivable balances are sold to our wholly owned special purpose entity, O&M Funding LLC. The Receivables Financing Agreement matures in March 2025. We had no borrowings at June 30, 2023 and $96.0 million outstanding at December 31, 2022 under our Receivables Financing Agreement. At June 30, 2023 and December 31, 2022, we had maximum revolving borrowing capacity of $450 million and $354 million under our Receivables Financing Agreement. On March 29, 2022, we entered into a term loan credit agreement with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (the Credit Agreement) that provides for two new credit facilities (i) a $500 million Term Loan A facility (the Term Loan A), and (ii) a $600 million Term Loan B facility (the Term Loan B). The interest rate on the Term Loan A is based on the sum of either Term SOFR or the Base Rate and an Applicable Rate which varies depending on the current Debt Ratings or Total Leverage Ratio, determined as to whichever shall result in more favorable pricing to the Borrowers (each as defined in the Credit Agreement). The interest rate on the Term Loan B is based on either the Term SOFR or the Base Rate plus an Applicable Rate. The Term Loan A will mature in March 2027 and the Term Loan B will mature in March 2029. In addition to our scheduled principal payments of $3.1 million on the Term Loan A and $3.0 million on the Term Loan B, we made unscheduled principal payments of $35 million on Term Loan A and $30 million on Term Loan B during the six months ended June 30, 2023. On March 10, 2021, we issued $500 million of 4.500% senior unsecured notes due in March 2029 (the 2029 Unsecured Notes), with interest payable semi-annually (the Notes Offering). The 2029 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 4.500%. We may redeem all or part of the 2029 Unsecured Notes prior to March 31, 2024, at a price equal to 100% of the principal amount of the 2029 Unsecured Notes redeemed, plus accrued and unpaid interest, if any, to, but not including, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 10, 2021 (the Indenture). On or after March 31, 2024, we may redeem all or part of the 2029 Unsecured Notes at the applicable redemption prices described in the Indenture, plus accrued and unpaid interest, if any, to, but not including, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2029 Unsecured Notes at any time prior to March 31, 2024, at a redemption price equal to 104.5% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. On March 29, 2022, we completed the sale of $600 million in aggregate principal amount of our 6.625% senior notes due in April 2030 (the 2030 Unsecured Notes), with interest payable semi-annually. The 2030 Unsecured Notes were sold at 100% of the principal amount with an effective yield of 6.625%. We may redeem all or part of the 2030 Unsecured Notes, prior to April 1, 2025, at a price equal to 100% of the principal amount of the 2030 Unsecured Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, plus a “make-whole” premium, as described in the Indenture dated March 29, 2022 (the New Indenture). From and after April 1, 2025, we may redeem all or part of the 2030 Unsecured Notes at the applicable redemption prices described in the New Indenture, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. We may also redeem up to 40% of the aggregate principal amount of the 2030 Unsecured Notes at any time prior to April 1, 2025, at a redemption price equal to 106.625% with an amount equal to or less than the net cash proceeds from certain equity offerings, plus accrued and unpaid interest, if any, to, but excluding, the redemption date. The 2029 Unsecured Notes and the 2030 Unsecured Notes are subordinated to any of our secured indebtedness, including indebtedness under our credit agreements. On March 29, 2022, we entered into an amendment to our revolving credit agreement, dated as of March 10, 2021 with an administrative agent and collateral agent and a syndicate of financial institutions, as lenders (Revolving Credit Agreement). The amendment (i) increased the aggregate revolving credit commitments under the Revolving Credit Agreement by $150 million, to an aggregate amount of $450 million and (ii) replaced the Eurocurrency Rate with the Adjusted Term SOFR Rate (each as defined in the Revolving Credit Agreement). The Revolving Credit Agreement matures in March 2027. At June 30, 2023 and December 31, 2022, our Revolving Credit Agreement was undrawn, and we had letters of credit, which reduce Revolver availability, totaling $27.9 million, leaving $422 million available for borrowing. We also had letters of credit and bank guarantees which support certain leased facilities as well as other normal business activities in the United States and Europe that were issued outside of the Revolving Credit Agreement for $2.1 million and $2.3 million as of June 30, 2023 and December 31, 2022. The Revolving Credit Agreement, the Credit Agreement, the Receivables Financing Agreement, the 2024 Notes, the 2029 Unsecured Notes, and the 2030 Unsecured Notes contain cross-default provisions which could result in the acceleration of payments due in the event of default of any of the related agreements. The terms of the applicable credit agreements also require us to maintain ratios for leverage and interest coverage, including on a pro forma basis in the event of an acquisition or divestiture. We were in compliance with our debt covenants at June 30, 2023. As of June 30, 2023, scheduled future principal payments of debt, excluding finance leases and other, were as follows: Year 2023 (remainder) $ 9,250 2024 273,855 2025 40,375 2026 43,500 2027 367,875 2028 6,000 2029 1,028,845 2030 592,670 Of the $274 million due in 2024, $254 million is due in December 2024. Current maturities at June 30, 2023 include $15.6 million in principal payments on our Term Loan A, $6.0 million in principal payments on our Term Loan B, and $2.8 million in current portion of finance leases.

Retirement Plans

Retirement Plans	6 Months Ended
	Jun. 30, 2023
Retirement Benefits [Abstract]
Retirement Plans	Retirement Plans We have a frozen noncontributory, unfunded retirement plan for certain retirees in the United States (U.S. Retirement Plan). As of June 30, 2023 and December 31, 2022, the accumulated benefit obligation of the U.S. Retirement Plan was $38.5 million and $39.3 million. Certain of our foreign subsidiaries also have defined benefit pension plans The components of net periodic benefit cost for the three and six months ended June 30, 2023 and 2022 were as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 Service cost $ 446 $ 617 $ 887 $ 1,250 Interest cost 714 519 1,423 1,042 Recognized net actuarial loss 123 267 246 534 Net periodic benefit cost $ 1,283 $ 1,403 $ 2,556 $ 2,826

Derivatives

Derivatives	6 Months Ended
	Jun. 30, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivatives	Derivatives We are directly and indirectly affected by changes in foreign currency, which may adversely impact our financial performance and are referred to as “market risks.” When deemed appropriate, we use derivatives as a risk management tool to mitigate the potential impact of certain market risks. We do not enter into derivative financial instruments for trading purposes. We enter into foreign currency contracts to manage our foreign exchange exposure related to certain balance sheet items that do not meet the requirements for hedge accounting. These derivative instruments are adjusted to fair value at the end of each period through earnings. The gain or loss recorded on these instruments is substantially offset by the remeasurement adjustment on the foreign currency denominated asset or liability. We pay interest on our Credit Agreement which fluctuates based on changes in our benchmark interest rates. In order to mitigate the risk of increases in benchmark rates on our term loans, we entered into an interest rate swap agreement whereby we agree to exchange with the counterparty, at specified intervals, the difference between fixed and variable amounts calculated by reference to the notional amount. The interest rate swaps were designated as cash flow hedges. Cash flows related to the interest rate swap agreement are included in interest expense, net. We determine the fair value of our foreign currency derivatives and interest rate swaps based on observable market-based inputs or unobservable inputs that are corroborated by market data. We do not view the fair value of our derivatives in isolation, but rather in relation to the fair values or cash flows of the underlying exposure. All derivatives are carried at fair value in our consolidated balance sheets. We consider the risk of counterparty default to be minimal. We report cash flows from our hedging instruments in the same cash flow statement category as the hedged items. The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of June 30, 2023: Derivative Assets Derivative Liabilities Notional Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges Interest rate swaps $ 350,000 March 2027 Other assets, net $ 15,355 Other liabilities $ — Economic (non-designated) hedges Foreign currency contracts $ 76,916 July - August 2023 Other current assets $ 269 Other current liabilities $ 2 The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2022: Derivative Assets Derivative Liabilities Notional Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges Interest rate swaps $ 400,000 March 2027 Other assets, net $ 15,461 Other liabilities $ — Economic (non-designated) hedges Foreign currency contracts $ 58,321 January 2023 Other current assets $ 440 Other current liabilities $ 42 The notional amount of the interest rate swaps represents the amount in effect at the end of the period. Based on contractual terms, the notional amount will decrease in increments of $50 million on the last business day of March of each year until the maturity date. The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and six months ended June 30, 2023: Amount of Gain Recognized in Other Comprehensive Income (Loss) Location of Gain Reclassified from Accumulated Other Comprehensive Loss into Income Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded Amount of Gain Reclassified from Accumulated Other Comprehensive Loss into Income Three months ended June 30, 2023 Six months ended June 30, 2023 Three months ended June 30, 2023 Six months ended June 30, 2023 Three months ended June 30, 2023 Six months ended June 30, 2023 Interest rate swaps $ 6,792 $ 4,405 Interest expense, net $ (40,728) $ (82,926) $ 2,335 $ 4,511 The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and six months ended June 30, 2022: Amount of Gain Recognized in Other Comprehensive Income (Loss) Location of Loss Reclassified from Accumulated Other Comprehensive Loss into Income Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded Amount of Loss Reclassified from Accumulated Other Comprehensive Loss into Income Three months ended June 30, 2022 Six months ended June 30, 2022 Three months ended June 30, 2022 Six months ended June 30, 2022 Three months ended June 30, 2022 Six months ended June 30, 2022 Interest rate swaps $ 2,044 $ 2,044 Interest expense, net $ (35,839) $ (47,858) $ (1,692) $ (1,692) The amount of ineffectiveness associated with these contracts was immaterial for the periods presented. For the three and six months ended June 30, 2023, we recognized a loss of $0.9 million associated with our economic (non-designated) foreign currency contracts. For the three and six months ended June 30, 2022, we recognized losses of $1.3 million and $1.4 million associated with our economic (non-designated) foreign currency contracts. We recorded the change in fair value of derivative instruments and the remeasurement adjustment of the foreign currency denominated asset or liability in other operating expense (income), net for our foreign exchange contracts.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The effective tax rate was 8.8% and 18.7% for the three and six months ended June 30, 2023, compared to 25.6% and 21.7% in the same periods of 2022. The change in these rates resulted primarily from changes in income and losses. The liability for unrecognized tax benefits was $22.7 million at June 30, 2023 and $22.5 million at December 31, 2022. Included in the liability at June 30, 2023 and December 31, 2022 were $2.7 million of tax positions for which ultimate deductibility is highly certain but for which there is uncertainty about the timing of such deductibility.

Net (Loss) Income per Common Sh

Net (Loss) Income per Common Share	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Net (Loss) Income per Common Share	Net (Loss) Income per Common Share The following summarizes the calculation of net (loss) income per common share attributable to common shareholders for the three and six months ended June 30, 2023 and 2022: Three Months Ended Six Months Ended (in thousands, except per share data) 2023 2022 2023 2022 Net (loss) income $ (28,241) $ 28,604 $ (52,659) $ 67,884 Weighted average shares outstanding - basic 75,801 74,710 75,559 74,158 Dilutive shares — 1,587 — 2,011 Weighted average shares outstanding - diluted 75,801 76,297 75,559 76,169 Net (loss) income per common share: Basic $ (0.37) $ 0.38 $ (0.70) $ 0.92 Diluted $ (0.37) $ 0.37 $ (0.70) $ 0.89 Share-based awards for the three and six months ended June 30, 2023 of approximately 1.8 million and 1.7 million shares were excluded from the calculation of net loss per diluted common share as the effect would be anti-dilutive.

Accumulated Other Comprehensive

Accumulated Other Comprehensive (Loss) Income	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Accumulated Other Comprehensive (Loss) Income	Accumulated Other Comprehensive (Loss) Income The following table shows the changes in accumulated other comprehensive (loss) income by component for the three and six months ended June 30, 2023 and 2022: Retirement Plans Currency Derivatives Total Accumulated other comprehensive (loss) income, March 31, 2023 $ (7,348) $ (34,977) $ 8,064 $ (34,261) Other comprehensive (loss) income before reclassifications — (5,167) 6,792 1,625 Income tax — — (1,766) (1,766) Other comprehensive (loss) income before reclassifications, net of tax — (5,167) 5,026 (141) Amounts reclassified from accumulated other comprehensive income (loss) 123 — (2,335) (2,212) Income tax 13 — 608 621 Amounts reclassified from accumulated other comprehensive income (loss), net of tax 136 — (1,727) (1,591) Other comprehensive income (loss) 136 (5,167) 3,299 (1,732) Accumulated other comprehensive (loss) income, June 30, 2023 $ (7,212) $ (40,144) $ 11,363 $ (35,993) Retirement Plans Currency Translation Adjustments Derivatives Total Accumulated other comprehensive loss, March 31, 2022 $ (14,408) $ (26,781) $ — $ (41,189) Other comprehensive (loss) income before reclassifications — (18,831) 2,044 (16,787) Income tax — — (532) (532) Other comprehensive (loss) income before reclassifications, net of tax — (18,831) 1,512 (17,319) Amounts reclassified from accumulated other comprehensive loss 386 — 1,692 2,078 Income tax (89) — (440) (529) Amounts reclassified from accumulated other comprehensive loss, net of tax 297 — 1,252 1,549 Other comprehensive income (loss) 297 (18,831) 2,764 (15,770) Accumulated other comprehensive (loss) income, June 30, 2022 $ (14,111) $ (45,612) $ 2,764 $ (56,959) Retirement Plans Currency Derivatives Total Accumulated other comprehensive (loss) income, December 31, 2022 $ (7,201) $ (40,095) $ 11,441 $ (35,855) Other comprehensive (loss) income before reclassifications — (49) 4,405 4,356 Income tax — — (1,145) (1,145) Other comprehensive (loss) income before reclassifications, net of tax — (49) 3,260 3,211 Amounts reclassified from accumulated other comprehensive income (loss) 246 — (4,511) (4,265) Income tax (257) — 1,173 916 Amounts reclassified from accumulated other comprehensive income (loss), net of tax (11) — (3,338) (3,349) Other comprehensive loss (11) (49) (78) (138) Accumulated other comprehensive (loss) income, June 30, 2023 $ (7,212) $ (40,144) $ 11,363 $ (35,993) Retirement Plans Currency Derivatives Total Accumulated other comprehensive loss, December 31, 2021 $ (14,597) $ (25,994) $ — $ (40,591) Other comprehensive (loss) income before reclassifications — (19,618) 2,044 (17,574) Income tax — — (532) (532) Other comprehensive (loss) income before reclassifications, net of tax — (19,618) 1,512 (18,106) Amounts reclassified from accumulated other comprehensive loss 635 — 1,692 2,327 Income tax (149) — (440) (589) Amounts reclassified from accumulated other comprehensive loss, net of tax 486 — 1,252 1,738 Other comprehensive (loss) income 486 (19,618) 2,764 (16,368) Accumulated other comprehensive (loss) income, June 30, 2022 $ (14,111) $ (45,612) $ 2,764 $ (56,959)

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Segment Information	Segment Information We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our United States distribution division (Medical Distribution), outsourced logistics and value-added services, and Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria). We evaluate the performance of our segments based on their operating income excluding acquisition-related charges and intangible amortization and exit and realignment charges, along with other adjustments, that, either as a result of their nature or size, would not be expected to occur as part of our normal business operations on a regular basis. Segment assets exclude inter-segment account balances as we believe their inclusion would be misleading and not meaningful. The following tables present financial information by segment: Three Months Ended Six Months Ended 2023 2022 2023 2022 Net revenue: Products & Healthcare Services $ 1,930,723 $ 1,927,388 $ 3,846,212 $ 4,061,429 Patient Direct 632,503 572,627 1,239,863 845,538 Consolidated net revenue $ 2,563,226 $ 2,500,015 $ 5,086,075 $ 4,906,967 Operating income: Products & Healthcare Services $ 2,940 $ 61,243 $ 4,761 $ 150,325 Patient Direct 59,065 52,332 104,914 68,125 Acquisition-related charges and intangible amortization (22,203) (37,276) (44,392) (79,410) Exit and realignment charges (28,963) (1,214) (44,637) (2,896) Consolidated operating income $ 10,839 $ 75,085 $ 20,646 $ 136,144 Depreciation and amortization: Products & Healthcare Services $ 18,772 $ 19,209 $ 37,338 $ 38,203 Patient Direct 53,290 53,952 105,650 59,083 Consolidated depreciation and amortization $ 72,062 $ 73,161 $ 142,988 $ 97,286 Capital expenditures: Products & Healthcare Services $ 6,602 $ 18,418 $ 12,934 $ 29,061 Patient Direct 42,887 36,320 88,045 36,638 Consolidated capital expenditures $ 49,489 $ 54,738 $ 100,979 $ 65,699 June 30, 2023 December 31, 2022 Total assets: Products & Healthcare Services $ 2,492,214 $ 2,809,600 Patient Direct 2,509,479 2,507,216 Segment assets 5,001,693 5,316,816 Cash and cash equivalents 286,307 69,467 Consolidated total assets $ 5,288,000 $ 5,386,283 The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services: Three Months Ended Six Months Ended 2023 2022 2023 2022 Net revenue: United States $ 2,498,536 $ 2,376,573 $ 4,951,472 $ 4,638,592 International 64,690 123,442 134,603 268,375 Consolidated net revenue $ 2,563,226 $ 2,500,015 $ 5,086,075 $ 4,906,967

Recent Accounting Pronouncement

Recent Accounting Pronouncements	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Recent Accounting PronouncementsIn June 2016, the FASB issued Accounting Standards Update (ASU) No. 2016-13 Financial Instruments - Credit Losses, Measurement of Credit Losses on Financial Instruments, which changes the way entities measure credit losses for most financial assets and certain other instruments that are not measured at fair value through net earnings. Subsequent to the issuance of ASU No. 2016-13, the FASB issued various ASUs related to Credit Losses, Measurement of Credit Losses on Financial Instruments. These ASUs do not change the core principle of the guidance in ASU No. 2016-13. Instead these amendments are intended to clarify and improve operability of certain topics included within the credit losses standard. We adopted ASU No. 2016-13 and subsequent amendments beginning January 1, 2023. The adoption did not have a material impact on our consolidated financial statements and related disclosures.

Legal Proceedings

Legal Proceedings	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Legal Proceedings	Legal Proceedings O&M Halyard N95 Mask FDA Release On April 5, 2023 we received a communication from the National Institute for Occupational Safety & Health (NIOSH) that products from one lot of a model (No. 46827) of surgical N95 respirator manufactured by O&M Halyard did not pass laboratory tests for fluid resistance and for filtration efficiency, and that products from one lot of another model (No. 46727) did not pass fluid resistance testing, but did pass filtration efficiency testing. At present, our investigation has determined that there are a limited number of lots potentially implicated by the results of the NIOSH particulate filtration testing on model 46827. The vast majority of the products in those lots remain in our possession and under our control, and those lots that had products that did reach the market have passed internal follow-up testing. On April 12, 2023, the FDA recommended that consumers, health care providers, and facilities not use the two models (model numbers 46827 and 46727) of O&M Halyard surgical N95 respirators due to fluid resistance. In addition, the FDA also recommended against using certain of our surgical, procedure and pediatric face masks when fluid resistance is required. On or about that date, we voluntarily stopped the sale in the U.S. of the above-referenced surgical N95 respirators and similar models pending our investigation of the performance issues identified by the FDA and NIOSH. Regulatory bodies in other non-U.S. markets where we sell our facial protection products have inquired about the relevance of the FDA notification to products sold in their countries. The FDA updated its recommendation on April 21, 2023, to permit use of the model 46727 of Halyard N95 respirators when fluid resistance is not required. These items are included in our Products & Healthcare Services segment. We are thoroughly investigating the matters identified by the FDA and NIOSH and we are performing product retesting as we work closely with government agencies to resolve these matters. We are unable to reasonably estimate the amount of any possible loss or range of possible losses or predict the ultimate outcome of these matters. However, there is a risk that these matters and any other safety concerns could have a material adverse effect on our results of operations, financial condition, or cash flows, including as a result of a significant volume of customer product returns and/or recall of products, implementation of corrective action plans, and/or other costly remedial actions in the US and elsewhere. In addition, these matters could potentially have other negative impacts including: government investigations and enforcement actions by the FDA or other US or international regulators or governmental entities; the suspension or revocation of the authority to produce, distribute or sell products, and other sanctions; losses due to patient claims, including product liability claims and lawsuits; and customer claims related to their direct costs arising from supply disruption. Other Litigation We are party to various legal claims that are ordinary and incidental to our business, including ones related to commercial disputes, employment, workers’ compensation, product liability, regulatory and other matters. We maintain insurance coverage for employment, product liability, workers’ compensation and other personal injury litigation matters, subject to policy limits, applicable deductibles and insurer solvency. We establish reserves from time to time based upon periodic assessment of the potential outcomes of pending matters. Based on current knowledge and the advice of counsel, we believe that the accrual as of June 30, 2023 for currently pending matters considered probable of loss, which is not material, is sufficient. In addition, we believe that other currently pending matters are not reasonably possible to result in a material loss, as payment of the amounts claimed is remote, the claims are immaterial, individually and in the aggregate, or the claims are expected to be adequately covered by insurance, subject to policy limits, applicable deductibles, exclusions, and insurer solvency.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesWe anticipate that the noncancellable obligations beyond 12 months related to outsourced information technology operations, as disclosed in our Annual Report on Form 10-K for the year ended December 31, 2022, will no longer be material as a result of executed contract terminations, expected contract terminations, and insourcing of information technology operations.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements include the accounts of Owens & Minor, Inc. and the subsidiaries it controls (we, us, or our) and contain all adjustments (which are comprised only of normal recurring accruals and use of estimates) necessary to conform with U.S. generally accepted accounting principles (GAAP). All significant intercompany accounts and transactions have been eliminated. The results of operations for interim periods are not necessarily indicative of the results expected for the full year. Our business has two distinct segments: Products & Healthcare Services and Patient Direct. Products & Healthcare Services provides distribution, outsourced logistics and value-added services, and manufactures and sources medical surgical products through our production and kitting operations. Patient Direct expands our business along the continuum of care through delivery of disposable medical supplies sold directly to patients and home health agencies and is a leading provider of integrated home healthcare equipment and related services in the United States.
Reclassifications	Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires us to make assumptions and estimates that affect reported amounts and related disclosures. Actual results may differ from these estimates.
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents and Restricted Cash Cash, cash equivalents and restricted cash includes cash and marketable securities with an original maturity or maturity at acquisition of three months or less. Cash, cash equivalents and restricted cash are stated at cost. Nearly all of our cash, cash equivalents and restricted cash are held in cash depository accounts in major banks in North America, Europe, and Asia. Cash that is held by a major bank and has restrictions on its availability to us is classified as restricted cash. Restricted cash as of June 30, 2023 and December 31, 2022 primarily represents cash held in an escrow account as required by the Centers for Medicare & Medicaid Services in conjunction with the Bundled Payments for Care Improvement initiatives related to wind-down costs of Fusion5. Restricted cash as of June 30, 2023 also includes $6.4 million of cash deposits received subject to limitations on use until remitted to a third-party financial institution (the Purchaser), pursuant to the Master Receivables Purchase Agreement (RPA).
Rental Revenue	Rental Revenue Within our Patient Direct segment, revenues are recognized under fee-for-service arrangements for equipment we rent to patients and sales of equipment, supplies and other items we sell to patients. Revenue that is generated from equipment that we rent to patients is primarily recognized over the noncancelable rental period, typically one month, and commences on delivery of the equipment to the patients. Revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including private insurers, prepaid health plans, Medicare, Medicaid and patients. Rental re venue, less estimated a
Sales of Accounts Receivable	Sales of Accounts Receivable On March 14, 2023, we entered into the RPA, pursuant to which accounts receivable with an aggregate outstanding amount not to exceed $200 million are sold, on a limited-recourse basis, to the Purchaser in exchange for cash. As of June 30, 2023 there were a total of $115 million of uncollected accounts receivable, that had been sold and removed from our consolidated balance sheet. We account for these transactions as sales in accordance with ASC 860, Transfers and Servicing, with the sold receivables removed from our consolidated balance sheets. Under the RPA, we provide certain servicing and collection actions on behalf of the Purchaser; however, we do not maintain any beneficial interest in the accounts receivable sold. Proceeds from the sale of accounts receivable are recorded as an increase to cash and cash equivalents and a reduction to accounts receivable, net of allowances in the consolidated balance sheets. Cash received from the sale of accounts receivable is reflected as cash provided by operating activities in the consolidated statements of cash flows. Total accounts receivable sold under the RPA were $412 million for the three and six months ended June 30, 2023. During the three and six months ended June 30, 2023, we received net cash proceeds of $409 million from the sale of accounts receivable under the RPA and collected $297 million of the sold accounts receivable. The losses on sale of accounts receivable, inclusive of professional fees incurred to establish the agreement, recorded in other operating expense (income), net in the consolidated statements of operations were $2.9 million and $3.6 million for the three and six months ended June 30, 2023. The RPA is separate and distinct from the accounts receivable securitization program (the Receivables Financing Agreement) .
Fair Value	Fair value is determined based on assumptions that a market participant would use in pricing an asset or liability. The assumptions used are in accordance with a three-tier hierarchy, defined by GAAP, that draws a distinction between market participant assumptions based on (i) observable inputs such as quoted prices in active markets (Level 1), (ii) inputs other than quoted prices in active markets that are observable either directly or indirectly (Level 2) and (iii) unobservable inputs that require the use of present value and other valuation techniques in the determination of fair value (Level 3). The carrying amounts of cash and cash equivalents, restricted cash, accounts receivable, accounts payable, and accrued payroll and related liabilities reported in the consolidated balance sheets approximate fair value due to the short-term nature of these instruments. The fair value of debt is estimated based on quoted market prices or dealer quotes for the identical liability when traded as an asset in an active market (Level 1) or, if quoted market prices or dealer quotes are not available, on the borrowing rates currently available for loans with similar terms, credit ratings, and average remaining maturities (Level 2). See Note 6 for the fair value of debt. The fair value of our derivative contracts is determined based on the present value of expected future cash flows considering the risks involved, including non-performance risk, and using discount rates appropriate for the respective maturities. Observable Level 2 inputs are used to determine the present value of expected future cash flows. See Note 8 for the fair value of derivatives. Our acquisitions may include contingent consideration as part of the purchase price. The fair value of contingent consideration is estimated as of the acquisition date and at the end of each subsequent reporting period based on the present value of the contingent payments to be made using a weighted probability of possible payments (Level 3). Subsequent changes in fair value are recorded as adjustments to acquisition-related charges and intangible amortization within the consolidated statements of operations.
Segment Information	We periodically evaluate our application of accounting guidance for reportable segments and disclose information about reportable segments based on the way management organizes the enterprise for making operating decisions and assessing performance. We report our business under two segments: Products & Healthcare Services and Patient Direct. The Products & Healthcare Services segment includes our United States distribution division (Medical Distribution), outsourced logistics and value-added services, and Global Products division which manufactures and sources medical surgical products through our production and kitting operations. The Patient Direct segment includes our home healthcare divisions (Byram and Apria).
Recent Accounting Pronouncements	In June 2016, the FASB issued Accounting Standards Update (ASU) No. 2016-13 Financial Instruments - Credit Losses, Measurement of Credit Losses on Financial Instruments, which changes the way entities measure credit losses for most financial assets and certain other instruments that are not measured at fair value through net earnings. Subsequent to the issuance of ASU No. 2016-13, the FASB issued various ASUs related to Credit Losses, Measurement of Credit Losses on Financial Instruments. These ASUs do not change the core principle of the guidance in ASU No. 2016-13. Instead these amendments are intended to clarify and improve operability of certain topics included within the credit losses standard. We adopted ASU No. 2016-13 and subsequent amendments beginning January 1, 2023. The adoption did not have a material impact on our consolidated financial statements and related disclosures.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2023
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 accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. June 30, 2023 December 31, 2022 Cash and cash equivalents $ 286,307 $ 69,467 Restricted cash included in Other current assets 22,796 — Restricted cash included in Other assets, net — 16,718 Total cash, cash equivalents, and restricted cash $ 309,103 $ 86,185
Schedule of Restrictions on Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets that sum to the total of those same amounts presented in the accompanying consolidated statements of cash flows. June 30, 2023 December 31, 2022 Cash and cash equivalents $ 286,307 $ 69,467 Restricted cash included in Other current assets 22,796 — Restricted cash included in Other assets, net — 16,718 Total cash, cash equivalents, and restricted cash $ 309,103 $ 86,185

Acquisition (Tables)

Acquisition (Tables)	6 Months Ended
	Jun. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The following table presents the final fair value of the assets acquired and liabilities assumed recognized as of the Acquisition Date. The fair value and useful lives of tangible and intangible assets acquired were determined based on various valuation methods, including the income and cost approach, using several significant unobservable inputs including, but not limited to projected cash flows and a discount rate. These inputs are considered Level 3 inputs. Fair Value as of Acquisition Date Assets acquired: Current assets $ 139,560 Goodwill 1,251,347 Intangible assets 315,300 Other non-current assets 354,237 Total assets $ 2,060,444 Liabilities assumed: Current liabilities $ 247,276 Noncurrent liabilities 128,561 Total liabilities 375,837 Fair value of net assets acquired, net of cash $ 1,684,607
Schedule of Pro Forma	The following table provides pro forma results of net revenue and net loss for the three and six months ended June 30, 2022 as if Apria was acquired on January 1, 2022, based on the final purchase price allocation. The pro forma results below are not necessarily indicative of the results that would have been if the acquisition had occurred on the dates indicated, nor are the pro forma results indicative of results which may occur in the future. Three Months Ended June 30, 2022 Six Months Ended June 30, 2022 Net revenue $ 2,500,015 $ 5,184,080 Net income (loss) $ 34,408 $ (44,454)

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Amount of Goodwill	The following table summarizes the goodwill balances by segment and the changes in the carrying amount of goodwill through June 30, 2023: Patient Direct Products & Healthcare Services Consolidated Carrying amount of goodwill, December 31, 2022 $ 1,533,670 $ 103,035 $ 1,636,705 Acquisition adjustment 1,582 — 1,582 Currency translation adjustments — (1,138) (1,138) Carrying amount of goodwill, June 30, 2023 $ 1,535,252 $ 101,897 $ 1,637,149
Schedule of Intangible Assets	Intangible assets subject to amortization at June 30, 2023 and December 31, 2022 were as follows: June 30, 2023 December 31, 2022 Customer Tradenames Other Customer Tradenames Other Gross intangible assets $ 446,344 $ 202,000 $ 73,184 $ 447,107 $ 202,000 $ 73,181 Accumulated amortization (224,154) (59,874) (34,480) (197,540) (50,094) (29,612) Net intangible assets $ 222,190 $ 142,126 $ 38,704 $ 249,567 $ 151,906 $ 43,569 Weighted average useful life 13 years 10 years 6 years 13 years 10 years 6 years
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	As of June 30, 2023, based on the current carrying value of intangible assets subject to amortization, estimated amortization expense were as follows: Year 2023 (remainder) $ 41,489 2024 65,285 2025 55,157 2026 53,721 2027 46,878 2028 28,867

Exit and Realignment Costs (Tab

Exit and Realignment Costs (Tables)	6 Months Ended
	Jun. 30, 2023
Restructuring and Related Activities [Abstract]
Schedule of Restructuring and Related Costs Accrual Activity	The following table summarizes the activity related to exit and realignment cost accruals through June 30, 2023 and 2022: Total Accrued exit and realignment costs, December 31, 2022 $ 969 Provision for exit and realignment activities: Severance 4,127 Professional fees 9,012 Vendor contract and lease termination costs 1,824 Other 711 Cash payments (5,546) Accrued exit and realignment costs, March 31, 2023 11,097 Provision for exit and realignment activities: Severance 505 Professional fees 22,953 Vendor contract and lease termination costs 1,707 Other 3,798 Cash payments (20,196) Accrued exit and realignment costs, June 30, 2023 $ 19,864 Accrued exit and realignment costs, December 31, 2021 $ 8,306 Provision for exit and realignment activities: Severance 811 Other 871 Cash payments (6,903) Accrued exit and realignment costs, March 31, 2022 3,085 Provision for exit and realignment activities: Severance 246 Other 968 Cash payments (3,477) Accrued exit and realignment costs, June 30, 2022 $ 822

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Debt, Net of Unamortized Deferred Financing Costs	Debt, net of unamortized deferred financing costs, consists of the following: June 30, 2023 December 31, 2022 Carrying Estimated Carrying Estimated 4.375% Senior Notes, due December 2024 $ 245,659 $ 240,032 $ 245,510 $ 237,772 Receivables Securitization Program — — 93,142 96,000 Term Loan A 454,349 452,060 490,816 485,000 4.500% Senior Notes, due March 2029 492,703 417,752 492,762 396,625 Term Loan B 546,014 563,203 576,587 597,733 6.625% Senior Notes, due April 2030 579,023 538,085 585,180 516,060 Finance leases and other 16,508 16,508 16,877 16,877 Total debt 2,334,256 2,227,640 2,500,874 2,346,067 Less current maturities (24,403) (24,403) (17,906) (17,906) Long-term debt $ 2,309,853 $ 2,203,237 $ 2,482,968 $ 2,328,161
Schedule of Maturities of Long-Term Debt	As of June 30, 2023, scheduled future principal payments of debt, excluding finance leases and other, were as follows: Year 2023 (remainder) $ 9,250 2024 273,855 2025 40,375 2026 43,500 2027 367,875 2028 6,000 2029 1,028,845 2030 592,670

Retirement Plans (Tables)

Retirement Plans (Tables)	6 Months Ended
	Jun. 30, 2023
Retirement Benefits [Abstract]
Schedule of Components of Net Periodic Benefit Cost For Domestic Retirement Plan	The components of net periodic benefit cost for the three and six months ended June 30, 2023 and 2022 were as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 Service cost $ 446 $ 617 $ 887 $ 1,250 Interest cost 714 519 1,423 1,042 Recognized net actuarial loss 123 267 246 534 Net periodic benefit cost $ 1,283 $ 1,403 $ 2,556 $ 2,826

Derivatives (Tables)

Derivatives (Tables)	6 Months Ended
	Jun. 30, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule Of Derivative Instruments	The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of June 30, 2023: Derivative Assets Derivative Liabilities Notional Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges Interest rate swaps $ 350,000 March 2027 Other assets, net $ 15,355 Other liabilities $ — Economic (non-designated) hedges Foreign currency contracts $ 76,916 July - August 2023 Other current assets $ 269 Other current liabilities $ 2 The following table summarizes the terms and fair value of our outstanding derivative financial instruments as of December 31, 2022: Derivative Assets Derivative Liabilities Notional Amount Maturity Date Classification Fair Value Classification Fair Value Cash flow hedges Interest rate swaps $ 400,000 March 2027 Other assets, net $ 15,461 Other liabilities $ — Economic (non-designated) hedges Foreign currency contracts $ 58,321 January 2023 Other current assets $ 440 Other current liabilities $ 42
Schedule Of Cash Flow Hedges Included In Accumulated Other Comprehensive Income (Loss)	The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and six months ended June 30, 2023: Amount of Gain Recognized in Other Comprehensive Income (Loss) Location of Gain Reclassified from Accumulated Other Comprehensive Loss into Income Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded Amount of Gain Reclassified from Accumulated Other Comprehensive Loss into Income Three months ended June 30, 2023 Six months ended June 30, 2023 Three months ended June 30, 2023 Six months ended June 30, 2023 Three months ended June 30, 2023 Six months ended June 30, 2023 Interest rate swaps $ 6,792 $ 4,405 Interest expense, net $ (40,728) $ (82,926) $ 2,335 $ 4,511 The following table summarizes the effect of cash flow hedge accounting on our consolidated statements of operations for the three and six months ended June 30, 2022: Amount of Gain Recognized in Other Comprehensive Income (Loss) Location of Loss Reclassified from Accumulated Other Comprehensive Loss into Income Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded Amount of Loss Reclassified from Accumulated Other Comprehensive Loss into Income Three months ended June 30, 2022 Six months ended June 30, 2022 Three months ended June 30, 2022 Six months ended June 30, 2022 Three months ended June 30, 2022 Six months ended June 30, 2022 Interest rate swaps $ 2,044 $ 2,044 Interest expense, net $ (35,839) $ (47,858) $ (1,692) $ (1,692)

Net (Loss) Income per Common _2

Net (Loss) Income per Common Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Schedule of Calculation of Net (Loss) Income Per Common Share	The following summarizes the calculation of net (loss) income per common share attributable to common shareholders for the three and six months ended June 30, 2023 and 2022: Three Months Ended Six Months Ended (in thousands, except per share data) 2023 2022 2023 2022 Net (loss) income $ (28,241) $ 28,604 $ (52,659) $ 67,884 Weighted average shares outstanding - basic 75,801 74,710 75,559 74,158 Dilutive shares — 1,587 — 2,011 Weighted average shares outstanding - diluted 75,801 76,297 75,559 76,169 Net (loss) income per common share: Basic $ (0.37) $ 0.38 $ (0.70) $ 0.92 Diluted $ (0.37) $ 0.37 $ (0.70) $ 0.89

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive (Loss) Income (Tables)	6 Months Ended
	Jun. 30, 2023
Equity [Abstract]
Schedule of Changes in Accumulated Other Comprehensive (Loss) Income By Component	The following table shows the changes in accumulated other comprehensive (loss) income by component for the three and six months ended June 30, 2023 and 2022: Retirement Plans Currency Derivatives Total Accumulated other comprehensive (loss) income, March 31, 2023 $ (7,348) $ (34,977) $ 8,064 $ (34,261) Other comprehensive (loss) income before reclassifications — (5,167) 6,792 1,625 Income tax — — (1,766) (1,766) Other comprehensive (loss) income before reclassifications, net of tax — (5,167) 5,026 (141) Amounts reclassified from accumulated other comprehensive income (loss) 123 — (2,335) (2,212) Income tax 13 — 608 621 Amounts reclassified from accumulated other comprehensive income (loss), net of tax 136 — (1,727) (1,591) Other comprehensive income (loss) 136 (5,167) 3,299 (1,732) Accumulated other comprehensive (loss) income, June 30, 2023 $ (7,212) $ (40,144) $ 11,363 $ (35,993) Retirement Plans Currency Translation Adjustments Derivatives Total Accumulated other comprehensive loss, March 31, 2022 $ (14,408) $ (26,781) $ — $ (41,189) Other comprehensive (loss) income before reclassifications — (18,831) 2,044 (16,787) Income tax — — (532) (532) Other comprehensive (loss) income before reclassifications, net of tax — (18,831) 1,512 (17,319) Amounts reclassified from accumulated other comprehensive loss 386 — 1,692 2,078 Income tax (89) — (440) (529) Amounts reclassified from accumulated other comprehensive loss, net of tax 297 — 1,252 1,549 Other comprehensive income (loss) 297 (18,831) 2,764 (15,770) Accumulated other comprehensive (loss) income, June 30, 2022 $ (14,111) $ (45,612) $ 2,764 $ (56,959) Retirement Plans Currency Derivatives Total Accumulated other comprehensive (loss) income, December 31, 2022 $ (7,201) $ (40,095) $ 11,441 $ (35,855) Other comprehensive (loss) income before reclassifications — (49) 4,405 4,356 Income tax — — (1,145) (1,145) Other comprehensive (loss) income before reclassifications, net of tax — (49) 3,260 3,211 Amounts reclassified from accumulated other comprehensive income (loss) 246 — (4,511) (4,265) Income tax (257) — 1,173 916 Amounts reclassified from accumulated other comprehensive income (loss), net of tax (11) — (3,338) (3,349) Other comprehensive loss (11) (49) (78) (138) Accumulated other comprehensive (loss) income, June 30, 2023 $ (7,212) $ (40,144) $ 11,363 $ (35,993) Retirement Plans Currency Derivatives Total Accumulated other comprehensive loss, December 31, 2021 $ (14,597) $ (25,994) $ — $ (40,591) Other comprehensive (loss) income before reclassifications — (19,618) 2,044 (17,574) Income tax — — (532) (532) Other comprehensive (loss) income before reclassifications, net of tax — (19,618) 1,512 (18,106) Amounts reclassified from accumulated other comprehensive loss 635 — 1,692 2,327 Income tax (149) — (440) (589) Amounts reclassified from accumulated other comprehensive loss, net of tax 486 — 1,252 1,738 Other comprehensive (loss) income 486 (19,618) 2,764 (16,368) Accumulated other comprehensive (loss) income, June 30, 2022 $ (14,111) $ (45,612) $ 2,764 $ (56,959)

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Schedule of Financial Information by Segment	The following tables present financial information by segment: Three Months Ended Six Months Ended 2023 2022 2023 2022 Net revenue: Products & Healthcare Services $ 1,930,723 $ 1,927,388 $ 3,846,212 $ 4,061,429 Patient Direct 632,503 572,627 1,239,863 845,538 Consolidated net revenue $ 2,563,226 $ 2,500,015 $ 5,086,075 $ 4,906,967 Operating income: Products & Healthcare Services $ 2,940 $ 61,243 $ 4,761 $ 150,325 Patient Direct 59,065 52,332 104,914 68,125 Acquisition-related charges and intangible amortization (22,203) (37,276) (44,392) (79,410) Exit and realignment charges (28,963) (1,214) (44,637) (2,896) Consolidated operating income $ 10,839 $ 75,085 $ 20,646 $ 136,144 Depreciation and amortization: Products & Healthcare Services $ 18,772 $ 19,209 $ 37,338 $ 38,203 Patient Direct 53,290 53,952 105,650 59,083 Consolidated depreciation and amortization $ 72,062 $ 73,161 $ 142,988 $ 97,286 Capital expenditures: Products & Healthcare Services $ 6,602 $ 18,418 $ 12,934 $ 29,061 Patient Direct 42,887 36,320 88,045 36,638 Consolidated capital expenditures $ 49,489 $ 54,738 $ 100,979 $ 65,699
Schedule of Consolidated Total Assets	June 30, 2023 December 31, 2022 Total assets: Products & Healthcare Services $ 2,492,214 $ 2,809,600 Patient Direct 2,509,479 2,507,216 Segment assets 5,001,693 5,316,816 Cash and cash equivalents 286,307 69,467 Consolidated total assets $ 5,288,000 $ 5,386,283
Schedule of Revenue from External Customers and Long-lived Assets, by Geographical	The following table presents net revenue by geographic area, which were attributed based on the location from which we ship products or provide services: Three Months Ended Six Months Ended 2023 2022 2023 2022 Net revenue: United States $ 2,498,536 $ 2,376,573 $ 4,951,472 $ 4,638,592 International 64,690 123,442 134,603 268,375 Consolidated net revenue $ 2,563,226 $ 2,500,015 $ 5,086,075 $ 4,906,967

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Narrative (Details) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($) segment	Jun. 30, 2022 USD ($)	Mar. 14, 2023 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of distinct segments | segment			2
Restricted cash deposits	$ 6.4		$ 6.4
Master Receivables Purchase Agreement
Summary Of Significant Accounting Policies [Line Items]
Accounts receivable sold	412		412
Cash proceeds from sale of accounts receivable	409		409
Cash proceeds from collection of accounts receivable	297		297
Master Receivables Purchase Agreement | Other Operating Expense (Income)
Summary Of Significant Accounting Policies [Line Items]
Loss on sale of accounts receivable	2.9		3.6
Master Receivables Purchase Agreement | Uncollectible Receivables
Summary Of Significant Accounting Policies [Line Items]
Uncollected accounts receivable, sold	115		115
Master Receivables Purchase Agreement | Maximum
Summary Of Significant Accounting Policies [Line Items]
Maximum uncollected receivables available					$ 200
Rental Equipment
Summary Of Significant Accounting Policies [Line Items]
Revenue related to equipment	$ 175	$ 144	$ 346	$ 151

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Schedule of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	Jun. 30, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Cash and cash equivalents	$ 286,307	$ 69,467
Restricted cash included in Other current assets	22,796	0
Restricted cash included in Other assets, net	0	16,718
Total cash, cash equivalents, and restricted cash	$ 309,103	$ 86,185	$ 73,029	$ 72,035

Acquisition - Narrative (Detail

Acquisition - Narrative (Details) - USD ($) $ in Thousands		3 Months Ended		6 Months Ended
	Mar. 29, 2022	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Business Acquisition [Line Items]
Acquisition adjustment				$ 1,582
Goodwill expected tax deductible amount		$ 33,000		33,000
Acquisition-related charges and intangible amortization		22,203	$ 37,276	44,392	$ 79,410
Acquisition-related Charges and Intangible Amortization
Business Acquisition [Line Items]
Acquisition-related charges and intangible amortization		$ 1,300	6,400	$ 2,500	38,300
Apria, Inc
Business Acquisition [Line Items]
Acquisition debt					108,000
Minimum | Primarily Customer Relationships, Including Payor and Capitated Relationships, and Trade Names
Business Acquisition [Line Items]
Estimated weighted average useful lives	1 year
Maximum | Primarily Customer Relationships, Including Payor and Capitated Relationships, and Trade Names
Business Acquisition [Line Items]
Estimated weighted average useful lives	15 years
Apria, Inc
Business Acquisition [Line Items]
Percentage of business acquired	100%
Business combination consideration transferred	$ 1,700,000
Cash acquired from acquisition	144,000
Fair value receivables	88,700
Acquisition adjustment	$ 1,300,000
Pro forma net income (loss)			34,408		(44,454)
Pro forma, amortization of intangible assets			(5,800)		3,100
Pro forma, adjustments for interest expense					15,400
Seller transaction and stock compensation expense			$ 39,400		$ 39,400

Acquisition - Estimated Fair Va

Acquisition - Estimated Fair Value of The Assets Acquired and Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	Mar. 29, 2022
Assets acquired:
Goodwill	$ 1,637,149	$ 1,636,705
Apria, Inc
Assets acquired:
Current assets			$ 139,560
Goodwill			1,251,347
Intangible assets			315,300
Other non-current assets			354,237
Total assets			2,060,444
Liabilities assumed:
Current liabilities			247,276
Noncurrent liabilities			128,561
Total liabilities			375,837
Fair value of net assets acquired, net of cash			$ 1,684,607

Acquisition - Pro Forma (Detail

Acquisition - Pro Forma (Details) - Apria, Inc - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2022
Business Acquisition, Pro Forma Information, Nonrecurring Adjustment [Line Items]
Net revenue	$ 2,500,015	$ 5,184,080
Net income (loss)	$ 34,408	$ (44,454)

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Changes in Carrying Amount of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Goodwill [Roll Forward]
Carrying amount of goodwill, December 31, 2022	$ 1,636,705
Acquisition adjustment	1,582
Currency translation adjustments	(1,138)
Carrying amount of goodwill, June 30, 2023	1,637,149
Patient Direct
Goodwill [Roll Forward]
Carrying amount of goodwill, December 31, 2022	1,533,670
Acquisition adjustment	1,582
Currency translation adjustments	0
Carrying amount of goodwill, June 30, 2023	1,535,252
Products & Healthcare Services
Goodwill [Roll Forward]
Carrying amount of goodwill, December 31, 2022	103,035
Acquisition adjustment	0
Currency translation adjustments	(1,138)
Carrying amount of goodwill, June 30, 2023	$ 101,897

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Intangible Assets Subject to Amortization (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Net intangible assets	$ 403,020	$ 445,042
Customer Relationships
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	446,344	447,107
Accumulated amortization	(224,154)	(197,540)
Net intangible assets	$ 222,190	$ 249,567
Weighted average useful life	13 years	13 years
Tradenames
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	$ 202,000	$ 202,000
Accumulated amortization	(59,874)	(50,094)
Net intangible assets	$ 142,126	$ 151,906
Weighted average useful life	10 years	10 years
Other Intangibles
Finite-Lived Intangible Assets [Line Items]
Gross intangible assets	$ 73,184	$ 73,181
Accumulated amortization	(34,480)	(29,612)
Net intangible assets	$ 38,704	$ 43,569
Weighted average useful life	6 years	6 years

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 403,020		$ 403,020		$ 445,042
Amortization expense for intangible assets	20,900	$ 30,900	41,800	$ 41,200
Patient Direct
Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	279,000		279,000		308,000
Products & Healthcare Services
Finite-Lived Intangible Assets [Line Items]
Intangible assets, net	$ 124,000		$ 124,000		$ 137,000

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2023 (remainder)	$ 41,489
2024	65,285
2025	55,157
2026	53,721
2027	46,878
2028	$ 28,867

Exit and Realignment Costs - Na

Exit and Realignment Costs - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring and Related Activities [Abstract]
Exit and realignment charges	$ 28,963	$ 1,214	$ 44,637	$ 2,896

Exit and Realignment Costs - Ac

Exit and Realignment Costs - Accrual for Exit and Realignment Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022
Restructuring Reserve [Roll Forward]
Accrued exit and realignment costs, beginning of period	$ 11,097	$ 969	$ 3,085	$ 8,306
Cash payments	(20,196)	(5,546)	(3,477)	(6,903)
Accrued exit and realignment costs, end of period	19,864	11,097	822	3,085
Severance
Restructuring Reserve [Roll Forward]
Provision for exit and realignment activities:	505	4,127	246	811
Professional fees
Restructuring Reserve [Roll Forward]
Provision for exit and realignment activities:	22,953	9,012
Vendor contract and lease termination costs
Restructuring Reserve [Roll Forward]
Provision for exit and realignment activities:	1,707	1,824
Other
Restructuring Reserve [Roll Forward]
Provision for exit and realignment activities:	$ 3,798	$ 711	$ 968	$ 871

Debt - Schedule of Debt, Net of

Debt - Schedule of Debt, Net of Unamortized Deferred Financing Costs (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	Mar. 29, 2022	Mar. 10, 2021
Debt Instrument [Line Items]
Long-term debt	$ 2,309,853	$ 2,482,968
Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Interest rate of debt	4.375%
Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Interest rate of debt	4.50%			4.50%
Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Interest rate of debt	6.625%		6.625%
Carrying Amount
Debt Instrument [Line Items]
Total debt	$ 2,334,256	2,500,874
Less current maturities	(24,403)	(17,906)
Long-term debt	2,309,853	2,482,968
Carrying Amount | Finance leases and other
Debt Instrument [Line Items]
Finance leases and other	16,508	16,877
Carrying Amount | Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Long-term debt	245,659	245,510
Carrying Amount | Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Long-term debt	492,703	492,762
Carrying Amount | Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Long-term debt	579,023	585,180
Carrying Amount | Receivables Securitization Program
Debt Instrument [Line Items]
Long-term debt	0	93,142
Carrying Amount | Secured Debt | Term Loan A
Debt Instrument [Line Items]
Long-term debt	454,349	490,816
Carrying Amount | Secured Debt | Term Loan B
Debt Instrument [Line Items]
Long-term debt	546,014	576,587
Estimated Fair Value
Debt Instrument [Line Items]
Total debt	2,227,640	2,346,067
Less current maturities	(24,403)	(17,906)
Long-term debt	2,203,237	2,328,161
Estimated Fair Value | Finance leases and other
Debt Instrument [Line Items]
Finance leases and other	16,508	16,877
Estimated Fair Value | Senior Notes | 4.375% Senior Notes, due December 2024
Debt Instrument [Line Items]
Long-term debt	240,032	237,772
Estimated Fair Value | Senior Notes | 4.500% Senior Notes, due March 2029
Debt Instrument [Line Items]
Long-term debt	417,752	396,625
Estimated Fair Value | Senior Notes | 6.625% Senior Notes, due April 2030
Debt Instrument [Line Items]
Long-term debt	538,085	516,060
Estimated Fair Value | Receivables Securitization Program
Debt Instrument [Line Items]
Long-term debt	0	96,000
Estimated Fair Value | Secured Debt | Term Loan A
Debt Instrument [Line Items]
Long-term debt	452,060	485,000
Estimated Fair Value | Secured Debt | Term Loan B
Debt Instrument [Line Items]
Long-term debt	$ 563,203	$ 597,733

Debt - Narrative (Details)

Debt - Narrative (Details) $ in Thousands			6 Months Ended
	Mar. 29, 2022 USD ($) creditFacility	Mar. 10, 2021 USD ($)	Jun. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Debt Instrument [Line Items]
Number of credit facilities | creditFacility	2
Long-term debt, maturity, year one			$ 273,855
Short-term finance leases			2,800
Revolving Credit Facility
Debt Instrument [Line Items]
Face amount	$ 450,000
Maximum borrowing capacity	150,000
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding, amount			2,100	$ 2,300
Line of Credit
Debt Instrument [Line Items]
Remaining borrowing capacity				422,000
Long-term debt, maturity, year one			274,000
Line of Credit | Payments due in December related to the 2024 Notes, Term Loan A, and Term Loan B
Debt Instrument [Line Items]
Long-term debt, maturity, year one			254,000
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding, amount			27,900
4.375% Senior Notes, due December 2024 | Senior Notes
Debt Instrument [Line Items]
Face amount			$ 246,000
Interest rate of debt			4.375%
Debt issued, percent of par			99.60%
Effective yield percentage			4.422%
Senior notes redemption price, percentage			100%
Rate of interest discounted			0.30%
Receivables Financing Agreement
Debt Instrument [Line Items]
Current borrowing capacity	450,000
Borrowings outstanding			$ 0
Letters of credit outstanding, amount				96,000
Receivables Financing Agreement | Line of Credit
Debt Instrument [Line Items]
Remaining borrowing capacity			450,000	$ 354,000
Term Loan A
Debt Instrument [Line Items]
Face amount	500,000
Scheduled principal payment			3,100
Unscheduled principal payment			35,000
Long-term debt, maturity, principal payments			15,600
Term Loan B
Debt Instrument [Line Items]
Face amount	600,000
Scheduled principal payment			3,000
Unscheduled principal payment			30,000
Long-term debt, maturity, principal payments			$ 6,000
4.500% Senior Notes, due March 2029 | Senior Notes
Debt Instrument [Line Items]
Face amount		$ 500,000
Interest rate of debt		4.50%	4.50%
Debt issued, percent of par		100%
Effective yield percentage		4.50%
Senior notes redemption price, percentage			100%
4.500% Senior Notes, due March 2029 | Senior Notes | Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Senior notes redemption price, percentage			104.50%
Redemption price, percentage of principal amount redeemed			40%
6.625% Senior Notes, due April 2030 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 600,000
Interest rate of debt	6.625%		6.625%
Debt issued, percent of par	100%
Effective yield percentage	6.625%
Senior notes redemption price, percentage			100%
6.625% Senior Notes, due April 2030 | Senior Notes | Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Senior notes redemption price, percentage			106.625%
Redemption price, percentage of principal amount redeemed			40%

Debt - Schedule of Future Princ

Debt - Schedule of Future Principal Payments of Debt (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Debt Disclosure [Abstract]
2023 (remainder)	$ 9,250
2024	273,855
2025	40,375
2026	43,500
2027	367,875
2028	6,000
2029	1,028,845
2030	$ 592,670

Retirement Plans - Components o

Retirement Plans - Components of Net Periodic Benefit Cost - Narrative (Details) - USD ($) $ in Millions	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Defined Benefit Plan Disclosure [Line Items]
Defined benefit plan, type [extensible enumeration]	Pension Plan [Member]	Pension Plan [Member]
United States
Defined Benefit Plan Disclosure [Line Items]
Accumulated benefit obligation	$ 38.5	$ 39.3

Retirement Plans - Components_2

Retirement Plans - Components of Net Periodic Benefit Cost (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Retirement Benefits [Abstract]
Service cost	$ 446	$ 617	$ 887	$ 1,250
Interest cost	714	519	1,423	1,042
Recognized net actuarial loss	123	267	246	534
Net periodic benefit cost	$ 1,283	$ 1,403	$ 2,556	$ 2,826

Derivatives - Schedule of the t

Derivatives - Schedule of the terms and fair value of our outstanding derivative financial instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Cash flow hedges | Interest rate swaps
Derivative [Line Items]
Notional Amount	$ 50,000
Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Notional Amount	76,916	$ 58,321
Cash flow hedges | Cash flow hedges | Interest rate swaps
Derivative [Line Items]
Notional Amount	350,000	400,000
Other assets, net | Cash flow hedges | Cash flow hedges | Interest rate swaps
Derivative [Line Items]
Derivative Asset, Fair Value	15,355	15,461
Other current assets | Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Derivative Asset, Fair Value	269	440
Other liabilities | Cash flow hedges | Cash flow hedges | Interest rate swaps
Derivative [Line Items]
Derivative Liabilities, Fair Value	0	0
Other current liabilities | Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Derivative Liabilities, Fair Value	$ 2	$ 42

Derivatives - Narrative (Detail

Derivatives - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Cash flow hedges | Interest rate swaps
Derivative [Line Items]
Notional amount	$ 50,000		$ 50,000
Economic (non-designated) hedges | Foreign currency contracts
Derivative [Line Items]
Notional amount	76,916		76,916		$ 58,321
Loss on derivative not designed as hedging instrument	$ 900	$ 1,300	$ 900	$ 1,400

Derivatives - Schedule of the e

Derivatives - Schedule of the effect of cash flow hedge (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Derivative Instruments, Gain (Loss) [Line Items]
Total Amount of Expense Line Items Presented in the Consolidated Statement of Operations in Which the Effects are Recorded	$ (40,728)	$ (35,839)	$ (82,926)	$ (47,858)
Interest rate swaps
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain Recognized in Other Comprehensive Income (Loss)	6,792	2,044	4,405	2,044
Interest rate swaps | Interest expense, net | Reclassification out of Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain (Loss) Reclassified from Accumulated Other Comprehensive Loss into Income	$ 2,335	$ (1,692)	$ 4,511	$ (1,692)

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Effective income tax rate	8.80%	25.60%	18.70%	21.70%
Liability for unrecognized tax benefit	$ 22.7		$ 22.7		$ 22.5
Unrecognized tax benefit, timing uncertainty	$ 2.7		$ 2.7		$ 2.7

Net (Loss) Income per Common _3

Net (Loss) Income per Common Share - Schedule of Calculation of Net (Loss) Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2023	Jun. 30, 2022
Earnings Per Share [Abstract]
Net (loss) income	$ (28,241)	$ (24,418)	$ 28,604	$ 39,279	$ (52,659)	$ 67,884
Weighted average shares outstanding - basic (in shares)	75,801		74,710		75,559	74,158
Diluted shares (in shares)	0		1,587		0	2,011
Weighted average shares outstanding - diluted (in shares)	75,801		76,297		75,559	76,169
Net (loss) income per common share:
Basic (in usd per share)	$ (0.37)		$ 0.38		$ (0.70)	$ 0.92
Diluted (in usd per share)	$ (0.37)		$ 0.37		$ (0.70)	$ 0.89

Net (Loss) Income per Common _4

Net (Loss) Income per Common Share - Narrative (Details) - shares shares in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2023
Share-Based Payment Arrangement
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Share-based awards (in shares)	1.8	1.7

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive (Loss) Income - Changes in Accumulated Other Comprehensive (Loss) Income By Component (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2023	Jun. 30, 2022
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning Balance	$ 924,400	$ 945,604	$ 947,622	$ 938,501	$ 945,604	$ 938,501
Other comprehensive (loss) income before reclassifications	1,625		(16,787)		4,356	(17,574)
Income tax	(1,766)		(532)		(1,145)	(532)
Other comprehensive (loss) income before reclassifications, net of tax	(141)		(17,319)		3,211	(18,106)
Amounts reclassified from accumulated other comprehensive income (loss)	(2,212)		2,078		(4,265)	2,327
Income tax	621		(529)		916	(589)
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	(1,591)		1,549		(3,349)	1,738
Total other comprehensive loss, net of tax	(1,732)	1,594	(15,770)	(598)	(138)	(16,368)
Ending Balance	896,229	924,400	958,659	947,622	896,229	958,659
Total
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning Balance	(34,261)	(35,855)	(41,189)	(40,591)	(35,855)	(40,591)
Total other comprehensive loss, net of tax	(1,732)	1,594	(15,770)	(598)
Ending Balance	(35,993)	(34,261)	(56,959)	(41,189)	(35,993)	(56,959)
Retirement Plans
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning Balance	(7,348)	(7,201)	(14,408)	(14,597)	(7,201)	(14,597)
Other comprehensive (loss) income before reclassifications	0		0		0	0
Income tax	0		0		0	0
Other comprehensive (loss) income before reclassifications, net of tax	0		0		0	0
Amounts reclassified from accumulated other comprehensive income (loss)	123		386		246	635
Income tax	13		(89)		(257)	(149)
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	136		297		(11)	486
Total other comprehensive loss, net of tax	136		297		(11)	486
Ending Balance	(7,212)	(7,348)	(14,111)	(14,408)	(7,212)	(14,111)
Currency Translation Adjustments
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning Balance	(34,977)	(40,095)	(26,781)	(25,994)	(40,095)	(25,994)
Other comprehensive (loss) income before reclassifications	(5,167)		(18,831)		(49)	(19,618)
Income tax	0		0		0	0
Other comprehensive (loss) income before reclassifications, net of tax	(5,167)		(18,831)		(49)	(19,618)
Amounts reclassified from accumulated other comprehensive income (loss)	0		0		0	0
Income tax	0		0		0	0
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	0		0		0	0
Total other comprehensive loss, net of tax	(5,167)		(18,831)		(49)	(19,618)
Ending Balance	(40,144)	(34,977)	(45,612)	(26,781)	(40,144)	(45,612)
Derivatives
Accumulated Other Comprehensive Income (Loss), Net of Tax [Roll Forward]
Beginning Balance	8,064	11,441	0	0	11,441	0
Other comprehensive (loss) income before reclassifications	6,792		2,044		4,405	2,044
Income tax	(1,766)		(532)		(1,145)	(532)
Other comprehensive (loss) income before reclassifications, net of tax	5,026		1,512		3,260	1,512
Amounts reclassified from accumulated other comprehensive income (loss)	(2,335)		1,692		(4,511)	1,692
Income tax	608		(440)		1,173	(440)
Amounts reclassified from accumulated other comprehensive income (loss), net of tax	(1,727)		1,252		(3,338)	1,252
Total other comprehensive loss, net of tax	3,299		2,764		(78)	2,764
Ending Balance	$ 11,363	$ 8,064	$ 2,764	$ 0	$ 11,363	$ 2,764

Segment Information - Financial

Segment Information - Financial Information by Segment (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($) segment	Jun. 30, 2022 USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment			2
Segment Reporting, Revenue Reconciling Item [Line Items]
Net revenue	$ 2,563,226	$ 2,500,015	$ 5,086,075	$ 4,906,967
Operating income:	10,839	75,085	20,646	136,144
Acquisition-related charges and intangible amortization	(22,203)	(37,276)	(44,392)	(79,410)
Exit and realignment charges	(28,963)	(1,214)	(44,637)	(2,896)
Depreciation and amortization:	72,062	73,161	142,988	97,286
Consolidated capital expenditures	49,489	54,738	100,979	65,699
Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Net revenue	2,563,226	2,500,015	5,086,075	4,906,967
Operating Segments | Products & Healthcare Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Net revenue	1,930,723	1,927,388	3,846,212	4,061,429
Operating income:	2,940	61,243	4,761	150,325
Depreciation and amortization:	18,772	19,209	37,338	38,203
Consolidated capital expenditures	6,602	18,418	12,934	29,061
Operating Segments | Patient Direct
Segment Reporting, Revenue Reconciling Item [Line Items]
Net revenue	632,503	572,627	1,239,863	845,538
Operating income:	59,065	52,332	104,914	68,125
Depreciation and amortization:	53,290	53,952	105,650	59,083
Consolidated capital expenditures	42,887	36,320	88,045	36,638
Segment Reconciling Items
Segment Reporting, Revenue Reconciling Item [Line Items]
Acquisition-related charges and intangible amortization	(22,203)	(37,276)	(44,392)	(79,410)
Exit and realignment charges	$ (28,963)	$ (1,214)	$ (44,637)	$ (2,896)

Segment Information - Consolida

Segment Information - Consolidated Total Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	$ 5,288,000	$ 5,386,283
Cash and cash equivalents	286,307	69,467
Operating Segments
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	5,001,693	5,316,816
Operating Segments | Products & Healthcare Services
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	2,492,214	2,809,600
Operating Segments | Patient Direct
Segment Reporting, Asset Reconciling Item [Line Items]
Assets	$ 2,509,479	$ 2,507,216

Segment Information - Net reven

Segment Information - Net revenue by geographic area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Segment Reporting Information [Line Items]
Net revenue	$ 2,563,226	$ 2,500,015	$ 5,086,075	$ 4,906,967
United States
Segment Reporting Information [Line Items]
Net revenue	2,498,536	2,376,573	4,951,472	4,638,592
International
Segment Reporting Information [Line Items]
Net revenue	$ 64,690	$ 123,442	$ 134,603	$ 268,375