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Accounts receivable, net

7. Accounts receivable, net

Accounts receivable consisted of the following:

	December 31,
	2018			2017
Accounts receivable	$	37,497		$	31,349
Less — allowance for sales returns and doubtful accounts		(3,420	)		(3,225	)
	$	34,077		$	28,124

The Company’s allowance for sales returns and doubtful accounts was comprised of the following:

Balance as of December 31, 2016	$	2,109
Additions		1,166
Write-offs		(50	)
Balance as of December 31, 2017		3,225
Additions		1,157
Write-offs		(962	)
Balance as of December 31, 2018	$	3,420

The entire disclosure for claims held for amounts due a entity, excluding financing receivables. Examples include, but are not limited to, trade accounts receivables, notes receivables, loans receivables. Includes disclosure for allowance for credit losses.

Inventories

12 Months Ended

Dec. 31, 2018

Inventory Disclosure [Abstract]

Inventories

8. Inventories

Inventories, net of related reserves for excess and obsolescence, consisted of the following:

	December 31,
	2018		2017
Raw materials	$	4,711	$	6,537
Work in process		1,759		991
Finished goods		6,851		6,742
	$	13,321	$	14,270

Raw materials include various components used in the Company’s manufacturing process. The Company’s excess and obsolete inventory review process includes analysis of sales forecasts and historical sales as compared to inventory, and working with operations to maximize recovery of excess inventory. During the years ended December 31, 2018, 2017 and 2016, the Company charged $5,949, $5,497, and $7,472, respectively, to cost of goods sold within the consolidated statements of operations. As of December 31, 2018 and 2017, the Company recorded a reserve for excess and obsolete inventory of $2,951 and $2,954, respectively.

Prepaid Expenses and Other Current Assets

12 Months Ended

Dec. 31, 2018

Prepaid Expenses and Other Current Assets

9. Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consisted of the following:

	December 31,
	2018		2017
Deferred offering costs	$	—	$	2,724
Prepaid rent		—		29
Prepaid subscriptions		594		584
Prepaid inventory testing		116		36
Prepaid conferences and marketing expenses		392		588
Prepaid insurance		223		196
Prepaid deposits		764		—
Other		239		242
	$	2,328	$	4,399

All deposits held by the Company are deposits held by vendors which are expected to be released within twelve months and therefore they are properly recorded as current assets.

Property and Equipment

12 Months Ended

Dec. 31, 2018

Property, Plant and Equipment [Abstract]

Property and Equipment

10. Property and Equipment

Property and equipment consisted of the following:

	December 31,
	2018			2017
Leasehold improvements	$	34,345		$	35,143
Furniture, computers and equipment		44,752			43,375
		79,097			78,518
Accumulated depreciation and amortization		(62,435	)		(59,212	)
Construction in progress		22,961			22,806
	$	39,623		$	42,112

On June 1, 2017, in connection with the deconsolidation of the Real Estate Entities, the property and equipment associated with the Real Estate Entities in the net aggregate amount of $9,932, was derecognized from the Company’s consolidated balance sheet (see Note 5).

Depreciation expense was $3,309, $3,591, and $5,702 for the years ended December 31, 2018, 2017 and 2016, respectively. During the year ended December 31, 2018, the Company disposed of $1,309 in equipment with accumulated depreciation of $99. Cash proceeds of $1 were received and a loss on disposal of $1,209 was recorded. During the year ended December 31, 2017, the Company disposed of $418 in equipment with accumulated depreciation of $418. Cash proceeds of $8 were received and a gain on the disposal of $8 was recorded. As of December 31, 2018 and 2017, the Company had $21,889 of buildings under capital leases recorded within leasehold improvements. As of December 31, 2018 and 2017, the Company had $12,779 and $5,989 recorded within accumulated depreciation and amortization related to buildings under capital leases, respectively. Construction in progress primarily represents ongoing construction work on the 275 Dan Road SPE, LLC property (see Note 17). Leasehold improvements at December 31, 2018 includes $

1,464

related to ongoing renovations at 85 Dan Road not yet placed in service. Leasehold improvements at December 31, 2017 includes $

618

related to ongoing renovations at 85 Dan Road not yet placed in service.

Notes Receivable - Related Parties

12 Months Ended

Dec. 31, 2018

Note Receivable Related Parties

11. Notes Receivable—Related Parties

During 2010, the Company’s board of directors approved a loan program that permitted the Company to make loans to three officers of the Company (the “Employer Loans”) to (i) provide them with liquidity (“Liquidity Loans”) and (ii) fund the exercise of vested stock options (“Option Loans”). The Employer Loans mature with all principal and accrued interest due on the tenth anniversary of the issuance date of each subject loan, except that in certain circumstances the Employer Loans may mature earlier. The borrower may prepay all or any portion of his Employer Loan at any time without premium or penalty.)

The Company has not executed any new Employer Loans since the year ended December 31, 2012. However, certain Employer Loans made prior to 2013 remain outstanding as of December 31, 2018. Interest on the Liquidity Loans accrues at various rates ranging from 2.30%—3.86% per annum, compounded annually. The Liquidity Loans are secured by stock and options in the Company held by the borrowers. The Company has no personal recourse against the borrowers beyond the pledged shares and options with respect to the Liquidity Loans. In 2013, the Company reserved the total outstanding principal of all the then outstanding loans and the interest on the loan to one former employee as the loans are secured by pledged shares and options which had a limited liquid market for the holder to liquidate the holdings to repay the loans and collectability of the outstanding principal on the loans is not assured. The net principal and interest receivable under the Liquidity Loans as of December 31, 2018 and 2017 was $478 and $413, respectively, and is included in the notes receivable from related parties balance in the consolidated balance sheets. Interest income related to these notes was $64, $111 and $108 for the years ended December 31, 2018, 2017 and 2016, respectively. As part of the separation agreement between the Company and its former CEO entered into in March 2015, the Company agreed that it would forgive one-half of the then outstanding principal balance of the former CEO’s Liquidity Loans if the Company completed a liquidity event, as defined in the agreement, prior to the maturity of such loans. A liquidity event includes a change of control of the Company and a firm commitment underwritten public offering of the Company’s securities. As of December 31, 2018 and 2017, the former CEO’s Liquidity Loans had an outstanding aggregate principal balance of $2,000. As of December 31, 2018 and 2017, the current CEO’s Liquidity Loan had an outstanding aggregate principal balance of $0 and $997, respectively. As of December 31, 2018 and 2017, the Liquidity Loan to one former employee had an outstanding aggregate principal balance of $350. As of December 31, 2018 and 2017, the Option Loan to one former employee totaled $635 and was secured by 675,990 shares of Class A common stock held by the former employee.

Interest on the Option Loans accrued at various rates ranging from 2.30%—3.86% per annum, compounded annually. There was no interest income related to the Option Loans for 2018, 2017 and 2016. The Option Loans were also secured by stock and options in the Company held by the borrowers. The Company has full recourse against such pledged shares and options and personal recourse against the borrower for up to 50% of the original principal amount of the Option Loan and 100% of the accrued interest owed to the Company. In accordance with the applicable accounting guidance, the principal balance of the Option Loans was reported as an offset to additional paid-in capital from the exercise of the options. On August 21, 2014, two officers satisfied their outstanding Option Loans by exchanging shares of Organogenesis Inc. common stock being held as collateral equal to the value of their outstanding Option Loans plus accrued interest thereon.

The Employer Loans accrue interest at various rates ranging from 2.30%—3.86% per annum, compounded annually. The total principal and interest receivable under the Employer Loans as of December 31, 2018 and 2017 was $2,937 and $3,873

, respectively. The value of the stock and options securing the Employer Loans as of December 31, 2018 and 2017 was $

4,448

and $3,646, respectively. During 2017, the Company recorded an impairment

of $113

on the Employer Loan to our CEO to reserve the total outstanding interest of the loan as uncollectible. The Company did not record any impairment on the employee loans during the year ended December 31, 2018.

As of December 31, 2018 and 2017, notes receivable from related parties consisted of the following:

Balance as of December 31, 2016	$	415
Accrued interest		111
Impairment		(113	)
Balance as of December 31, 2017		413
Accrued interest		64
Balance as of December 31, 2018	$	477

In connection with the Avista Merger (see Note 1), the Company forgave the outstanding aggregate principal balance of $997

and $133 of accrued interest related to the current CEO’s Liquidity Loans immediately prior to consummation of the Avista Merger. Concurrently with the loan forgiveness, the Company also made a bonus payment of

$904

to the current CEO to cover certain taxes associated with the loan forgiveness, which was recorded within selling, general and administrative expense on the consolidated statement of operations. As discussed above, the total outstanding aggregate principal balance and interest were previously reserved for in prior years when deemed uncollectible and therefore were carried at

on the consolidated balance sheets at the time of the loan forgiveness.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

12. Goodwill and Intangible Assets

During 2017, the Company recorded $19,446 of goodwill associated with the acquisition of NuTech Medical (see Note 5). Goodwill was $25,539 as of December 31, 2018 and 2017, respectively. There were no impairments recorded against goodwill during the years ended December 31, 2018 or 2017.

Identifiable intangible assets consisted of the following as of December 31, 2018:

	Original Cost		Accumulated Amortizatio n			Net Book Value
Developed technology	$	29,820	$	(8,454	)	$	21,366
Trade names and trademarks		2,000		(413	)		1,587
Independent sales agency network		4,500		(1,569	)		2,931
Non-compete agreements		260		(53	)		207
Total	$	36,580	$	(10,489	)	$	26,091

Identifiable intangible assets consisted of the following as of December 31, 2017:

	Original Cost		Accumulated Amortization			Net Book Value
Developed technology	$	29,820	$	(6,389	)	$	23,431
Trade names and trademarks		2,000		(238	)		1,762
Independent sales agency network		4,500		(181	)		4,319
Non-compete agreements		260		(13	)		247
Total	$	36,580	$	(6,821	)	$	29,759

Amortization of intangible assets, calculated on a straight-line basis, was $3,669, $2,037 and $1,617 for the years ended December 31, 2018, 2017 and 2016, respectively. Estimated future annual amortization expense related to these intangibles assets is as follows:

2019		5,993
2020		3,192
2021		3,257
2022		3,247
2023		3,283
Thereafter		7,119
Total	$	26,091

Accrued Expenses and Other Current Liabilities

12 Months Ended

Dec. 31, 2018

Accrued Expenses and Other Current Liabilities

13. Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of the following:

	December 31,
	2018		2017
Accrued compensation	$	15,218	$	11,826
Accrued professional fees		309		539
Accrued interest - capital lease obligations		4,174		3,950
Accrued litigation		1,000		1,000
Accrued royalties		2,463		3,610
Accrued interest - deferred acquisition consideration		618		318
Other		1,633		1,308
	$	25,415	$	22,551

Long-Term Debt - Affiliates

12 Months Ended

Dec. 31, 2018

Debt Disclosure [Abstract]

Long-Term Debt - Affiliates

14. Long-Term Debt—Affiliates

Long-term debt payable to affiliates consisted of the following:

	December 31,
	2018		2017
2010 Loans	$	—	$	19,850
2015 Loans		—		11,396
2016 Loans		—		17,000
Accrued interest		—		9,241
		—		57,487
Less debt discount		—		(5,345	)
	$	—	$	52,142

Due to affiliates consisted of the following:

	December 31,
	2018		2017
65 Dan Road SPE, LLC	$	—	$	200
85 Dan Road Associates		—		3,900
275 Dan Road SPE, LLC		—		400
	$	—	$	4,500

The Company borrowed the 2010 Loans and the 2015 Loans, collectively the “Loans,” from its affiliates, or entities controlled by its affiliates. The Loans are subordinated to amounts outstanding under the Credit Agreement and the Master Lease Agreement (“ML Agreement”) (see Note 15). The Loans are secured by substantially all the assets of the Company and require the Company to adhere to certain non-financial covenants. The Company has accrued but not paid interest on the Loans since inception until the payoff in December 2018 as discussed below. Events of default have been waived by the lenders each year through the payoff in December 2018.

The 2010 and 2015 Loans bear interest at an annual rate of 1.6%. The principal plus accrued interest on the loans were due upon or the repayment of the debt to which these notes

were

subordinated. Therefore, they

were

classified as long-term liabilities in the consolidated balance sheet as of December 31, 2018 and 2017. Interest expense on these loans totaled $470, $540 and $503 for the years ended December 31, 2018, 2017 and 2016, respectively. The accrued interest on the loans totaled $0 and $4,436 as of December 31, 2018 and 2017, respectively.

In June 2013, the Company entered into a secured financing arrangement with 65 Dan Road SPE, LLC, 85 Dan Road Associates and 275 Dan Road SPE, LLC, referred to as the Real Estate Loans. The Real Estate Loans bear interest at a rate of 1.6% per annum, and

were

secured by substantially all of the personal property and assets of the Company and

were

subordinated to amounts outstanding under the Credit Agreement, ML agreement and the sellers of NuTech Medical. The Company had accrued but not paid interest on the Loans since inception until the payoff in December 2018. Interest expense on these loans totaled $68 and $45 for the years ended December 2018 and 2017, respectively. The accrued interest on the loans totaled $0 and $325 as of December 31, 2018 and 2017, respectively.

In April 2016, the Company issued the 2016 Loans in the aggregate principal amount of $17,000. The 2016 Loans accrued interest at an annual rate of 15%, and required monthly interest-only payments beginning January 2017, with all outstanding principal and accrued interest due upon the repayment of the debt to which these notes

were

subordinate. The 2016 Loans also required an additional fee of $680 initially to be paid in January 2017 but further extended to be paid upon the repayment of the 2016 Loans. The 2016 Loans

were

collateralized by substantially all assets of the Company and

were

subordinated to indebtedness under the Credit Agreement and the Master Lease Agreement. The 2016 Loans were collateralized by substantially all assets of the Company and are subordinated to indebtedness under the Credit Agreement, ML Agreement and the sellers of NuTech Medical. Interest expense on the 2016 Loans totaled $2,667 and $2,735 for the years ended December 31, 2018 and 2017, respectively, which included interest expense related to the amortization of the debt discount of $268 and $92 during the years ended December 31, 2018 and 2017, respectively. As of December 31, 2018 and 2017, the unamortized debt discount was $0 and $5,345, respectively. The accrued interest on the 2016 Loans totaled $0 and $4,387 as of December 31, 2018 and 2017, respectively.

The Company did not pay the fee of $680 which is included in other liabilities or the accrued interest due on January 31, 2017 and February 28, 2017, respectively. In March 2017, the investors waived the Company’s failure to comply with the payment schedule of the original agreement and confirmed that no event of default had occurred. It was further agreed that neither the fee nor any accrued interest would be payable before April 30, 2018, but that interest would accrue on the unpaid fee beginning January 31, 2017 at a rate of 15%. In December 2018, the Company paid the fee in full as discussed below. Interest expense on the fee totaled $96 and $93 for the years ended December 31, 2018 and 2017, respectively. The accrued interest on the unpaid fee, which was included in long-term debt—affiliates, totaled $0 and $93 as of December 31, 2018 and December 31, 2017, respectively.

In March 2017, in connection with the Credit Agreement, the holders of the 2010 Loans, 2015 Loans and the 2016 Loans entered into a subordination agreement whereby the loanholders agreed to subordinate all amounts due under the 2010 Loans, the 2015 Loans and the 2016 Loans and all their security interests to the indebtedness and obligations under the Credit Agreement. The Credit Agreement matures in April 2020. In April 2017, in connection with the ML Agreement (See Note 15), the loanholders entered into an additional subordination agreement with the lender. The loanholders also agreed to subordinate all amounts due under the 2010 Loans, 2015 Loans and 2016 Loans and all of their security interests to the indebtedness and obligations under the ML Agreement. The maturity date of this additional lender’s debt was December 2022. Due to the effective change in term resulting from the March 2017 subordination agreement, the 2016 Loans were concluded to have been extinguished, and the resulting gain of $2,043 was recorded to additional paid-in capital due to the controlling interest in the Company held by the investors. The Company also concluded that a second extinguishment occurred in April 2017 due to the change in effective maturity date. The resulting gain of $2,534 was also recorded to additional paid-in capital. A debt discount of $4,577 was recorded as a result of these two extinguishments. This discount was being amortized to interest expense using the effective interest method over the term of the 2016 Loans as an increase to the carrying value of the 2016 Loans on the consolidated balance sheets.

In connection with the issuance of the 2016 Loans, the Company issued to the loanholders warrants to purchase 905,774 shares of Class A common stock at an exercise price of $3.58 per share. The warrants are exercisable immediately and expire during April 2021. The warrants contain a down round protection provision whereby the exercise price and number of shares exercisable upon either the issuance of shares or other equity linked instruments at a price less than $3.58 per share or upon the contractual price reset of other equity linked instruments post issuance. The warrants were determined to be liability classified and were recorded at fair value (see Note 2). The resulting discount on the 2016 Loans at inception was $

464

. This discount is being amortized to interest expense using the effective interest method over the term of the 2016 Loans as an increase to the carrying value of the 2016 Loans on the consolidated balance sheet (see Note 18).

In April 2018 and August 2018, the Company received $10,000 and $5,000, respectively, in loan proceeds from three members of its board of directors who are also stockholders (the “2018 Loans”). The amounts borrowed bear an annualized 8% interest rate, are payable on demand and are subordinated to the Credit Agreement, ML Agreement and the sellers of NuTech Medical. Interest expense on the 2018 Loans totaled $687 for the year ended December 31, 2018. The accrued interest on the 2018 Loans totaled $0 as of December 31, 2018.

Concurrently with the signing of the Avista Merger Agreement (see Note 1) the Company’s lenders agreed to release the subordination on the affiliate debt and the affiliate guarantee on the term debt, and the holders of the affiliate debt executed and delivered to the Company an exchange agreement whereby such creditors and the Company agreed that, concurrently with the consummation of the Avista Merger, outstanding principal of $45,746 related to the affiliate debt was converted into 6,502,679 shares of ORGO Class A common stock, and the Company made a cash payment to such creditors equal to $35,641, including $

22,000

of principal and $

13,

641

of accrued interest and accrued affiliate loan fees as of and through the closing date of the Avista Merger. Following the consummation of the transactions contemplated by the exchange agreement, the affiliate debt is deemed fully paid and satisfied in full and discharged and terminated. As a result of the full satisfaction of the affiliated debt, the Company recorded a $2,095 loss on the extinguishment of the affiliated debt in the consolidated statement of operations. The loss is comprised of the write-off of the unamortized debt discount of $5,078 offset by $2,982 which is the difference between the debt principal converted into Class A common stock less the fair value of the common stock issued for the conversion at a per share price of $13.35.

Line of Credit and Notes Payable

12 Months Ended

Dec. 31, 2018

Line of Credit Facility [Abstract]

Line of Credit and Notes Payable

15. Line of Credit and Notes Payable

Line of credit and notes payable consisted of the following:

	December 31,
	2018			2017
Line of credit	$	26,484		$	17,618
Notes payable	$	15,885		$	15,895
Less debt discount		(762	)		(1,079	)
Less current maturities		(2,545	)		—
Notes payable, net of debt discount	$	12,578		$	14,816

Credit Agreement

On March 21, 2017, the Company entered into a credit agreement (the “Credit Agreement”) with Silicon Valley Bank (“SVB”) whereby SVB agreed to extend to the Company a revolving credit facility in an aggregate amount not to exceed $30,000 with a letter of credit sub-facility and a swing line sub-facility as a sublimit of the revolving loan facility. The amount available to borrow under both sub-facilities is dependent on a borrowing base, which is defined as a percentage of the Company’s book value of qualifying finished goods and eligible accounts receivable. The Credit Agreement requires that a portion of the proceeds be used to pay in full, all amounts then outstanding under an existing line of credit agreement. As of December 31, 2018, the Company has borrowed an aggregate of $26,484 under the revolving credit facility and the total amount available for future revolving borrowings was $3,516. Interest payments under the credit agreement are payable on the first business day of each calendar month with a final payment on March 21, 2020 (“the Maturity Date”) when all amounts of principal and interest under the revolving credit facility become due. The revolving credit facility accrues interest at (i) a rate per annum equal to the greater of the prime rate and the federal funds rate effective for such day plus 0.50%, plus (ii) an applicable margin of either 0.50% or 1.50% depending on the Company’s liquidity ratio for the immediately preceding 30-day period; provided, however, that in an event of default, as defined in the Credit Agreement, the interest rate applicable to borrowings will be increased by 2.00%

In connection with the Credit Agreement, the holders of the 2010 Loans, 2015 Loans, 2016 Loans and 2018 Loans entered into a subordination agreement whereby the holders agreed to delay any payments of principal, fees or interest until the SVB Agreement terminates in 2020 (see Note 14).

In connection with the Credit Agreement, the Company has incurred costs of $702,

which is recorded within other assets on the consolidated balance sheet and amortized over the life of the agreement.

In connection with the Credit Agreement, on March 21, 2017, the Company repaid all remaining principal and accrued interest outstanding under an existing line of credit agreement. The Company did not record any associated gain or loss with the extinguishment of this line of credit.

In February 2018, the Company further amended its Credit Agreement to provide additional flexibility in the financial covenants and revised the borrowing base formula to increase availability. There were no other changes to the terms of the Credit Agreement as a result of the amendment.

In April 2018, the Company further amended its Credit Agreement in order to receive additional funding of $5,000 through a term loan. The amendment increased the commitment under the Credit Agreement to an aggregate amount not to exceed $35,000, consisting of a term loan not to exceed $5,000 and a revolving loan not to exceed $30,000. In order to facilitate this amendment certain members of the board of directors provided unconditional personal guarantees with respect to the principal and accrued interest due under the $5,000 term loan.

In May 2018, the Company executed a forbearance and amendment to the Credit Agreement with SVB to forbear against the exercise of remedies related to existing events of default, including the failure to comply with its financial covenants for specified periods of time and to add an additional minimum revenue covenant.

Concurrently with the execution of the Agreement (see Note 1), the Company entered into a consent agreement with SVB to, among other things, waive the existing events of default related to failed financial covenants under the Credit Agreement, subject to certain conditions, and extend the forbearance period to September 30, 2018.

In September 2018, the Company entered into a waiver and amendment to the consent agreement to waive the existing events of default under the Credit Agreement, extend the period to modify the financial covenants under the Credit Agreement to October 31, 2018 and waive the financial covenant testing requirements for the period ended September 30, 2018 under the Credit Agreement.

In October 2018, the Company entered into (a) an amendment to its Credit Agreement to extend the maturity date on the $5,000 term loan from the earlier to occur of (i) October 31, 2018 and (ii) 30 days after the date of the occurrence of an initial public offering, to December 31, 2018 and (b) an amendment to the consent agreement to extend the period to modify the existing financial covenants to December 31, 2018 and waive the financial covenant testing requirements for the periods ended October 31, 2018 and November 30, 2018.

January 2019

, the Company entered into an amendment to its Credit Agreement to extend the deadline to set covenants and to waive the financial covenant testing requirement for the period ended December

2018

to March 31,

2019

. Borrowings under the credit agreement are collateralized by a first priority lien on substantially all of the Company’s assets. The Credit Agreement contains certain financial and nonfinancial covenants, including minimum revenue and liquidity ratios.

The Company recognized interest expense under the Credit Agreement of $1,644 and $736 during the years ended December 31, 2018 and 2017, respectively, which includes interest expense related to the amortization of the asset to record deferred financing of $243 and $145 during the years ended December 31, 2018 and 2017, respectively. As of December 31, 2018 and 2017, the unamortized portion of the costs was $318 and $463, respectively, and recorded within other assets on the consolidated balance sheet. During the year ended December 31, 2018, the Company made no principal payments in connection with the Credit Agreement.

In connection with the term loan, the Company incurred costs of $

which are recorded as a reduction of the carrying value of the note payable on the Company’s consolidated balance sheet and were amortized to interest expense through October 2018.

The Company recognized interest expense on the term loan of $294 during the year ended December 31, 2018 which includes interest expense related to the amortization of the debt issuance costs of $80. As of December 31, 2018, the unamortized portion of the costs was $0. Accrued interest on the term loan totaled $0 as of December 31, 2018.

In December 2018, the Company fully repaid and cancelled the term loan including the outstanding principal and accrued and unpaid interest.

Notes Payable

The Company had unsecured notes payable to two institutional lenders. The notes were subordinate to all amounts outstanding under the line of credit. Interest was paid monthly at an amended rate per annum of 10% (8% from January to April 2016), plus an additional

% payment in-kind (“PIK”) interest was accrued monthly for the term of the debt. Monthly principal payments totaling $375 were scheduled to begin September 2015, subsequently amended to begin February 2016, with the principal and accrued interest payable in August 2017. The notes were subject to debt to equity covenants and certain non-financial covenants. The notes also included warrants to purchase shares of Class A common stock. The warrants were classified as equity and recorded at their relative fair value on the issue date and the carrying value of the debt was reduced by this amount. The notes were being accreted to their par value of $9,000 over the term of the notes on the effective interest method.

In April 2017, the Company repaid the remaining outstanding principal amount of $2,250 and accrued interest amount, including PIK interest amount of $2,512 under the note. The Company did not record any associated gain or loss with this note extinguishment because the carrying value of the note was equal to the outstanding amount. The warrants remain outstanding as of December 31, 2018 (see Note 18).

Master Lease Agreement

On April 28, 2017, the Company entered into a master lease agreement with Eastward Fund Management LLC that allows the Company to borrow up to $20,000 on or prior to June 30, 2018. The funding is made up of two tranches. The initial funding of $14,000 occurred on the date the agreement was signed. As the Company maintains all the risks and rewards of the leased assets it has been accounted for as a loan. The ML Agreement requires monthly payments of $122 for months 1 through 24 and $452 for months 25- through 60, however, in an event of default, as defined in ML Agreement, the additional interest rate on all unpaid amounts due will be 1.5% and the loan will become due upon written notice. Payments under the ML Agreement are payable on the first day of each month beginning on May 1, 2017 through April 1, 2022 (“the Maturity Date”) when all amounts of principal and interest become due. The ML Agreement also provides that the Company may voluntarily prepay the loan at any time; however, if the Company elects to prepay the loan or terminates the loan early within the first 24 months, the Company will pay an additional

% of the outstanding principal, and any accrued and unpaid interest and fees. This prepayment fee decreases to

% after the first 24 months. A final payment fee of

6.5

% multiplied by the principal amount of the borrowings under the ML Agreement is due upon the earlier to occur of the first day of the final payment term month or prepayment of all outstanding principal. The Company calculates interest using the effective interest method at an annual effective interest rate of 15%.

In connection with the ML Agreement, the Company paid fees of $308, which were recorded as a debt discount. The debt discount is reflected as a reduction of the carrying value of the loan payable on the Company’s consolidated balance sheet and is being amortized to interest expense over the term of the loan using the effective interest method.

The loan is secured by substantially all of the Company’s tangible and intangible assets. The agreement requires the Company to adhere to certain financial covenants.

In connection with the ML Agreement, the Company issued a warrant to purchase of 473,011 shares of Class A common stock at $2.53 per share as a pre-condition for the agreement. The warrants became exercisable on April 27, 2017 and were recorded at the relative fair value of $958. The warrants expire on the earlier to occur of ten years from the date of issuance or three years from the effective date of the Company’s initial public offering. The warrants were classified as equity and recorded at their relative fair value on the issue date and the carrying value of the debt was reduced by this amount as a debt discount. The debt discount is being amortized to interest expense using the effective interest method over the term of the loan. Prior to the closing of the Avista Merger on December 10, 2018, the warrant was deemed net exercised for 302,434 shares of the Company’s Class A common stock.

In December 2017, the Company received an additional $2,000 in funding under the ML Agreement. No additional amounts are currently available under the ML Agreement. This additional funding requires additional monthly payments of $18 for months 1 through 24 and $64 for months 25- through 60. Payments for this additional funding under the ML Agreement are payable on the first day of each month beginning on January 1, 2018 through December 1, 2022 when all amounts of principal and interest become due. A final payment fee of

16.5

% multiplied by the principal amount of the additional funding borrowings is due upon the earlier to occur of the first day of the final payment term month or prepayment of all outstanding principal. The Company calculates interest using the effective interest method at an annual effective interest rate of 13.5%.

In May 2018, the Company entered into a forbearance agreement with Eastward pursuant to which Eastward agreed to forbear from exercising any and all of the rights and remedies available to it under the ML Agreement to the extent such rights and remedies arise exclusively as a result of the events of default under Credit Agreement described above as well as the Company’s failure to deliver prompt notice of such events of default to Eastward.

Concurrently with the execution of the Agreement (see Note 1), the Company entered into a consent agreement with Eastward to, among other things, waive the existing events of default related to events of default under the Credit Agreement described above as well as the failure to deliver prompt notice of such events of default to Eastward.

The Company recognized interest expense under the ML Agreement of $2,236 and $1,309 during the years ended December 31, 2018 and 2017 respectively including interest expense related to the amortization of the debt discount of $317 and $187 during the years ended December 31, 2018 and 2017 respectively. As of December 31, 2018, the unamortized debt discount was $762. During the year ended December 31, 2018, the Company paid $10 in principal payments in connection with the ML Agreement. During the year ended December 31, 2017, the Company made no principal payments in the connection with the ML Agreement.

In March 2019, the Company prepaid the outstanding principal and accrued interest on the ML Agreement. (See Note 28).

Future payments of notes payable, as of December 31, 2018, are as follows:

2019	$	2,211
2020		4,646
2021		5,384
2022		3,644
Total	$	15,885

Capitalized Leases

12 Months Ended

Dec. 31, 2018

Leases, Capital [Abstract]

Capitalized Leases

16. Capitalized Leases

On January 1, 2013, the Company entered into a capital lease arrangement with 275 Dan Road SPE, LLC for the property located at 275 Dan Road in Canton, MA. 275 Dan Road SPE, LLC is a related party as the owners of the entity are also stockholders of the Company. The Company assessed the entity under the VIE rules in accordance with ASC 810 and concluded that it is not a variable interest entity since it has no debt and has sufficient equity. The lease has a ten-year term and escalating monthly rental payments ending in December 2022.

In January 2013, the Company entered into a new capital lease agreement with Dan Road Associates that requires escalating monthly rent payments of approximately $87 with future rent increases of 10% effective in each of January 2016, January 2019, and January 2022. The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.

In January 2013, the Company entered into a new capital lease agreement with 85 Dan Road Associates that requires escalating monthly rent payments of approximately $70 with future rent increases of 10% effective in each of January 2016, January 2019, and January 2022. The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.

In January 2013, the Company entered into a new capital lease agreement with 65 Dan Road Associates that requires escalating monthly rent payments of approximately $57 with future rent increases of 10% effective in each of January 2016, January 2019, and January 2022. The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.

On June 1, 2017, in connection with the deconsolidation of the Real Estate Entities, the Company’s financial statements no longer eliminated the impacts of the capital leases for Dan Road Associates, 85 Dan Road Associates and 65 Dan Road Associates. Accordingly, as of June 1, 2017, the Company recognized the capital lease agreements that the Company entered into with Dan Road Equity, Dan Road Associates and Dan Road SPE for the properties located at 150 Dan Road, Canton, Massachusetts and the office buildings in immediate proximity of the Company’s facility in Canton, Massachusetts. Dan Road Equity, Dan Road Associates and Dan Road SPE are related parties as the owners of the entities are also Stockholders’ of the Company. The lease agreements with Dan Road Equity I, 85 Dan Road Associates and 65 Dan Road SPE contain escalating monthly rental payments and terminate on December 31, 2022 with yearly renewals for a five-year period.

The Company records the capital lease asset within property and equipment and the liability is recorded within the capital lease obligations on the consolidated balance sheets.

The future lease payments are as follows:

2019	$	9,573
2020		4,308
2021		4,308
2022		4,737
		22,926
Less amount representing interest		(5,271	)
Present value of minimum lease payments		17,655
Less current maturities		(7,501	)
Long-term portion	$	10,154

The principal portion of rent in arrears on the capital leases is included in the current portion of capital lease obligations. The interest portion of rent in arrears for the Dan Road entities totaled

$4,174 and $3,950

as of December 31, 2018 and 2017, respectively and is included in accrued expenses on the consolidated balance sheets (See Note 13). In addition to rent, the Company is responsible for payment of all operating costs and common area maintenance under the aforementioned leases. The Company also pays for repairs and improvements.

Stockholders' Equity

12 Months Ended

Dec. 31, 2018

Equity [Abstract]

Stockholders' Equity

17. Stockholders’ Equity

As of December 31, 2018, the Company’s certificate of incorporation, as amended and restated, authorized the Company to issue 400,000,000 shares of $0.0001 par value Class A common stock; 20,000,000 shares of $0.0001 par value Class B common stock; and 1,000,000 shares of $0.0001 par value preferred stock.

On August 17, 2018, the Company issued 6,538,732 shares of Class A common stock for an aggregate purchase price of $46,000 pursuant to the Initial Avista Investment (see Note 1). The proceeds were offset by issuance costs of $270 which include legal and professional accounting fees directly associated with this equity investment.

On December 10, 2018, the Company issued 9,022,741 shares of ORGO Class A common stock and 4,100,000 warrants to purchase one-half of one share of ORGO Class A common stock for an aggregate purchase price of $46,000 pursuant to the Additional Avista Investment (see Note 1).

Additionally on December 10, 2018, the Company converted a portion of the affiliate debt into 6,502,679 shares of ORGO Class A common stock. In addition, 1,390,993 shares of ORGO Class B common stock were converted to the same number of shares of ORGO Class A common stock in connection with the closing of the Avista Merger. No ORGO Class B common stock is outstanding.

Each share of ORGO Class A common stock entitles the holder to one vote on all matters submitted to the stockholders for a vote. ORGO Class A common stockholders are entitled to receive dividends, as may be declared by the board of directors. Through December 31, 2018, no cash dividends have been declared or paid.

Redeemable Common Stock

share prior to the second anniversary of the acquisition. These shares had been classified as temporary equity and had been accreted to the full redemption amount of $9.28 per share as the holders have the right to exercise the put right on March 24, 2019. These shares have the same rights and preferences as common stock. During the year ended December 31, 2018 and 2017, the Company recorded $0 and $423 related to the accretion of these shares to their redemption amount, respectively. In December 2018, the Company received notification that the put option was being exercised. Accordingly, the Company reclassified the carrying value of the redeemable Class A common stock of $6,762 to a current liability as of December 31, 2018, which it expects to settle in March 2019.

As of December 31, 2018 and 2017, the Company had reserved 33,432,421 and 8,229,517 shares of Class A common stock, respectively, for the exercise of outstanding stock options under the Company’s 2003 and 2018 Stock Incentive Plans, shares remaining available for grant under the Company’s 2018 Stock Incentive Plan (see Note 19) and the exercise of outstanding warrants to purchase shares of common stock (see Note 18). As of the closing of the Avista Merger on December 10, 2018, no additional awards may be made under the Organogenesis Inc. 2003 Stock Incentive Plan.

Warrants

12 Months Ended

Dec. 31, 2018

Warrants and Rights Note Disclosure [Abstract]

Warrants

18. Warrants

As of each balance sheet date, outstanding warrants to purchase shares of Class A common stock consisted of the following:

December 31, 2018

Date Exercisable

Number of
Shares Issuable

Exercise
Price

Exercisable for

Classification

Expiration

November 3, 2010

109,620

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2013

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2015

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

December 10, 2018

2,050,000

11.50

Common Stock

Equity

December 10, 2023

December 10, 2018

15,500,000

11.50

Common Stock

Equity

December 10, 2023

17,732,700

December 31, 2017

Date Exercisable

Number of
Shares
Issuable

Exercise
Price

Exercisable for

Classification

Expiration

November 3, 2010

109,620

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2013

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2015

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

April 12, 2016

905,774

3.58

Common Stock

Liability

April 12, 2021

April 27, 2017

473,011

2.53

Common Stock

Equity

Earlier of 4/27/2027 or three years from the effective date of the Company’s filing of an initial underwritten and sale of securities registration statement

1,561,485

In connection with the notes payable issued in 2010, the Company issued warrants to two institutional lenders to purchase an aggregate 109,620 shares of Class A common stock at an exercise price of $3.95 per share. The warrants were classified as equity and were recorded at fair value on the date they were issued. The fair value of the warrants of $97 was recorded as additional paid-in-capital and a reduction in the carrying value of the related notes payable. Under the terms of the warrant agreement, the Company was required to issue additional warrants to the lenders if any portion of the notes were still outstanding on August 31, 2013 and August 31, 2015.

In August 2013, the Company issued additional warrants to the same lenders to purchase 36,540 shares of Class A common stock at an exercise price of $3.95 per share. The warrants were classified as equity and were recorded at fair value on the date they were issued. The fair value of the warrants of $9 was recorded as additional paid-in capital and interest expense.

In August 2015, the Company issued additional warrants to the same lenders to purchase 36,540 shares of Class A common stock at an exercise price of $3.95 per share. The warrants were classified as equity and were recorded at fair value on the date they were issued. The fair value of the warrants of $9 was recorded as additional paid-in capital and interest expense.

The fair value of the warrants was calculated on the dates of grant using the Black-Scholes option pricing model. For the warrants issued in August 2015, the Company assumed a risk-free interest rate of 1.74%, a dividend yield of 0%, an expected volatility of 43.49%, which was calculated based on the historical volatility of comparable peer companies, and a two-year expected life of the warrants.

In connection with the 2016 Loans, on April 12, 2016, the Company issued to the lenders warrants to purchase up to 905,774 shares of the Company’s Class A common stock at an exercise price of $3.58 per share. The warrants were immediately exercisable and had a five-year term, expiring on April 12, 2021. The warrants were classified as a liability and were recorded at fair value on the date of grant. The fair value of the warrants of $464 was recorded as a warrant liability and a reduction in the carrying value of the related loan. The fair value of the warrants was calculated on the date of grant using the binomial option pricing model. The Company assumed a risk-free interest rate of 1.22%, a dividend yield of 0%, and an expected volatility of 41.36%, which was calculated based on the historical volatility of publicly-traded peer companies, and the contractual term of five years. The warrants were net exercised immediately prior to the closing of the Avista Merger on December 10, 2018 and the Company issued 444,041 shares of Class A common stock. The Company remeasured the fair value of the warrants immediately prior to the exercise on December 10, 2018. The Company recognized a loss of $469 and $1,037 in the consolidated statements of operations for the years ended December 31, 2018 and 2017, respectively, related to the change in fair value of the warrants.

In connection with the ML Agreement, on April 28, 2017, the Company issued to the lenders warrants to purchase 473,011 shares of the Company’s Class A common stock at an exercise price of $2.53 per share as a pre-condition for the agreement. The warrants were immediately exercisable and expire on the earlier of April 27, 2027 or three years from the effective date of the Company’s filing of an initial underwritten and sale of securities registration statement. The warrants were classified as equity as it is exercisable into common stock only and, as such, would not require a transfer of assets and were recorded at fair value which was estimated to be $958 using a probability weighted Black Scholes option pricing model that was based on a 40% chance of an initial underwritten and sale of securities registration statement occurring within the next 18 months. Additionally, the model incorporated the following assumptions: 44.81%-57.51% volatility, 1.73%-2.35% risk-free rate, 4.25-10 year expected term, and no dividend yield. The issuance date fair value was recorded as a debt discount and is being amortized as interest expense. The warrants were net exercised immediately prior to the closing of the Avista Merger on December 10, 2018 and the Company issued 302,443 shares of Class A common stock.

In connection with the Additional Avista Investment on December 10, 2018, the Company issued 4,100,000 warrants to purchase one half of one share of Class A common stock at an exercise price of $11.50 per share. The warrants were classified as equity and were recorded as additional paid-in capital.

In connection with the Avista Merger on December 10, 2018, 31,000,000 public warrants to purchase one half of one share of Class A common stock at an exercise price of $11.50 per share remained outstanding from the former AHPAC Shareholders (See Note 3). The warrants were classified as equity and recorded to additional paid-in-capital.

Stock Options

12 Months Ended

Dec. 31, 2018

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock option

19. Stock Options

2018 Stock Incentive Plan

On November 28, 2018, the board of directors of the Company adopted, and on December 10, 2018 the Company’s stockholders approved, the Organogenesis Holdings Inc. 2018 Equity Incentive Plan (the “2018 Plan”). The purposes of the 2018 Plan are to (i) provide long-term incentives and rewards to those employees, officers, directors and other key persons (including consultants) of the Company and its subsidiaries who are in a position to contribute to the long-term success and growth of the Company and its subsidiaries, (ii) to assist the Company and its subsidiaries in attracting and retaining persons with the requisite experience and ability, and (iii) to more closely align the interests of such employees, officers, directors and other key persons with the interests of the Company’s stockholders.

The 2018 Plan authorizes the Company’s board of directors or a committee of not less than two independent directors (in either case, the “Administrator”) to grant the following types of awards: non-statutory stock options; incentive stock options; restricted stock awards; restricted stock units; stock appreciation rights; unrestricted stock awards; performance share awards; and dividend equivalent rights. As of December 31, 2018, the 2018 Plan is administered by the Company’s board of directors. Stock options awarded under the 2018 Plan expire 10 years after the grant date. Stock options granted to employees of the Company typically vest over four or five years.

As of December 31, 2018, a total of 9,198,996 shares of Class A common stock have been authorized to be issued under the 2018 Plan (subject to adjustment in the case of any stock dividend, stock split, reverse stock split, or similar change in capitalization of the Company). As of December 31, 2018, options to purchase 90,000 shares of Class A common stock were outstanding under the 2018 Plan. No other awards had been issued under the 2018 Plan.

In respect of any shares of Class A common stock under any award under the 2018 Plan which shares are forfeited, canceled, satisfied without the issuance of shares of Class A common stock, otherwise terminated, or, for shares of Class A common stock issued pursuant to any unvested full value award, reacquired by the Company at not more than the grantee’s purchase price (other than by exercise) (“Unissued Shares”), such Unissued Shares shall be added back to the pool of authorized shares under the 2018 Plan except that upon the exercise of any award to the extent that the Award is exercised through tendering (or attesting to) previously owned shares or through withholding shares that would otherwise be awarded and to the extent shares are withheld for tax withholding purposes, the pool of authorized shares shall be reduced by the gross number of shares of Class A common stock being exercised without giving effect to the number of shares tendered or withheld.

Subject to the requirements of law or any stock exchange or similar rules which would require a vote of the Company’s stockholders, the Administrator may, at any time, amend or discontinue the 2018 Plan and the Administrator may, at any time, amend or cancel any outstanding award for the purpose of satisfying changes in law or for any other lawful purpose, but no such action shall adversely affect rights under any outstanding award without the holder’s consent.

2003 Stock Incentive Plan

The Organogenesis Inc. 2003 Stock Incentive Plan, as amended (the “2003 Plan”), provides for the Company to issue restricted stock awards, or to grant incentive stock options or non-statutory stock options. Incentive stock options may be granted only to the Company’s employees. Restricted stock awards and non-statutory stock options may be granted to employees, members of the board of directors, outside advisors and consultants of the Company.

As of the closing of the Avista Merger on December 10, 2018, a total of 7,176,715 shares of Class

A common stock were issuable upon exercise of outstanding options under the 2003 Plan. Effective as of the closing of the Avista Merger on December 10, 2018, no additional awards may be made under the 2003 Plan and as a result (i) any shares in respect of stock options that are expired or terminated under the 2003 Plan without having been fully exercised will not be available for future awards; (ii) any shares in respect of restricted stock that are forfeited to, or otherwise repurchased by us, will not be available for future awards; and (iii)any shares of common stock that are tendered to the Company by a participant to exercise an award will not be available for future awards.

Following the closing of the Avista Merger, the 2003 Plan is administered by the Company’s board of directors. Stock options awarded under the 2003 Plan expire 10 years after the grant date. Stock options granted to employees of the Company typically vest over four or five years.

During the years ended December 31, 2018 and 2017, the Company granted options to purchase

248,567

shares and

895,194

shares, respectively, of Class A common stock to employees under the 2003 Plan and 2018 Plan. The Company recorded stock-based compensation expense for options granted to employees of $1,075, $919 and $473 within selling, general and administration expense in the consolidated statement of

operations during the years ended December 31, 2018, 2017 and 2016, respectively.

The Company has historically not granted stock options to non-employees.

Stock Option Valuation

The assumptions that the Company used to determine the grant-date fair value of stock options granted to employees and directors were as follows, presented on a weighted average basis:

	Year Ended December 31,
	2018			2017
Risk-free interest rate		2.73	%		2.05	%
Expected term (in years)		5.89			6.25
Expected volatility		42.0	%		45.7	%
Expected dividend yield		0.0	%		0.0	%
Exercise price	$	5.99		$	3.45
Fair value of common share	$	5.82		$	3.45

Stock Options

The following table summarizes the Company’s stock option activity since December 31, 2017 (in thousands, except share and per share amounts):

	Number of Shares			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value
Outstanding as of December 31, 2017		7,150,214		$	1.77		6.70		24,581
Granted		248,567			5.99
Cancelled / forfeited		(76,664	)		1.55
Exercised		(55,402	)		—
Outstanding as of December 31, 2018		7,266,715			1.91		6.50		33,976
Options exercisable as of December 31, 2018		5,396,880			1.53		5.21		27,280
Options vested or expected to vest as of December 31, 2018		6,948,699		$	1.82		5.76		33,096

The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the fair value of the Company’s Class A common stock for those stock options that had exercise prices lower than the fair value of the Company’s Class A common stock.

The weighted average grant-date fair value per share of stock options granted during the years ended December 31, 2018 and 2017 was $2.39 and $1.62, respectively.

The total fair value of options vested during the years ended December 31, 2018 and 2017 was $963 and $1,070, respectively.

As of December 31, 2018, the total unrecognized stock compensation expense was $1,733 and is expected to be recognized over a weighted-average period of 2.77 years.

At December 31, 2018, there was one partial recourse note outstanding totaling $635, which was secured with the 675,990 shares and options held by the executive (see Note 11). As a result of the loan still outstanding, the 675,990 options securing the loan are included within the options outstanding and recorded at par value with an offset to additional paid in capital.

Royalties

12 Months Ended

Dec. 31, 2018

Royalties [Abstract]

Royalties

20. Royalties

The Company licenses the use of trademarks and domain names for one of its advanced wound care products from a major pharmaceutical company. Beginning January 2012, the Company was obligated to pay the licensor a royalty based on a percentage of net sales of the product, in perpetuity. Royalty expense was $253, $292 and $287 for each of the years ended December 31, 2018, 2017 and 2016, respectively.

The Company entered into a license agreement with a university for certain patent rights related to the development, use and production of one of its advanced wound care products. Under this agreement, the Company incurred a royalty based on a percentage of net product sales, for the use of these patents until the patents expired, which was in November 2006. Accrued royalties totaled $1,187 as of December 31, 2018 and 2017, and are classified as part of accrued expenses on the Company’s

consolidated balance sheets. There was no royalty expense incurred during the years ended December 31, 2018 or 2017 related to this agreement.

In October 2017, the Company entered into a license agreement to resolve a patent infringement claim by a third party. Under the license agreement, the Company is required to pay royalties based on a percentage of net sales of the licensed product that occur, after December 31, 2016, through the expiration date of the underlying patent, subject to minimum royalty payment provisions. The Company recorded royalty expense of $2,059 and $3,122 during the years ended December 31, 2018 and 2017, respectively, within selling, general and administrative expenses on the consolidated statement of

operations. In July 2018, the Company made a payment of

$200

related to maintenance of the underlying patent. The Company is required to make one final payment of

$150 in April 2019, related to maintenance of the underlying patent.

As part of the NuTech Medical acquisition (see Note 5), the Company inherited certain product development and consulting agreements for ongoing consulting services and royalty payments based on a percentage of net sales on certain products over a period of 15 years from the execution of the agreements. During the years ended December 31, 2018 and 2017, the Company recognized royalty expense of $77 and $25 within selling, general and administrative expenses on the consolidated statement of operations.

Income Taxes

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Income Taxes

21. Income Taxes

On December 22, 2017, the U.S. enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act of 2017 (the “Tax Act”). The Tax Act made broad and complex changes to the U.S. tax code, including, but not limited to, reducing the federal corporate income tax rate to 21 percent, imposing a mandatory one-time transition tax on certain unrepatriated earnings of foreign subsidiaries and eliminating the corporate alternative minimum tax (“AMT”) and changing how existing AMT credits can be realized. The Company was required to recognize the tax effect of the tax law changes in the year of enactment. In order to calculate these effects, we were required to determine the transition tax amount, remeasure our United States deferred tax assets and liabilities, and consider the impact to our AMT credit carryforwards. For the year ended December 31, 2017, we recorded provisional amounts in accordance with that guidance where it was possible for us to make reasonable estimates of the effects of the Tax Act. We evaluated the decrease in our corporate tax rate and recorded a provisional, one-time expense of $19,761 at December 31, 2017. We fully offset out tax effect by a decrease in our valuation allowance, which resulted in no net tax effect in 2017. During the fourth quarter of 2018, we completed our accounting for all aspects of the Tax Act. We did not identify material changes from our 2017 provisional analysis.

The components of the income tax provision (benefit) consisted of the following for the years ended December 31, 2018, 2017 and 2016:

	Year Ended December 31,
	2018			2017			2016
(Benefit from) provision for income taxes:
Current tax expense
Federal	$	(212	)	$	—		$	—
State		101			214			65
Foreign		9			62			—
Total current tax expense (benefit)		(102	)	$	276			65
Deferred tax expense (benefit)
Federal		212			(6,401	)		—
State		—			(900	)		—
Foreign		(26	)		—			—
Total deferred tax expense (benefit)	$	186		$	(7,301	)	$	—
Total income tax expense (benefit)	$	84		$	(7,025	)	$	65

At December 31, 2018, the Company had available for the reduction of future years’ federal taxable income, net operating loss carry-forwards of approximately $165,256 expiring from the year ended December 31, 2019 through 2038, and state net operating loss carry-forwards of approximately $56,991 expiring from the year ended December 31, 2020 through 2038. At December 31, 2018, the Company had available for the reduction of future years’ federal taxable income, research and development credits of approximately $878 expiring between December 31, 2019 and December 31, 2038.

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2018 and 2017 are as follows:

	December 31,
	2018			2017
Net operating loss carryforwards
Federal	$	34,707		$	26,725
State		3,208			1,327
Foreign		26			—
Capitalized research and development		—			101
Other		12,219			8,706
Stock-based compensation		29			293
Fresh start and intangible assets acquired		(2,765	)		(3,757	)
Net deferred tax assets before valuation allowance		47,424			33,395
Valuation allowance		(47,186	)		(32,971	)
Net deferred tax assets	$	238		$	424

At December 31, 2018 and 2017, the Company recorded a valuation allowance of $47,186 and $32,971, respectively, on the deferred tax assets to reduce the total to an amount that management believes will ultimately be realized. In 2018, the valuation allowance

increased

by $14,215 primarily due to the federal and state net operating losses generated in 2018, which require a full valuation allowance. Realization of deferred tax assets is dependent upon sufficient future taxable income during the period that deductible temporary differences and carryforwards are expected to be available to reduce taxable income.

At December 31, 2018, the Company recorded a net deferred tax asset of $238 relating to relating to AMT credits which will be refundable under the Tax Act beginning with the 2018 tax return. This deferred tax asset will be realized, regardless of future taxable income, and thus no valuation allowance has been provided against this asset. At December 31, 2018, fifty percent (

%) of the AMT deferred tax asset was reclassified to prepaids

and

other current assets, which represents the amount of refundable AMT credit the Company will claim with the 2018 tax return.

The Company has not recorded withholding taxes on the undistributed earnings of its Swiss subsidiary because it is the Company’s intent to reinvest such earnings indefinitely.

Ownership changes, as defined in the Internal Revenue Code, may limit the amount of net operating losses and research and development tax credit carryforwards that can be utilized annually to offset future taxable income. Subsequent ownership changes could further affect the limitation in future years.

The differences between income taxes expected at the U.S. federal statutory income tax rate of 21 percent and the reported consolidated income tax benefit (expense) are summarized as follows:

	December 31,
	2018			2017			2016
U.S. federal statutory income tax rate		21.0	%		35.0	%		35.0	%
Tax reform act		—	%		(134.4	)%		—	%
State income taxes, net of federal benefit		(18.4	)%		147.5	%		(30.9	)%
Foreign rate differential		(3.9	)%		3.0	%		(3.6	)%
Research and development tax credits		3.5	%		2.3	%		2.5	%
Nondeductible expenses		(2.3	)%		(6.8	)%		(3.2	)%
Noncontrolling interest		—	%		2.2	%		—	%
Uncertain tax position reserves		(0.1	)%		(0.5	)%		(0.2	)%
Effective income tax rate		(0.2	)%		48.3	%		(0.4	)%

The Company recognizes the tax benefit from an uncertain tax position only if it is more-likely-than-not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. The tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The amount of unrecognized tax benefits is $3,722, $3,801 and $3,802 as of December 31, 2018, 2017 and 2016, respectively, which have been subject to a full valuation allowance. The net decrease primarily relates to the expiration of the statute of limitations for previously utilized Massachusetts R&D credits and accrued interest on uncertain state tax positions.

A tabular roll forward of the Company’s uncertainties in its income tax provision liability is presented below:

	Year Ended December 31,
	2018			2017			2016
Gross balance at beginning of year	$	3,486		$	3,663		$	3,417
Additions based on tax positions related to the current period		157			231			325
Reductions for tax positions of prior years		(357	)		(408	)		(79	)
Gross balance at end of year		3,286		$	3,486		$	3,663

The Company files income tax returns in the U.S. federal and state jurisdictions and Switzerland. With limited exceptions, the Company is no longer subject to federal, state, local or foreign examinations for years prior to December 31, 2013. However, carryforward attributes that were generated prior to December 31, 2014 may still be adjusted upon examination by state or local tax authorities if they either have been or will be used in a future period.

The Company recognizes interest and penalty related expense in tax expenses. There was $209 and $159 of interest recorded for uncertain tax positions for the years ended December 31, 2018 and 2017, respectively, which was classified in accrued expenses in the consolidated balance sheets. These amounts are not reflected in the reconciliation above.

Net Loss Per Share

12 Months Ended

Dec. 31, 2018

Earnings Per Share [Abstract]

Net Loss Per Share

22. Net Loss Per Share

Basic and diluted net loss per share attributable to Organogenesis Holdings Inc. was calculated as follows:


				Year Ended December 31,
	2018			2017			2016
Numerator:
Net loss	$	(64,831	)	$	(7,525	)	$	(14,766	)
Less: Net income attributable to non-controlling interests		—			863			2,221
Less: Accretion of redeemable common shares		—			423			—
Net loss attributable to Organogenesis Holdings Inc.	$	(64,831	)	$	(8,811	)	$	(16,987	)
Denominator:
Weighted average common shares outstanding — basic and diluted		69,318,456			63,876,767			63,196,067
Net loss per share — basic and diluted	$	(0.94	)	$	(0.14	)	$	(0.27	)

The Company’s potentially dilutive securities, which include stock options and warrants to purchase shares of Class A common stock, have been excluded from the computation of diluted net loss per share as the effect would be to reduce the net loss per share. Therefore, the weighted average number of common shares outstanding used to calculate both basic and diluted net loss per share attributable to common stockholders is the same.

The Company excluded the following potential shares of Class A of common stock, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to Organogenesis Holdings Inc. for the periods indicated because including them would have had an anti-dilutive effect:

	Year Ended December 31,
	2018		2017		2016
Options to purchase common stock		7,266,715		7,150,214		5,627,881
Redeemable common stock		728,549		728,549		—
Warrants to purchase common stock		17,732,700		1,561,485		1,088,474
		25,727,964		9,440,248		6,716,355

Product and Geographic Sales

12 Months Ended

Dec. 31, 2018

Segment Reporting [Abstract]

Product and Geographic Sales

23. Product and Geographic Sales

The following table sets forth revenue by product category:

	Year Ended December 31,
	2018		2017		2016
Advanced Wound Care revenue	$	164,332	$	178,896	$	138,732
Surgical and Sports Medicine revenue		29,117		19,612		—
Total revenue	$	193,449	$	198,508	$	138,732

For the years ended December 31, 2018, 2017 and 2016 revenue generated outside the US represented 1% of total revenue.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2018

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies Disclosure

24. Commitments and Contingencies

Operating Lease

During March 2014, in conjunction with the acquisition of Dermagraft from Shire plc, the Company entered into a rental sublease agreement for certain operating and office space in California. The original sublease agreements called for escalating monthly rental payments and was set to expire in January 2017. These sublease agreements were renegotiated in 2016 and subsequently extended through 2021. Rent expense is being recorded on a straight-line basis over the term of the lease. Rent expense associated with this lease agreement for the years ended December 31, 2018, 2017 and 2016 was $1,554, $1,764, and 2,451, respectively.

During November 2011, the Company entered into vehicle lease and fleet services agreements for the lease of vehicles and service on these vehicles for certain employees. The minimum lease term for each newly leased vehicle is one year with three consecutive one year renewal terms. Lease expense associated with the lease of the vehicles for the years ended December 31, 2018, 2017 and 2016 was $2,834, $2,276 and $1,735, respectively.

In conjunction with the acquisition of NuTech Medical in March 2017, the Company assumed the lease of the headquarters of NuTech Medical in Birmingham, Alabama. Under the lease, the Company is required to make monthly rental payments of $20 through December 31, 2018.

The Company has extended the lease through December 31, 2020 with a monthly rental payment of $21. Rental expense associated with this lease, for the years ended December 31, 2018 and 2017, was

$240 and $180, respectively.

Future minimum lease payments due under noncancelable operating lease agreements as of December 31, 2018 are as follows:

2019	$	4,530
2020		3,937
2021		3,209
2022		446
	$	12,122

Legal Matters

In conducting its activities, the Company, from time to time, is subject to various claims and also has claims against others. In management’s opinion, the ultimate resolution of such claims would not have a material effect on the financial position of the Company. The Company accrues for these claims when amounts due are probable and estimable.

The Company accrued $1,000 as of December 31, 2018 and 2017 in relation to certain pending lawsuits filed against the Company by former employees.

As discussed in Note 5, the purchase price for NuTech Medical included $7,500 of future payments issued as deferred acquisition consideration. As of December 31, 2018, the Company has paid $2,500 in deferred acquisition consideration. The amount, if any, of the remaining $5,000 of deferred acquisition consideration plus accrued interest owed to the sellers of NuTech Medical is currently in

dispute. As of December 31, 2018, the Company recorded $618 of accrued interest related to the deferred acquisition consideration which is recorded in accrued expenses and other current liabilities. The Company has asserted certain claims for indemnification that would offset in whole or in part its payment obligation and the sellers of NuTech Medical have filed a lawsuit alleging breach of contract and seeking specific performance of the alleged payment obligation and attorneys’ fees.

Related Parties

12 Months Ended

Dec. 31, 2018

Related Party Transactions

25. Related Parties

Capital lease obligations to affiliates are further described in Notes 13 and 16, respectively. Notes receivable from related parties are further described in Note 11.

On March 24, 2017, the Company purchased NuTech Medical from its sole shareholder for approximately $12,000 in cash, $7,500 in deferred acquisition consideration and 3,6427,46 shares of the Company’s Class A common stock issued to the sole shareholder (see Note 5). In connection with the acquisition of NuTech Medical, the Company entered into an operating lease with Oxmoor Holdings, LLC, an entity that is affiliated with the sole shareholder, related to the facility at NuTech Medical’s headquarters in Birmingham, Alabama. Under the lease, the Company is required to make monthly rent payments of approximately $20 through

December 31, 2018. The Company has extended the lease through December 31, 2020.

Employee Benefit Plan

12 Months Ended

Dec. 31, 2018

Retirement Benefits [Abstract]

Compensation and Employee Benefit Plans

26. Employee Benefit Plan

The Company maintains a 401(k) Savings Plan (the “Plan”) for all employees. Under the Plan, eligible employees may contribute, subject to statutory limitations, a percentage of their salary to the Plan. Contributions made by the Company are made at the discretion of the board of directors and vest immediately. During the years ended December 31, 2018 and 2017, the Company made employer contributions of $1,883 and $1,006, respectively.

As part of the NuTech Medical acquisition (see Note 5), the Company inherited the Savings Incentive Match Plan for Employees (“SIMPLE”) IRA plan for all eligible former NuTech Medical employees. The plan, which operates as a tax deferred employer-provided retirement plan, allows eligible employees to contribute part of their pre-tax compensation to the plan. Employers are required to make either matching contributions, or non-elective contributions, which are paid to eligible employees regardless of whether the employee made salary-reducing contributions to the plan. Plan participants may elect to make pre-tax contributions up to the maximum amount allowed by the Internal Revenue Service. The Company is required to make matching contributions up to

for all qualifying employees. The Company terminated the SIMPLE IRA plan as of January 1, 2018.

Selected Quarterly Financial Information (Unaudited)

12 Months Ended

Dec. 31, 2018

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Information

27. Selected Quarterly Financial Information (Unaudited)

Selected quarterly results of operations for the years ended December 31, 2018 and 2017 are as follows:

	Three Months Ended March 31, 2018			Three Months Ended June 30, 2018			Three Months Ended September 30, 2018			Three Months Ended December 31, 2018
Net revenue	$	35,529		$	43,552		$	50,769		$	63,599
Cost of goods sold		14,521			17,300			19,477			17,510
Gross profit		21,008			26,252			31,292			46,089
Operating expenses:
Selling, general and administrative		38,165			37,735			38,583			47,478
Research and development		2,824			2,048			2,779			3,091
Write-off of deferred offering costs		—			3,494			—			—
Total operating expenses		40,989			43,277			41,362			50,569
Loss from operations		(19,981	)		(17,025	)		(10,070	)		(4,480	)
Other income (expense), net:
Interest expense		(2,429	)		(2,801	)		(2,960	)		(2,663	)
Interest income		19			20			20			5
Change in fair value of warrants		(74	)		(175	)		(50	)		(170	)
Loss on the extinguishment of debt		—			—			—			(2,095	)
Other expense, net		5			(2	)		9			150
Total other income (expense), net		(2,479	)		(2,958	)		(2,981	)		(4,773	)
Net loss before income taxes		(22,460	)		(19,983	)		(13,051	)		(9,253	)
Income tax expense		(28	)		(27	)		(27	)		(2	)
Net loss		(22,488	)		(20,010	)		(13,078	)		(9,255	)
Net income attributable to non-controlling interest in affiliates		—			—			—			—
Net loss attributable to Organogenesis Holdings Inc.	$	(22,488	)	$	(20,010	)	$	(13,078	)	$	(9,255	)
Net loss per share attributable to Organogenesis Holdings Inc.—basic and diluted	$	(0.35	)	$	(0.30	)	$	(0.19	)	$	(0.12	)
Weighted average common shares outstanding—basic and diluted		64,320,931			66,361,998			69,496,279			76,952,174

	Three Months Ended March 31, 2017			Three Months Ended June 30, 2017			Three Months Ended September 30, 2017			Three Months Ended December 31, 2017
Net revenue	$	39,837		$	54,071		$	51,458		$	53,142
Cost of goods sold		13,305			15,406			16,087			16,422
Gross profit		26,532			38,665			35,371			36,720
Operating expenses:
Selling, general and administrative		27,952			33,716			35,662			36,387
Research and development		1,551			2,454			2,325			2,735
Total operating expenses		29,503			36,170			37,987			39,122
Loss from operations		(2,971	)		2,495			(2,616	)		(2,402	)
Other income (expense), net:
Interest expense		(1,592	)		(2,031	)		(2,233	)		(2,283	)
Interest income		38			35			28			28
Change in fair value of warrants		55			(505	)		(534	)		(53	)
Other expense, net		62			(119	)		(1	)		49
Total other income (expense), net		(1,437	)		(2,620	)		(2,740	)		(2,259	)
Net loss before income taxes		(4,408	)		(125	)		(5,356	)		(4,661	)
Income tax (expense) benefit		6,683			156			(47	)		233
Net income (loss)		2,275			31			(5,403	)		(4,428	)
Net income attributable to non-controlling interest in affiliates		590			273			—			—
Net income (loss) attributable to Organogenesis Holdings Inc.	$	1,685		$	(242	)	$	(5,403	)	$	(4,428	)
Net (loss) income per share attributable to Organogenesis Holdings Inc.—basic	$	0.02		$	(0.00	)	$	(0.08	)	$	(0.07	)
Net (loss) income per share attributable to Organogenesis Holdings Inc.—diluted	$	0.02		$	(0.00	)	$	(0.08	)	$	(0.07	)
Weighted average common shares outstanding—basic		63,311,814			64,022,549			64,040,527			64,121,501
Weighted average common shares outstanding—diluted		66,670,850			64,022,549			64,040,527			64,121,501

Subsequent Events

12 Months Ended

Dec. 31, 2018

Subsequent Events [Abstract]

Subsequent Events

28. Subsequent Events

The Company has evaluated subsequent events through March 18, 2019, the date on which these consolidated financial statements were issued.

Lease agreement

On March 13, 2019, the Company

entered into an agreement to lease approximately 43,850 square

feet of office and laboratory space in Norwood, Massachusetts. Pursuant to the lease agreement, the lease commenced on March 13, 2019. The rent commencement date will be February 1, 2020. The initial lease term is ten years from the rent commencement date and includes an early option for an early extension term of five years which is exercisable during the first two years after the rent commencement date.

In addition to the early extension term, the lease provides the Company with an option to extend the lease term for a period of ten years, in addition to the five year early extension term, if exercised, at rental rates equal to the then fair market value. Annual lease payments during the first year are $1,052 with increases of $44 each year during the initial ten year lease term with increase of $44 during the first year of the early extension term and $33 during years two though five of the early extension term.

Upon execution of the agreement, the Company delivered a security deposit in the form of a letter of credit of

$526 to the landlord. Following 36 months from the rent commencement date the security deposit may be reduced by $263.

New Credit Agreement

In March 2019, the Company and its subsidiaries, Organogenesis Inc. and Prime Merger Sub, LLC (collectively, and jointly and severally, “Borrower”), and Silicon Valley Bank, as Administrative Agent, Issuing Lender and Swingline Lender, and the several other lenders thereto (the “Lenders”) entered into a Credit Agreement (the “New Credit Agreement”) providing for a term loan (the “Term Loan Facility”) and a revolving credit facility (the “Revolving Facility”, and together with the Term Loan Facility, the “Debt Facility”) in an aggregate principal amount

of $100,000.

The Term Loan Facility is structured in three tranches, as follows: (i) the first tranche of $40,000 was made

available to Borrower and fully funded on March 14, 2019; (ii) the second tranche of

$10,000 shall be made available to Borrower until

September 30, 2019

upon: (a) the Lenders’ receipt of financial statements for the quarter ended June 30, 2019, (b) Borrower’s demonstrated compliance with the financial covenants in

the New Credit Agreement and (c) Borrower’s achievement of trailing twelve month revenue of at least

$221,250 and a trailing three month EBITDA

(as defined in the New Credit Agreement)

loss not in excess of $5,000; and (iii) the third tranche of $10,000 shall be made available to Borrower until March 31, 2020 upon the Lenders’ confirmation of Borrower’s compliance with the financial covenants in the Credit Agreement through December 31, 2019; provided, however, that if Borrower does not achieve the milestones required for the second tranche, the amount that may become available under the third tranche shall be increased from $10,000 to $20,000. The interest rate for term loan advances made under the Term Loan Facility is a per annum interest rate equal to 3.75% above the Wall Street Journal Prime Rate.

The New Credit Agreement requires Borrower to make monthly interest-only payments on outstanding balances under the Term Loan Facility through March 14, 2021. Thereafter, each term loan advance shall be repaid in thirty six equal monthly installments of principal, plus accrued interest, with the Term Loan Facility maturing on March 14, 2024 (the “Term Loan Maturity Date”).

Borrower’s final payment on the Term Loan Facility, due on the Term Loan Maturity Date, shall include all outstanding principal and accrued and unpaid interest under the Term Loan Facility, plus a final payment (the “Final Payment”) equal to the original aggregate principal amount of the Term Loan Facility multiplied by 6.25%. Borrower may prepay the Term Loan Facility, subject to paying the Prepayment Premium (described below) and the Final Payment. The Prepayment Premium is equal to 3.00% of the outstanding principal amount of the Term Loan Facility if the prepayment occurs on or prior to the one year anniversary of the closing, 2.00% of the outstanding principal amount of the Term Loan Facility if the prepayment occurs after such one year anniversary and prior to the second anniversary of the closing, and 1.00% of the outstanding principal amount of the Term Loan Facility if the prepayment occurs after the two year anniversary but prior to the three year anniversary of the closing, and 0% thereafter. Once repaid, amounts borrowed under the Term Loan Facility may not be re-borrowed.

The Revolving Facility is equal to the lesser of $40,000

and the amount determined by the Borrowing Base (as defined in the New Credit Agreement). The interest rate for advances under the Revolving Facility is a floating per annum interest rate equal to the

Wall Street Journal

Prime Rate. In the event that the aggregate amount of interest earned by the Lenders from the Revolving Facility in any given month is less than the interest that would have been earned if Borrower had average outstanding advances in an amount equal to

25%

of the then-available Revolving Commitments (as defined in the New Credit Agreement) then Borrower must pay the Agent Minimum Interest (as defined in the New CreditAgreement) in an amount equal to interest that would have accrued if average outstanding advances under the Revolving Facility had been 25% of the then-available Revolving Commitments less any interest actually earned by the Lenders. Borrower is also required to pay an unused line fee equal to

0.25%

per annum, calculated based on the difference of $40,000

minus

the greater of (i) the average balance outstanding under the Revolving Facility for such period and (ii) 25% of the then-available Revolving Commitments. The maturity date for advances made under the Revolving Facility is March 14, 2024.

Borrower may elect to reduce or terminate the Revolving Facility in its entirety at any time by repaying all outstanding principal, unpaid accrued interest and a reduction or termination fee equal to

4.00%

of the aggregate Revolving Commitments so reduced or terminated if the reduction or termination occurs on or prior to the one year anniversary of the closing,

3.00%

of the aggregate Revolving Commitments so reduced or terminated if the reduction or termination occurs after such one year anniversary and prior to the second anniversary of the closing, and

2.00%

of the aggregate Revolving Commitments so reduced or terminated if the reduction or termination occurs after the two year anniversary but prior to the three year anniversary of the closing, and

$0 thereafter.

The New Credit Agreement requires Borrower to pay an aggregate non-refundable facility fee of $

500

on March 14, 2019 and $

100

on each anniversary of the closing until March 14, 2023.

Under the New Credit Agreement, Borrower is required to achieve Minimum Trailing Twelve Month Consolidated Revenue (as defined in the New Credit Agreement), tested quarterly, at the following levels: $200,000 for the trailing twelve months ending March 31, 2019; $213,500 for the trailing twelve months ending June 30, 2019; $221,250 for the trailing twelve months ending September 30, 2019; and $231,500 for the trailing twelve months ending December 31, 2019, with minimum revenue covenant levels for 2020 to be agreed between the Lenders and the Borrower no later than February 15, 2020. In addition, Borrower is required to maintain Minimum Liquidity (as defined in the New Credit Agreement) equal to the greater of (i) 6 months Monthly Burn (as defined in the New Credit Agreement) and (ii) $10,000. Finally, on or prior to December 31, 2019, Borrower is obligated to enter into amended lease agreements with the owners of its facilities on Dan Road in Canton, Massachusetts providing for a lease term ending on a date that is later than March 14, 2024 and including arm’s length terms with respect to assignability, bankruptcy, early termination and other provisions as the Lenders deem reasonably necessary.

The New Credit Agreement requires Borrower to make representations and warranties and comply with covenants that are customary in loan agreements of this type, including restrictions on the payment of dividends, repurchase of stock, incurrence of indebtedness, dispositions and acquisitions. The New Credit Agreement also contains customary events of default, including non-payment of principal or interest, violations of covenants, bankruptcy, change of control, material adverse effect, cross defaults to other debt and material judgments. Borrower’s obligations to the Lenders are secured by substantially all of Borrower’s assets, including intellectual property.

In March 2019, in connection with entering into the New Credit Agreement, all amounts due under the Credit Agreement, including unpaid principal and accrued interest, and all amounts due under the ML Agreement, including unpaid principal, accrued interest and early termination penalty, were repaid with proceeds from the New Credit Agreement and the Credit Agreement and ML Agreement were terminated.

Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Use of Estimates

Principles of Consolidation

All intercompany balances and transactions have been eliminated in consolidation.

Consolidated Variable Interest Entities

Segment Reporting

Cash and Cash Equivalents

Restricted Cash

The Company had restricted cash of $114 and $49 as of December 31, 2018 and 2017, respectively. Restricted cash represents employee deposits in connection with the Company’s health benefit plan.

Accounts Receivable

Inventories

Property and Equipment, Net


Leasehold improvements		Lesser of the life of the lease or the economic life of the asset
Furniture and computers		3 - 5 years
Equipment		5 - 10 years

Goodwill

The Company compares the fair value of the reporting unit to its carrying value. If the fair value of the reporting unit exceeds the carrying value of the net assets, goodwill is not impaired.

If the fair value of the reporting unit is less than the carrying value, the difference is recorded as an impairment loss up to the amount of goodwill.

There was no impairment of goodwill identified during the years ended December 31, 2018, 2017 or 2016.

Intangible Assets Subject to Amortization


Trade names and trademarks		10-12 years
Developed technology		10-12 years
Independent sales agency network		3 years
Non-compete agreements		5 years

Impairment of Long-Lived Assets

Deferred Offering Costs

from the Initial Avista Investment equity financing transaction.

Warrant Liability

Revenue Recognition

Shipping and Handling

The Company records amounts incurred related to shipping and handling costs as a cost of goods sold.

Product Warranties

Stock-Based Compensation

Advertising

Research and Development Costs

Interest Income

Foreign Currency

Income Taxes

Fair Value of Financial Instruments

•

Level 1—Quoted prices in active markets for identical assets or liabilities.

•

Net Loss per Share

Medical Device Excise Tax

Emerging Growth Company

companies.

Reclassification of Prior Period Balances

Recently Adopted Accounting Pronouncements

In May 2017, the FASB issued ASU No. 2017-09,

Compensation—Stock Compensation (Topic 718): Scope of Modification Accounting

periods within those fiscal years. Early adoption is permitted. The adoption of this standard in 2018 did not have a material impact on the consolidated financial statements.

In March 2016, the FASB issued ASU No. 2016 09,

Improvements to Employee Share Based Payment Accounting

In October 2016, the FASB issued ASU No. 2016-16,

Income Taxes (Topic 740): Intra-Entity Transfer of Assets Other than Inventory

The adoption of this standard in 2018 did not have a material impact on the consolidated financial statements.

In August 2016, the FASB issued ASU No. 2016-15,

Classification of Certain Cash Receipts and Cash Payments

The adoption of this standard in 2018 did not have a material impact on the consolidated financial statements.

Recently Issued Accounting Pronouncements

In August 2018, the FASB issued ASU No. 2018-13,

Fair Value Measurement (Topic 820), Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement (“ASU 2018-13”)

In February 2016, the FASB issued ASU 2016 02,

Leases (Topic 842)

In May 2014, the FASB issued ASU 2014-09,

Revenue from Contracts with Customers (Topic 606)

Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2018

Accounting Policies [Abstract]

Summary of Estimated Useful Lives of Property Plant and Equipment

Property and equipment estimated useful lives are as follows:


Leasehold improvements		Lesser of the life of the lease or the economic life of the asset
Furniture and computers		3 - 5 years
Equipment		5 - 10 years

Schedule of Finite-Lived Intangible Assets

Amortization of intangible assets subject to amortization is calculated on the straight-line method based on the following estimated useful lives:


Trade names and trademarks		10-12 years
Developed technology		10-12 years
Independent sales agency network		3 years
Non-compete agreements		5 years

Real Estate Entities (Tables)

12 Months Ended

Dec. 31, 2018

Real Estate [Abstract]

Schedule of Variable Interest Entities

The following table shows the VIE deconsolidation as of June 1, 2017:

June 1, 2017	Dan Road Associates			85 Dan Road Associates			65 Dan Road Associates			Total
Cash	$	247		$	51		$	368		$	666
Due from affiliates		2,018			6,414			4,448			12,880
Prepaid expenses and other current assets		126			—			—			126
Total current assets		2,391			6,465			4,816			13,672
Property and equipment		3,149			3,982			2,801			9,932
Total assets	$	5,540		$	10,447		$	7,617		$	23,604
Accrued expenses and other current liabilities	$	(8	)	$	(52	)	$	(43	)	$	(103	)
Notes payable, net of current portion		(7,029	)		(6,389	)		(5,186	)		(18,604	)
Other liabilities		(232	)		—			—			(232	)
Total liabilities		(7,269	)		(6,441	)		(5,229	)		(18,939	)
Net assets		(1,729	)		4,006			2,388			4,665
Accumulated deficit		3,297			—			—			3,297
Non-controlling interest in affiliates		1,568			4,006			2,388			7,962
Consideration transferred		—			—			—			—
Gain (loss) on deconsolidation	$	—		$	—		$	—		$	—

Tabular disclosure of the significant judgments and assumptions made in determining whether a variable interest (as defined) held by the entity requires the variable interest entity (VIE) (as defined) to be consolidated and (or) disclose information about its involvement with the VIE, individually or in aggregate (as applicable); the nature of restrictions, if any, on the consolidated VIE's assets and on the settlement of its liabilities reported by an entity in its statement of financial position, including the carrying amounts of such assets and liabilities; the nature of, and changes in, the risks associated with involvement in the VIE; how involvement with the VIE affects the entity's financial position, financial performance, and cash flows; the lack of recourse if creditors (or beneficial interest holders) of the consolidated VIE have no recourse to the general credit of the primary beneficiary (if applicable); the terms of arrangements, giving consideration to both explicit arrangements and implicit variable interests, if any, that could require the entity to provide financial support to the VIE, including events or circumstances that could expose the entity to a loss; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; the significant factors considered and judgments made in determining that the power to direct the activities of a VIE that most significantly impact the VIE's economic performance are shared (as defined); the carrying amounts and classification of assets and liabilities of the VIE included in the statement of financial position; the entity's maximum exposure to loss, if any, as a result of its involvement with the VIE, including how the maximum exposure is determined and significant sources of the entity's exposure to the VIE; a comparison of the carrying amounts of the assets and liabilities and the entity's maximum exposure to loss; information about any liquidity arrangements, guarantees, and (or) other commitments by third parties that may affect the fair value or risk of the entity's variable interest in the VIE; whether or not the entity has provided financial support or other support (explicitly or implicitly) to the VIE that it was not previously contractually required to provide or whether the entity intends to provide that support, including the type and amount of the support and the primary reasons for providing the support; and supplemental information the entity determines necessary to provide.

Schedule of fair values of the assets acquired and liabilities assumed

Acquisition of NuTech Medical (Tables)

12 Months Ended

Dec. 31, 2018

Business Combinations [Abstract]

The following table summarizes the estimated fair value of the consideration transferred, fair values of the assets acquired and liabilities assumed by the Company, and the resulting goodwill:

Consideration
Cash	$	12,000
Common stock		2,515
Redeemable common stock		6,339
Restricted common stock		7,548
Stock options		207
Defered acquistion consideration		8,000
Working capital adjustment		(500	)
Contingent consideration forfeiture rights		(377	)
Total consideration		35,732
Common stock transferred		(16,402	)
Deferred acquisition consideration		(7,500	)
Common stock options issued		(207	)
Contingent consideration forfeiture rights		377
Cash received		(210	)
	$	11,790
Allocated as follows:
Cash	$	210
Accounts receivable		3,131
Inventory		2,730
Other current assets		51
Property and equipment		284
Goodwill		19,446
Identifiable intangible assets		20,410
Total assets acquired		46,262
Accounts payable		2,850
Accrued expenses and other current liabilities		803
Deferred tax liability		6,877
Total liabilities assumed		10,530
Net assets acquired	$	35,732

Schedule of unaudited pro forma statements of operations

This pro forma information does not purport to represent what the Company’s actual results would have been if the acquisitions had occurred as of the date indicated or what such results would be for any future periods.

	For the Year Ended
	December 31,
	2017
Net revenue	$	204,177
Net income	$	(9,183	)

Fair Value Measurement of Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2018

Fair Value Disclosures [Abstract]

Fair Value, by Balance Sheet Grouping

	Fair Value Measurements as of December 31, 2018 Using:
	Level 1		Level 2		Level 3		Total
Liabilities:
Redeemable common stock liability	$	—	$	—	$	6,762	$	6,762
Contingent purchase earn-out liability		—		—		—		—
	$	—	$	—	$	6,762	$	6,762

	Fair Value Measurements as of December 31, 2017 Using:
	Level 1		Level 2		Level 3		Total
Assets:
Contingent consideration forfeiture rights	$	—	$	—	$	589	$	589
	$	—	$	—	$	589	$	589
Liabilities:
Warrant liability	$	—	$	—	$	2,238	$	2,238
Contingent purchase earn-out liability		—		—		—		—
	$	—	$	—	$	2,238	$	2,238

Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation

									Contingent
	Contingent							Redeemable	Purchase
	Consideration			Warrant				Common Stock	Earn-Out
	Forfeiture Rights			Liability				Liability	Liability
Balance as of December 31, 2016		—			(1,201	)		—		—
Initial fair value of contingent consideration forfeiture rights		377			—			—		—
Change in fair value		212			(1,037	)		—		—
Balance as of December 31, 2017		589			(2,238	)		—		—
Change in fair value		(589	)		(469	)		—		—
Issuance of common stock for the exercise of warrant					2,707
Reclassification of redeemable common stock					—			6,762
Balance as of December 31, 2018	$	—		$	—		$	6,762	$	—

Accounts receivable, net (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of accounts receivable

Accounts receivable consisted of the following:

	December 31,
	2018			2017
Accounts receivable	$	37,497		$	31,349
Less — allowance for sales returns and doubtful accounts		(3,420	)		(3,225	)
	$	34,077		$	28,124

Schedule of allowance for sales returns and doubtful accounts

The Company’s allowance for sales returns and doubtful accounts was comprised of the following:

Balance as of December 31, 2016	$	2,109
Additions		1,166
Write-offs		(50	)
Balance as of December 31, 2017		3,225
Additions		1,157
Write-offs		(962	)
Balance as of December 31, 2018	$	3,420

Inventories (Tables)

12 Months Ended

Dec. 31, 2018

Inventory Disclosure [Abstract]

Schedule of Inventory, Current

Inventories, net of related reserves for excess and obsolescence, consisted of the following:

	December 31,
	2018		2017
Raw materials	$	4,711	$	6,537
Work in process		1,759		991
Finished goods		6,851		6,742
	$	13,321	$	14,270

Prepaid Expenses and Other Current Assets (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of prepaid expenses and other current assets

Prepaid expenses and other current assets consisted of the following:

	December 31,
	2018		2017
Deferred offering costs	$	—	$	2,724
Prepaid rent		—		29
Prepaid subscriptions		594		584
Prepaid inventory testing		116		36
Prepaid conferences and marketing expenses		392		588
Prepaid insurance		223		196
Prepaid deposits		764		—
Other		239		242
	$	2,328	$	4,399

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2018

Property, Plant and Equipment [Abstract]

Property, Plant and Equipment

Property and equipment consisted of the following:

	December 31,
	2018			2017
Leasehold improvements	$	34,345		$	35,143
Furniture, computers and equipment		44,752			43,375
		79,097			78,518
Accumulated depreciation and amortization		(62,435	)		(59,212	)
Construction in progress		22,961			22,806
	$	39,623		$	42,112

Notes Receivable - Related Parties (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of Related Party Transactions

As of December 31, 2018 and 2017, notes receivable from related parties consisted of the following:

Balance as of December 31, 2016	$	415
Accrued interest		111
Impairment		(113	)
Balance as of December 31, 2017		413
Accrued interest		64
Balance as of December 31, 2018	$	477

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Finite-Lived Intangible Assets

Identifiable intangible assets consisted of the following as of December 31, 2018:

	Original Cost		Accumulated Amortizatio n			Net Book Value
Developed technology	$	29,820	$	(8,454	)	$	21,366
Trade names and trademarks		2,000		(413	)		1,587
Independent sales agency network		4,500		(1,569	)		2,931
Non-compete agreements		260		(53	)		207
Total	$	36,580	$	(10,489	)	$	26,091

Identifiable intangible assets consisted of the following as of December 31, 2017:

	Original Cost		Accumulated Amortization			Net Book Value
Developed technology	$	29,820	$	(6,389	)	$	23,431
Trade names and trademarks		2,000		(238	)		1,762
Independent sales agency network		4,500		(181	)		4,319
Non-compete agreements		260		(13	)		247
Total	$	36,580	$	(6,821	)	$	29,759

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense

2019		5,993
2020		3,192
2021		3,257
2022		3,247
2023		3,283
Thereafter		7,119
Total	$	26,091

Accrued Expenses and Other Current Liabilities (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of Accounts Payable and Accrued Liabilities

Accrued expenses and other current liabilities consisted of the following:

	December 31,
	2018		2017
Accrued compensation	$	15,218	$	11,826
Accrued professional fees		309		539
Accrued interest - capital lease obligations		4,174		3,950
Accrued litigation		1,000		1,000
Accrued royalties		2,463		3,610
Accrued interest - deferred acquisition consideration		618		318
Other		1,633		1,308
	$	25,415	$	22,551

Long-Term Debt - Affiliates (Tables)

12 Months Ended

Dec. 31, 2018

Debt Disclosure [Abstract]

Long-term debt payable

Long-term debt payable to affiliates consisted of the following:

	December 31,
	2018		2017
2010 Loans	$	—	$	19,850
2015 Loans		—		11,396
2016 Loans		—		17,000
Accrued interest		—		9,241
		—		57,487
Less debt discount		—		(5,345	)
	$	—	$	52,142

Due to affiliates

Due to affiliates consisted of the following:

	December 31,
	2018		2017
65 Dan Road SPE, LLC	$	—	$	200
85 Dan Road Associates		—		3,900
275 Dan Road SPE, LLC		—		400
	$	—	$	4,500

Schedule of line of credit facilities

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02.22)
-URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 1A
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28541-108399

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 6
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21506-112644

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08.(e),(f))
-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28551-108399

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21521-112644

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
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-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21538-112644

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=75038535&loc=d3e64711-112823

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 55
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=114775985&loc=d3e28878-108400

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21475-112644

+ Details

Line of Credit and Notes Payable (Tables)

12 Months Ended

Dec. 31, 2018

Line of Credit Facility [Abstract]

Line of credit and notes payable consisted of the following:

	December 31,
	2018			2017
Line of credit	$	26,484		$	17,618
Notes payable	$	15,885		$	15,895
Less debt discount		(762	)		(1,079	)
Less current maturities		(2,545	)		—
Notes payable, net of debt discount	$	12,578		$	14,816

Schedule of accounts, notes, loans and financing receivable

Future payments of notes payable, as of December 31, 2018, are as follows:

2019	$	2,211
2020		4,646
2021		5,384
2022		3,644
Total	$	15,885

Capitalized Leases (Tables)

12 Months Ended

Dec. 31, 2018

Leases, Capital [Abstract]

Future Lease Payments

The future lease payments are as follows:

2019	$	9,573
2020		4,308
2021		4,308
2022		4,737
		22,926
Less amount representing interest		(5,271	)
Present value of minimum lease payments		17,655
Less current maturities		(7,501	)
Long-term portion	$	10,154

Warrants (Tables)

12 Months Ended

Dec. 31, 2018

Warrants and Rights Note Disclosure [Abstract]

Schedule of Outstanding Warrants to Purchase Common Stock

As of each balance sheet date, outstanding warrants to purchase shares of Class A common stock consisted of the following:

December 31, 2018

Date Exercisable

Number of
Shares Issuable

Exercise
Price

Exercisable for

Classification

Expiration

November 3, 2010

109,620

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2013

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2015

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

December 10, 2018

2,050,000

11.50

Common Stock

Equity

December 10, 2023

December 10, 2018

15,500,000

11.50

Common Stock

Equity

December 10, 2023

17,732,700

December 31, 2017

Date Exercisable

Number of
Shares
Issuable

Exercise
Price

Exercisable for

Classification

Expiration

November 3, 2010

109,620

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2013

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

August 31, 2015

36,540

3.95

Common Stock

Equity

Later of 8/31/2019 or upon repayment of the notes payable

April 12, 2016

905,774

3.58

Common Stock

Liability

April 12, 2021

April 27, 2017

473,011

2.53

Common Stock

Equity

Earlier of 4/27/2027 or three years from the effective date of the Company’s filing of an initial underwritten and sale of securities registration statement

1,561,485

Tabular disclosure of warrants or rights issued. Warrants and rights outstanding are derivative securities that give the holder the right to purchase securities (usually equity) from the issuer at a specific price within a certain time frame. Warrants are often included in a new debt issue to entice investors by a higher return potential. The main difference between warrants and call options is that warrants are issued and guaranteed by the company, whereas options are exchange instruments and are not issued by the company. Also, the lifetime of a warrant is often measured in years, while the lifetime of a typical option is measured in months. Disclose the title of issue of securities called for by warrants and rights outstanding, the aggregate amount of securities called for by warrants and rights outstanding, the date from which the warrants or rights are exercisable, and the price at which the warrant or right is exercisable.

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock Options (Tables)

12 Months Ended

Dec. 31, 2018

Schedule of Fair Value of Stock Options Granted to Employees and Directors

The assumptions that the Company used to determine the grant-date fair value of stock options granted to employees and directors were as follows, presented on a weighted average basis:

	Year Ended December 31,
	2018			2017
Risk-free interest rate		2.73	%		2.05	%
Expected term (in years)		5.89			6.25
Expected volatility		42.0	%		45.7	%
Expected dividend yield		0.0	%		0.0	%
Exercise price	$	5.99		$	3.45
Fair value of common share	$	5.82		$	3.45

Summary of Stock Option Activity

The following table summarizes the Company’s stock option activity since December 31, 2017 (in thousands, except share and per share amounts):

	Number of Shares			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value
Outstanding as of December 31, 2017		7,150,214		$	1.77		6.70		24,581
Granted		248,567			5.99
Cancelled / forfeited		(76,664	)		1.55
Exercised		(55,402	)		—
Outstanding as of December 31, 2018		7,266,715			1.91		6.50		33,976
Options exercisable as of December 31, 2018		5,396,880			1.53		5.21		27,280
Options vested or expected to vest as of December 31, 2018		6,948,699		$	1.82		5.76		33,096

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2018

Income Tax Disclosure [Abstract]

Schedule of Components of Income Tax Expense (Benefit)

The components of the income tax provision (benefit) consisted of the following for the years ended December 31, 2018, 2017 and 2016:

	Year Ended December 31,
	2018			2017			2016
(Benefit from) provision for income taxes:
Current tax expense
Federal	$	(212	)	$	—		$	—
State		101			214			65
Foreign		9			62			—
Total current tax expense (benefit)		(102	)	$	276			65
Deferred tax expense (benefit)
Federal		212			(6,401	)		—
State		—			(900	)		—
Foreign		(26	)		—			—
Total deferred tax expense (benefit)	$	186		$	(7,301	)	$	—
Total income tax expense (benefit)	$	84		$	(7,025	)	$	65

Component of Company's Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2018 and 2017 are as follows:

	December 31,
	2018			2017
Net operating loss carryforwards
Federal	$	34,707		$	26,725
State		3,208			1,327
Foreign		26			—
Capitalized research and development		—			101
Other		12,219			8,706
Stock-based compensation		29			293
Fresh start and intangible assets acquired		(2,765	)		(3,757	)
Net deferred tax assets before valuation allowance		47,424			33,395
Valuation allowance		(47,186	)		(32,971	)
Net deferred tax assets	$	238		$	424

Schedule of Effective Income Tax Rate Reconciliation

The differences between income taxes expected at the U.S. federal statutory income tax rate of 21 percent and the reported consolidated income tax benefit (expense) are summarized as follows:

	December 31,
	2018			2017			2016
U.S. federal statutory income tax rate		21.0	%		35.0	%		35.0	%
Tax reform act		—	%		(134.4	)%		—	%
State income taxes, net of federal benefit		(18.4	)%		147.5	%		(30.9	)%
Foreign rate differential		(3.9	)%		3.0	%		(3.6	)%
Research and development tax credits		3.5	%		2.3	%		2.5	%
Nondeductible expenses		(2.3	)%		(6.8	)%		(3.2	)%
Noncontrolling interest		—	%		2.2	%		—	%
Uncertain tax position reserves		(0.1	)%		(0.5	)%		(0.2	)%
Effective income tax rate		(0.2	)%		48.3	%		(0.4	)%

Schedule of Unrecognized Tax Benefits Roll Forward

A tabular roll forward of the Company’s uncertainties in its income tax provision liability is presented below:

	Year Ended December 31,
	2018			2017			2016
Gross balance at beginning of year	$	3,486		$	3,663		$	3,417
Additions based on tax positions related to the current period		157			231			325
Reductions for tax positions of prior years		(357	)		(408	)		(79	)
Gross balance at end of year		3,286		$	3,486		$	3,663

Net Loss Per Share (Tables)

12 Months Ended

Dec. 31, 2018

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic and Diluted

Basic and diluted net loss per share attributable to Organogenesis Holdings Inc. was calculated as follows:


				Year Ended December 31,
	2018			2017			2016
Numerator:
Net loss	$	(64,831	)	$	(7,525	)	$	(14,766	)
Less: Net income attributable to non-controlling interests		—			863			2,221
Less: Accretion of redeemable common shares		—			423			—
Net loss attributable to Organogenesis Holdings Inc.	$	(64,831	)	$	(8,811	)	$	(16,987	)
Denominator:
Weighted average common shares outstanding — basic and diluted		69,318,456			63,876,767			63,196,067
Net loss per share — basic and diluted	$	(0.94	)	$	(0.14	)	$	(0.27	)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share

	Year Ended December 31,
	2018		2017		2016
Options to purchase common stock		7,266,715		7,150,214		5,627,881
Redeemable common stock		728,549		728,549		—
Warrants to purchase common stock		17,732,700		1,561,485		1,088,474
		25,727,964		9,440,248		6,716,355

Product and Geographic Sales (Tables)

12 Months Ended

Dec. 31, 2018

Segment Reporting [Abstract]

Schedule of Revenue by Product Category

The following table sets forth revenue by product category:

	Year Ended December 31,
	2018		2017		2016
Advanced Wound Care revenue	$	164,332	$	178,896	$	138,732
Surgical and Sports Medicine revenue		29,117		19,612		—
Total revenue	$	193,449	$	198,508	$	138,732

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2018

Commitments and Contingencies Disclosure [Abstract]

Schedule Of Operating Leased Assets

Future minimum lease payments due under noncancelable operating lease agreements as of December 31, 2018 are as follows:

2019	$	4,530
2020		3,937
2021		3,209
2022		446
	$	12,122

Quarterly Financial Information (unaudited) (Tables)

12 Months Ended

Dec. 31, 2018

Quarterly Financial Data [Abstract]

Quarterly Financial Information [Table Text Block]

Selected quarterly results of operations for the years ended December 31, 2018 and 2017 are as follows:

	Three Months Ended March 31, 2018			Three Months Ended June 30, 2018			Three Months Ended September 30, 2018			Three Months Ended December 31, 2018
Net revenue	$	35,529		$	43,552		$	50,769		$	63,599
Cost of goods sold		14,521			17,300			19,477			17,510
Gross profit		21,008			26,252			31,292			46,089
Operating expenses:
Selling, general and administrative		38,165			37,735			38,583			47,478
Research and development		2,824			2,048			2,779			3,091
Write-off of deferred offering costs		—			3,494			—			—
Total operating expenses		40,989			43,277			41,362			50,569
Loss from operations		(19,981	)		(17,025	)		(10,070	)		(4,480	)
Other income (expense), net:
Interest expense		(2,429	)		(2,801	)		(2,960	)		(2,663	)
Interest income		19			20			20			5
Change in fair value of warrants		(74	)		(175	)		(50	)		(170	)
Loss on the extinguishment of debt		—			—			—			(2,095	)
Other expense, net		5			(2	)		9			150
Total other income (expense), net		(2,479	)		(2,958	)		(2,981	)		(4,773	)
Net loss before income taxes		(22,460	)		(19,983	)		(13,051	)		(9,253	)
Income tax expense		(28	)		(27	)		(27	)		(2	)
Net loss		(22,488	)		(20,010	)		(13,078	)		(9,255	)
Net income attributable to non-controlling interest in affiliates		—			—			—			—
Net loss attributable to Organogenesis Holdings Inc.	$	(22,488	)	$	(20,010	)	$	(13,078	)	$	(9,255	)
Net loss per share attributable to Organogenesis Holdings Inc.—basic and diluted	$	(0.35	)	$	(0.30	)	$	(0.19	)	$	(0.12	)
Weighted average common shares outstanding—basic and diluted		64,320,931			66,361,998			69,496,279			76,952,174

	Three Months Ended March 31, 2017			Three Months Ended June 30, 2017			Three Months Ended September 30, 2017			Three Months Ended December 31, 2017
Net revenue	$	39,837		$	54,071		$	51,458		$	53,142
Cost of goods sold		13,305			15,406			16,087			16,422
Gross profit		26,532			38,665			35,371			36,720
Operating expenses:
Selling, general and administrative		27,952			33,716			35,662			36,387
Research and development		1,551			2,454			2,325			2,735
Total operating expenses		29,503			36,170			37,987			39,122
Loss from operations		(2,971	)		2,495			(2,616	)		(2,402	)
Other income (expense), net:
Interest expense		(1,592	)		(2,031	)		(2,233	)		(2,283	)
Interest income		38			35			28			28
Change in fair value of warrants		55			(505	)		(534	)		(53	)
Other expense, net		62			(119	)		(1	)		49
Total other income (expense), net		(1,437	)		(2,620	)		(2,740	)		(2,259	)
Net loss before income taxes		(4,408	)		(125	)		(5,356	)		(4,661	)
Income tax (expense) benefit		6,683			156			(47	)		233
Net income (loss)		2,275			31			(5,403	)		(4,428	)
Net income attributable to non-controlling interest in affiliates		590			273			—			—
Net income (loss) attributable to Organogenesis Holdings Inc.	$	1,685		$	(242	)	$	(5,403	)	$	(4,428	)
Net (loss) income per share attributable to Organogenesis Holdings Inc.—basic	$	0.02		$	(0.00	)	$	(0.08	)	$	(0.07	)
Net (loss) income per share attributable to Organogenesis Holdings Inc.—diluted	$	0.02		$	(0.00	)	$	(0.08	)	$	(0.07	)
Weighted average common shares outstanding—basic		63,311,814			64,022,549			64,040,527			64,121,501
Weighted average common shares outstanding—diluted		66,670,850			64,022,549			64,040,527			64,121,501

Nature of Business - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands		1 Months Ended		3 Months Ended								12 Months Ended
	Aug. 17, 2018	Mar. 31, 2017	Mar. 24, 2017	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Organization and Financing
Commoon stock par value				$ 0.0001				$ 0.0001				$ 0.0001	$ 0.0001
Business acquisition consideration deferred				$ 5,000				$ 5,000				$ 5,000	$ 5,000
Net loss				(9,255)	$ (13,078)	$ (20,010)	$ (22,488)	(4,428)	$ (5,403)	$ 31	$ 2,275	(64,831)	(8,388)	$ (16,987)
Working capital				4,743								4,743
Cash				21,291				2,309				21,291	2,309
Accumulated deficit				(130,240)				$ (65,409)				(130,240)	$ (65,409)
Advances to Affiliate				$ 40,669								$ 40,669
Organogenesis Inc
Organization and Financing
Commoon stock par value				$ 0.0001								$ 0.0001
Pipe Investor
Organization and Financing
Business acquistion consideration equity shares issued												$ 46,000
Pipe Investor \| Warrant
Organization and Financing
Shares options granted for business consideration												4,100,000
NuTech Medical
Organization and Financing
Date of business acquisition		Mar. 18, 2017
Busniess acquisition consideration paid in cash			$ 12,000
Business acquisition consideration deferred		$ 7,500									$ 7,500
Shares options granted for business consideration			3,642,746
Business acquistion consideration equity shares issued			$ 2,515
NuTech Medical \| Stock Option
Organization and Financing
Shares options granted for business consideration		137,543
Avista Merger Sub
Organization and Financing
Repayment of subordinated debt												$ 35,641
Principal repayment of subordinated debt												22,000
Accrued interest paid on subordinated debt												$ 13,641
Description of shares issuable												right to receive 2.03 shares of ORGO Class A common stock
Principal amount of debt to be converted												$ 45,746
Common Class A
Organization and Financing
Commoon stock par value				$ 0.0001								$ 0.0001
Common Class A \| Pipe Investor
Organization and Financing
Debt converted to common stock												6,502,679
Shares options granted for business consideration	6,538,732											9,022,741
Business acquistion consideration equity shares issued	$ 46,000
Common Class A \| NuTech Medical
Organization and Financing
Shares options granted for business consideration			728,549									2,185,647
Common Class A \| Avista Merger Sub
Organization and Financing
Shares options granted for business consideration												75,073,548
Redeemable Common Stock \| NuTech Medical
Organization and Financing
Shares options granted for business consideration			728,549

Significant Accounting Policies - Property, Plant and Equipment (Detail)	12 Months Ended
	Dec. 31, 2018
Leasehold improvements
Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Depreciation Methods	Lesser of the life of the lease or the economic life of the asset
Furniture and computers \| Minimum
Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	3 years
Furniture and computers \| Maximum
Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	5 years
Equipment \| Minimum
Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	5 years
Equipment \| Maximum
Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	10 years

Significant Accounting Policies -Schedule of Finite-Lived Intangible Assets (Detail)	12 Months Ended
	Dec. 31, 2018
Trade names and trademarks \| Minimum
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	10 years
Trade names and trademarks \| Maximum
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	12 years
Developed technology \| Minimum
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	10 years
Developed technology \| Maximum
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	12 years
Independent sales agency network
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	3 years
Non-compete agreements
Significant Accounting Policies [Line Items]
Finite-Lived Intangible Asset, Useful Life	5 years

Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Thousands		12 Months Ended
	Aug. 17, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Significant Accounting Policies [Line Items]
Restricted Cash, Current		$ 114	$ 49
Deferred offering costs		0	2,724
Deferred offering cost written off		3,494
Long term debt due to affiliates, fair value		$ 0	35,161
Medical device excise tax		2.30%
Long term debt due to affiliates		$ 0	57,322
Deferred Offering Costs		0	2,724
Equity issuance costs recorded to additional paid-in capital	$ 270	270
Selling, General and Administrative Expenses [Member]
Significant Accounting Policies [Line Items]
Deferred offering costs		770
Advertising costs		773	$ 947	$ 1,196
Deferred Offering Costs		$ 770

Reverse Acquisition with Avista and Organogenesis - Additional Information (Detail) $ / shares in Units, $ in Thousands			12 Months Ended
	Dec. 10, 2018 USD ($) $ / shares shares	Aug. 17, 2018 USD ($) $ / shares shares	Dec. 31, 2018 USD ($) $ / shares shares	Dec. 31, 2017 $ / shares shares
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Common Stock, Par or Stated Value Per Share \| $ / shares			$ 0.0001	$ 0.0001
Common Stock, Shares, Issued			91,261,412	66,983,138
Proceeds from Issuance of Warrants \| $	$ 46,000
Number of founder shares converted	6,502,679
Founder Shares Transactions [Member] \| Sponsor And Other Holders [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Common Stock, Consideration Transferred Upon Shares Surrender \| $		$ 0
Common Stock, Shares Agreed to Surrender in Which Shares were Canceled with Merger Agreement Execution		1,937,500
Private Placement Warrants [Member] \| Initial Shareholders And Other Holders [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Common Stock, Shares Agreed to Surrender Subjected to Satisfaction or Waiver of Certain Closing Conditions		16,400,000
Avista Merger [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Repayments of Subordinated Debt \| $		$ 35,641
Subordinated Debt Principal Repayment \| $		22,000
Subordinated Debt Accrued Interest And Loan Fee Payment \| $		$ 13,641
Debt Instrument, Convertible, Conversion Price \| $ / shares		$ 7.035
professional fees \| $			$ 11,205
Avista Healthcare Public Acquisition Corp [Member] \| Founder Shares Transactions [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Number of founder shares converted		500,000
Selling, General and Administrative Expenses [Member] \| Avista Merger [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
professional fees \| $			$ 3,072
Pipe Investor [Member] \| Avista Merger [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Number of warrants outstanding, exercise price		4,100,000
Common Stock, Shares, Issued		9,022,741
Class of Warrant or Right, Number of Securities Called by Warrants or Rights		4,100,000
Proceeds from Issuance of Warrants \| $		$ 46,000
Common Class A [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Number of warrants outstanding, exercise price	4,100,000		302,434
Common Stock, Par or Stated Value Per Share \| $ / shares			$ 0.0001
Class of Warrant or Right, Number of Securities Called by Warrants or Rights	4,100,000		302,434
Common Class A [Member] \| Avista Merger [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Stockholders' Equity Note, Stock Split, Conversion Ratio	2.03
Common Stock, Par or Stated Value Per Share \| $ / shares	$ 0.0001
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares	75,073,548
Debt Conversion, Converted Instrument, Shares Issued		6,502,679
Number of Founder shares converted to common stock	75,073,548
Common Class A [Member] \| Avista Healthcare Public Acquisition Corp [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Class of Warrant or Right Number of Warrants Outstanding	31,000,000
Number of founder shares converted		500,000
Number of new shares issued		500,000
Common Class A [Member] \| AHPAC [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Class of Warrant or Right, Exercise Price of Warrants or Rights \| $ / shares	$ 11.50
Number of warrants outstanding, exercise price	15,500,000
Number Of Founder Shares Domesticated		500,000
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares			890,993
Class of Warrant or Right, Number of Securities Called by Warrants or Rights	15,500,000
Number of Founder shares converted to common stock			890,993
Common Class A [Member] \| Pipe Investor [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares		6,538,732	9,022,741
Debt Conversion, Converted Instrument, Shares Issued			6,502,679
Number of Founder shares converted to common stock		6,538,732	9,022,741
Common Class B [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Common Stock, Par or Stated Value Per Share \| $ / shares			$ 0.0001
Number of founder shares converted	1,390,993
Common Class B [Member] \| Founder Shares Transactions [Member] \| Initial Shareholders And Other Holders [Member]
Disclosure of Reverse acquisition with Avista and Organogenesis [Line Items]
Common Stock, Shares Agreed to Surrender Subjected to Satisfaction or Waiver of Certain Closing Conditions		4,421,507

Real Estate Entities (Detail) $ in Thousands	12 Months Ended
Real Estate Entities (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	$ (18,939)
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net	4,665
Variable Interest Entity Nonconsolidated Accumulated Deficit	3,297
Noncontrolling Interest in Variable Interest Entity	7,962
Consideration transferred
Gain (loss) on deconsolidation
Cash Member
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	666
Due From Affiliates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	12,880
Prepaid Expenses and Other Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	126
Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	13,672
Property And Equipment
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	9,932
Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	23,604
Accrued Expenses and Other Current Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(103)
Notes Payable
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(18,604)
Other Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(232)
Dan Road Associates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net	(1,729)
Variable Interest Entity Nonconsolidated Accumulated Deficit	3,297
Noncontrolling Interest in Variable Interest Entity	1,568
Consideration transferred
Gain (loss) on deconsolidation
Dan Road Associates \| Cash Member
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	247
Dan Road Associates \| Due From Affiliates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	2,018
Dan Road Associates \| Prepaid Expenses and Other Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	126
Dan Road Associates \| Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	2,391
Dan Road Associates \| Property And Equipment
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	3,149
Dan Road Associates \| Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	5,540
Dan Road Associates \| Accrued Expenses and Other Current Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(8)
Dan Road Associates \| Notes Payable
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(7,029)
Dan Road Associates \| Other Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(232)
Dan Road Associates \| Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(7,269)
85 Dan Road Associates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net	4,006
Noncontrolling Interest in Variable Interest Entity	4,006
Consideration transferred
Gain (loss) on deconsolidation
85 Dan Road Associates \| Cash Member
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	51
85 Dan Road Associates \| Due From Affiliates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	6,414
85 Dan Road Associates \| Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	6,465
85 Dan Road Associates \| Property And Equipment
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	3,982
85 Dan Road Associates \| Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	10,447
85 Dan Road Associates \| Accrued Expenses and Other Current Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(52)
85 Dan Road Associates \| Notes Payable
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(6,389)
85 Dan Road Associates \| Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(6,441)
65 Dan Road Associates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net	2,388
Noncontrolling Interest in Variable Interest Entity	2,388
Consideration transferred
Gain (loss) on deconsolidation
65 Dan Road Associates \| Cash Member
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	368
65 Dan Road Associates \| Due From Affiliates
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	4,448
65 Dan Road Associates \| Current Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	4,816
65 Dan Road Associates \| Property And Equipment
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	2,801
65 Dan Road Associates \| Assets
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets	7,617
65 Dan Road Associates \| Accrued Expenses and Other Current Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(43)
65 Dan Road Associates \| Notes Payable
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	(5,186)
65 Dan Road Associates \| Liabilities
Variable Interest Entity, Nonconsolidated, Carrying Amount, Liabilities	$ (5,229)

Acquisition of NuTech Medical - Fair Values of the Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Mar. 24, 2017	Dec. 31, 2017	Dec. 31, 2018
Consideration
Defered acquistion consideration			$ 2,500
Consideration		$ 11,790
Allocated as follows:
Goodwill		$ 25,539	25,539
NuTech Medical
Consideration
Cash	$ 12,000
Common stock	2,515
Redeemable common stock	6,339
Restricted common stock	7,548
Stock options	207
Defered acquistion consideration	8,000
Working capital adjustment	(500)		$ 500
Contingent consideration forfeiture rights	(377)
Total consideration	35,732
Common stock transferred	(16,402)
Deferred acquisition consideration	(7,500)
Common stock options issued	(207)
Contingent consideration forfeiture rights	377
Cash received	(210)
Consideration	11,790
Allocated as follows:
Cash	210
Accounts receivable	3,131
Inventory	2,730
Other current assets	51
Property and equipment	284
Goodwill	19,446
Identifiable intangible assets	20,410
Total assets acquired	46,262
Accounts payable	2,850
Accrued expenses and other current liabilities	803
Deferred tax liability	6,877
Total liabilities assumed	10,530
Net assets acquired	$ 35,732

Acquisition of NuTech Medical - Pro Forma Statements of Operations (Detail) - NuTech Medical $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($)
Net revenue	$ 204,177
Net income	$ (9,183)

Acquisition of NuTech Medical - Additional Information (Detail) $ / shares in Units, $ in Thousands	1 Months Ended			12 Months Ended
	Mar. 24, 2017 USD ($) $ / shares shares	Apr. 12, 2016	Aug. 31, 2015	Dec. 31, 2018 USD ($) shares	Dec. 31, 2017 USD ($)	Mar. 24, 2019 $ / shares
Deferred acquisition consideration				$ 2,500
Options granted, number of options \| shares				248,567
Reason for reduction of purchase price	There was a $500 reduction to the purchase price due to changes in the amount of working capital acquired.
Stock option assumption, expected term		5 years	2 years	5 years 10 months 20 days	6 years 3 months
Stock option assumption, risk free interest rate				2.73%	2.05%
Stock option assumption, dividend yield				0.00%	0.00%
Goodwill				$ 25,539	$ 25,539
Gross accounts receivable				37,497	31,349
Method of Amortization	accelerated methods
Goodwill arising from acquisition				25,539	25,539
Deferred acquisition consideration, interest rate	6.00%
Deferred acquisition consideration, quarterly payments				1,000
Deferred acquisition consideration, final payment				4,000
Common Class A
Fair value of share \| $ / shares	$ 8.69
NuTech Medical
Acquisition purchase consideration	$ 35,732
Payments to acquire business	12,000
Deferred acquisition consideration	$ 8,000
Business acquisition shares issued \| shares	3,642,746
Fair value of share \| $ / shares	$ 3.45
Options granted, number of options \| shares	137,137
Business acquisition, legal and accounting charges	$ 500
Stock option assumption, volatility rate	47.91%
Stock option assumption, expected term	5 years
Stock option assumption, risk free interest rate	1.93%
Stock option assumption, dividend yield	0.00%
Goodwill	$ 19,446
Gross accounts receivable	3,268
Gross accounts receivable, fair value	$ 3,131
Remaining amortization period	9 years 7 months 6 days
Deferred tax liability	$ 6,877
Revenues					22,340
Business acquisition, legal and accounting charges					$ 295
Goodwill arising from acquisition	19,446
Deferred acquisition consideration, working capital adjustments	(500)			$ 500
Temporary Equity, Redemption Price Per Share \| $ / shares						$ 9.28
Business Combination Consideration Transferred Stock Options Issued	207
NuTech Medical \| Acquisition-related Costs
Goodwill	12,569
Goodwill acquired, discrete tax benefit	6,877
Goodwill arising from acquisition	$ 12,569
NuTech Medical \| Restricted Stock
Business acquisition shares issued \| shares	2,185,647
Business acquisition value of shares issued	$ 7,548
Restricted shares, forfeiture right asset	$ 377
NuTech Medical \| Common Class A
Business acquisition shares issued \| shares	728,549			2,185,647
Business acquisition value of shares issued	$ 2,515
Business acquisition shares issued, fair value per share \| $ / shares	$ 3.45
NuTech Medical \| Redeemable Common Stock
Business acquisition shares issued \| shares	728,549
Business acquisition value of shares issued	$ 6,339
Business acquisition shares issued, fair value per share \| $ / shares	$ 8.70
Temporary Equity, Redemption Price Per Share \| $ / shares	$ 9.28
Measurement Input, Discount Rate \| NuTech Medical \| Redeemable Common Stock
Fair value of the shares containing the put and call rights	2.91
Measurement Input, Expected Term \| NuTech Medical \| Redeemable Common Stock
Fair value of the shares containing the put and call rights term	2 years

Fair Value Measurement of Financial Instruments - Financial Assets And Liabilities Measured At Fair Value (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Assets:
Contingent consideration forfeiture rights		$ 589
Liabilities:
Contingent purchase earn-out liability		2,238
Fair Value, Measurements, Recurring \| Warrant
Liabilities:
Contingent purchase earn-out liability		2,238
Fair Value, Measurements, Recurring \| Contingent Purchase Earnout
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Contingent consideration forfeiture rights
Assets:
Contingent consideration forfeiture rights		589
Fair Value, Measurements, Recurring \| Redeemable common stock liability
Liabilities:
Redeemable common stock liability	6,762
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 1
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 1 \| Contingent Purchase Earnout
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 2
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 2 \| Contingent Purchase Earnout
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3
Assets:
Contingent consideration forfeiture rights		589
Liabilities:
Contingent purchase earn-out liability		2,238
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3 \| Warrant
Liabilities:
Contingent purchase earn-out liability		2,238
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3 \| Contingent Purchase Earnout
Liabilities:
Contingent purchase earn-out liability
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3 \| Contingent consideration forfeiture rights
Assets:
Contingent consideration forfeiture rights		$ 589
Fair Value, Measurements, Recurring \| Fair Value, Inputs, Level 3 \| Redeemable common stock liability
Liabilities:
Redeemable common stock liability	$ 6,762

Fair Value Measurement of Financial Instruments - Aggregate Fair Value Of Warrant Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Warrant Liability
Balance	$ (2,238)	$ (1,201)
Initial fair value of contingent consideration forfeiture rights
Change in fair value	(469)	(1,037)
Issuance of common stock for the exercise of warrant	2,707
Balance		(2,238)
Contingent Purchase Earn-Out Liability
Balance		0
Initial fair value of contingent consideration forfeiture rights
Change in fair value
Balance
Contingent Consideration Forfeiture Rights
Balance	589
Initial fair value of contingent consideration forfeiture rights		377
Change in fair value	(589)	212
Balance		$ 589
Redeemable common stock liability
Initial fair value of contingent consideration forfeiture rights	6,762
Balance	$ 6,762

Fair Value Measurement of Financial Instruments - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands		1 Months Ended	12 Months Ended
	Dec. 10, 2018	Mar. 24, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Mar. 24, 2019
Fair value of contingent consideration forfeiture rights				$ 589
Contingent purchase earn-out liability			$ 2,500
Expected Dividend Yield			0.00%	0.00%
Warrants Net Exercised			55,402
Fair Value Adjustment of Warrants			$ 469	$ 1,037	$ 737
Percentage of Fair Value Of Underlying Shares			10.00%
Accretion Expense			$ 0	423
Fair Value, Inputs, Level 3
Expected Dividend Yield			0.00%
Change In Fair Value of Underlying Shares			10.00%
NuTech Medical
Company issued acquisition of shares		3,642,746
Contingent purchase earn-out liability		$ 8,000
Expected Dividend Yield		0.00%
Change In Fair Value of Underlying Shares		47.91%
Temporary Equity, Redemption Price Per Share						$ 9.28
Accretion Expense			$ 0	423
Forfeiture Rights
Fair value of contingent consideration forfeiture rights			0	589
Dermagraft
Contingent purchase earn-out liability			0	$ 0
Dermagraft \| Contingent Purchase Earnout
Contingent purchase earn-out liability			3,300
Common Class A
Redeemable common stock, Carrying amount			$ 6,762
Common Class A \| NuTech Medical
Company issued acquisition of shares		728,549	2,185,647
Business Acquisition, Share Price		$ 3.45
Common Class A \| Avista
Warrants Net Exercised	444,041

Accounts receivable, net (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Receivables [Abstract]
Accounts receivable	$ 37,497	$ 31,349
Less — allowance for sales returns and doubtful accounts	(3,420)	(3,225)
Accounts receivable	$ 34,077	$ 28,124

Accounts receivable, net - Sales Returns and Doubtful Accounts (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Balance	$ 3,225	$ 2,109
Additions	1,157	1,166	$ 25
Write-offs	(962)	(50)
Balance	$ 3,420	$ 3,225	$ 2,109

Inventories (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Raw materials	$ 4,711	$ 6,537
Work in process	1,759	991
Finished goods	6,851	6,742
Inventory	$ 13,321	$ 14,270

Inventories - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Inventory reserve charged to cost of goods sold	$ 5,949	$ 5,497	$ 7,472
Reserve for excess and obsolete inventory	$ 2,951	$ 2,954

Prepaid Expenses and Other Current Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Deferred offering costs	$ 0	$ 2,724
Prepaid rent		29
Prepaid subscriptions	594	584
Prepaid inventory testing	116	36
Prepaid conferences and marketing expenses	392	588
Prepaid insurance	223	196
Prepaid deposits	764
Other	239	242
Prepaid Expense	$ 2,328	$ 4,399

Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment, Gross	$ 79,097	$ 78,518
Accumulated depreciation and amortization	(62,435)	(59,212)
Property, Plant and Equipment, Net	39,623	42,112
Leasehold improvements
Property, Plant and Equipment, Gross	34,345	35,143
Furniture, computers and equipment
Property, Plant and Equipment, Gross	44,752	43,375
Construction in progress
Property, Plant and Equipment, Net	$ 22,961	$ 22,806

Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Depreciation expense	$ 3,309	$ 3,591	$ 5,702
Proceeds from disposal of property and equipment	1	8	115
Gain on disposal of property and equipment	(1,209)	8	$ 9
Disposal of equipment	1,309	418
Accumulated depreciation in disposal of equipment	99	418
Property And Equipment [Member]
Property and equipment, net	9,932
Leasehold improvements
Capital leases recorded within leasehold improvements	21,889
Capital leases recorded	12,779	5,989
Leasehold improvements	$ 1,464	$ 618

Notes Receivable - Related Parties (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Balance	$ 413	$ 415
Accrued interest	64	111	$ 108
Impairment		(113)
Balance	$ 477	$ 413	$ 415

Notes Receivable - Related Parties - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net principal and interest receivable	$ 477	$ 413	$ 415
Interest income	64	111	108
Outstanding aggregate principal balance		52,142
Secured By Employee	635	635
Total principal and interest receivable	2,937	3,873
Impairment on employer loan	0	113
Bonus payment	904
Deemed uncollectible reserve	0
Value of stock and option	4,448	3,646
Avista Merger Agreement
Outstanding aggregate principal balance	$ 997
Option Loan
Borrower Principal Amount	50.00%
Accrued Interest Rate	100.00%
Interest Expense, Debt	$ 0	$ 0	$ 0
Class A
Stock Held By Employee	675,990	675,990
Liquidity Loan To One Former Employee
Outstanding aggregate principal balance	$ 350	$ 350
Former CEO Liquidity Loans
Outstanding aggregate principal balance	2,000	2,000
Current CEO Liquidity Loans
Outstanding aggregate principal balance	0	$ 997
Current CEO Liquidity Loans \| Avista Merger Agreement
Total principal and interest receivable	$ 133
Maximum \| Option Loan
Interest Rate	3.86%
Maximum \| Accrued Interest
Interest Rate	3.86%
Maximum \| Liquidity Loan
Interest Rate	3.86%
Minimum \| Option Loan
Interest Rate	2.30%
Minimum \| Accrued Interest
Interest Rate	2.30%
Minimum \| Liquidity Loan
Interest Rate	2.30%

Goodwill and Intangible Assets - Identifiable intangible assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Original Cost	$ 36,580	$ 36,580
Accumulated Amortization	(10,489)	(6,821)
Net Book Value	26,091	29,759
Developed technology
Original Cost	29,820	29,820
Accumulated Amortization	(8,454)	(6,389)
Net Book Value	21,366	23,431
Trade names and trademarks
Original Cost	2,000	2,000
Accumulated Amortization	(413)	(238)
Net Book Value	1,587	1,762
Independent sales agency network
Original Cost	4,500	4,500
Accumulated Amortization	(1,569)	(181)
Net Book Value	2,931	4,319
Non-compete agreements
Original Cost	260	260
Accumulated Amortization	(53)	(13)
Net Book Value	$ 207	$ 247

Goodwill and Intangible Assets - Estimated future annual amortization expense (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
2019	$ 5,993
2020	3,192
2021	3,257
2022	3,247
2023	3,283
Thereafter	7,119
Total	$ 26,091	$ 29,759

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Mar. 24, 2017
Goodwill	$ 25,539	$ 25,539
Amortization of Intangible Assets	$ 3,669	$ 2,037	$ 1,617
NuTech Medical
Goodwill				$ 19,446

Accrued Expenses and Other Current Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Accrued compensation	$ 15,218	$ 11,826
Accrued professional fees	309	539
Accrued interest - capital lease obligations	4,174	3,950
Accrued litigation	1,000	1,000
Accrued royalties	2,463	3,610
Accrued interest - deferred acquisition consideration	618	318
Other	1,633	1,308
Total Accrued Expenses and Other Current Liabilities	$ 25,415	$ 22,551

Long-Term Debt - Affiliates - Long-term debt payable (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Long-term debt, gross		$ 57,487
Accrued interest		9,241
Less debt discount		(5,345)
Long-term debt		52,142
2010 Loans
Debt Instrument [Line Items]
Long-term debt, gross		19,850
2015 Loans
Debt Instrument [Line Items]
Long-term debt, gross		11,396
2016 Loans
Debt Instrument [Line Items]
Long-term debt, gross		17,000
Accrued interest	0	4,387
Less debt discount	$ 0	$ (5,345)

Long-Term Debt - Affiliates - Due to affiliates (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Due to affiliates		$ 4,500
65 Dan Road SPE, LLC
Due to affiliates		200
85 Dan Road Associates
Due to affiliates		3,900
275 Dan Road SPE, LLC
Due to affiliates		$ 400

Long-Term Debt - Affiliates - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended						3 Months Ended								12 Months Ended
	Dec. 31, 2018	Aug. 31, 2018	Apr. 30, 2018	Apr. 30, 2017	Mar. 31, 2017	Jan. 31, 2017	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 10, 2018	Mar. 24, 2017	Apr. 30, 2016
Interest expense							$ 2,663	$ 2,960	$ 2,801	$ 2,429	$ 2,283	$ 2,233	$ 2,031	$ 1,592	$ 10,853	$ 8,139	$ 5,627
Accrued interest											9,241					9,241
Un-amortized debt discount											5,345					5,345
Interest Rate On The Un Paid Fee						15.00%
Gain on extinguishment of debt							$ (2,095)								(2,095)
Proceeds from loans																	23
Warrants expired	Apr. 30, 2021
Avista Merger Agreement
Write off of unamortized debt discount															5,078
Gain on extinguishment of debt															2,095
Debt conversion, converted shares	6,502,679
Cash payment to creditors	$ 35,641
Outstanding principal amount															45,746
Loss on Unamortized Debt Discount															$ 2,982
Warrant
Exercise price	$ 3.58						$ 3.58								$ 3.58
Common Class A
Warrants to purchase common stock	302,434						302,434								302,434			4,100,000
Price per share																			$ 8.69
Common Class A \| Avista Merger Agreement
Common stock per share	$ 13.35						$ 13.35								$ 13.35
Common Class A \| Warrant
Warrants to purchase common stock	905,774						905,774								905,774
Common stock per share	$ 2.53						$ 2.53								$ 2.53
Real Estate Loan Payable
Interest rate	1.60%						1.60%								1.60%
Accrued interest	$ 0						$ 0				325				$ 0	325
Interest Expense Debt															68	45
2016 Loans
Interest rate																				15.00%
Accrued interest	0						0				4,387				0	4,387
Aggregate principal amount																				$ 17,000
Amortization of the debt discount	464														268	92
Un-amortized debt discount	$ 0						$ 0				5,345				$ 0	5,345
Gain on extinguishment of debt				$ 2,534	$ 2,043
Price per share	$ 3.58						$ 3.58								$ 3.58
Interest Expense Debt															$ 2,667	2,735
Debt Instrument, Fee Amount						$ 680
Extinguishment of debt unamorized discount amortized to interest expense															4,577
Additional Fee Unpaid
Interest expense															96	93
Accrued interest	$ 0						$ 0				93				$ 0	93
2010 and 2015 Loans
Interest rate	1.60%						1.60%								1.60%
Accrued interest	$ 0						$ 0				$ 4,436				$ 0	4,436
Interest Expense Debt															$ 470	$ 540	$ 503
2018 Loans
Interest rate	8.00%						8.00%								8.00%
Accrued interest	$ 0						$ 0								$ 0
Proceeds from loans		$ 5,000	$ 10,000
Interest Expense Debt															687
Affiliate Debt Principal \| Avista Healthcare Public Acquisition Corp
Cash payment to creditors															22,000
Affiliate Debt Interest \| Avista Healthcare Public Acquisition Corp
Cash payment to creditors															$ 13,641
Other Liabilities
Debt Instrument, Fee Amount						$ 680

Line of Credit and Notes Payable (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Line of credit	$ 26,484	$ 17,618
Notes payable	15,885	15,895
Less debt discount	(762)	(1,079)
Less current maturities	2,545	0
Notes payable, net of debt discount	$ 12,578	$ 14,816

The carrying value as of the balance sheet date of the current and noncurrent portions of long-term obligations drawn from a line of credit, which is a bank's commitment to make loans up to a specific amount. Examples of items that might be included in the application of this element may consist of letters of credit, standby letters of credit, and revolving credit arrangements, under which borrowings can be made up to a maximum amount as of any point in time conditional on satisfaction of specified terms before, as of and after the date of drawdowns on the line. Includes short-term obligations that would normally be classified as current liabilities but for which (a) postbalance sheet date issuance of a long term obligation to refinance the short term obligation on a long term basis, or (b) the enterprise has entered into a financing agreement that clearly permits the enterprise to refinance the short-term obligation on a long term basis and the following conditions are met (1) the agreement does not expire within 1 year and is not cancelable by the lender except for violation of an objectively determinable provision, (2) no violation exists at the BS date, and (3) the lender has entered into the financing agreement is expected to be financially capable of honoring the agreement.

Line of Credit and Notes Payable - Future payments of notes payable (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
2019	$ 2,211
2020	4,646
2021	5,384
2022	3,644
Total	$ 15,885	$ 15,895

Line of Credit and Notes Payable - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended				3 Months Ended								12 Months Ended
	Apr. 30, 2018	Dec. 31, 2017	Apr. 30, 2017	Sep. 30, 2015	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 10, 2018	Oct. 31, 2018	May 01, 2017	Apr. 28, 2017	Mar. 21, 2017
Letter of credit sub facility		$ 17,618			$ 26,484				$ 17,618				$ 26,484	$ 17,618
Additional fund	$ 5,000
Line of Credit, Current																	$ 5,000
Interest Expense under the credit agreement					2,663	$ 2,960	$ 2,801	$ 2,429	2,283	$ 2,233	$ 2,031	$ 1,592	10,853	8,139	$ 5,627
deferred financing		145			243				145				243	145
Unamortized portion of costs		463			318				463				318	463
Carrying value of notes payable		0			2,545				0				2,545	0
Accrued interest		9,241							9,241					9,241
Principal payments				$ 375
Fair Value Adjustment of Warrants													469	1,037	$ 737
Company repaid remaining outstanding amount			$ 2,250
Paid-in-Kind Interest			$ 2,512
Other Assets Amortized Value													702
Warrant [Member]
Fair Value Adjustment of Warrants													9,000
Fair value													958
ML Agreement
Aggregate under revolving credit facility		$ 2,000							$ 2,000					2,000
Interest Expense under the credit agreement													2,236	$ 1,309
Line of Credit Facility, Frequency of Payment and Payment Terms		This additional funding requires additional monthly payments of $18 for months 1 through 24 and $64 for months 25- through 60. Payments for this additional funding under the ML Agreement are payable on the first day of each month beginning on January 1, 2018 through December 1, 2022
Annual effective interest rate		13.50%							13.50%					13.50%
Debt discount																			$ 308
Unamortized debt discount					762								762
Principal payment													10
Amortization of the debt discount													317	$ 187
Credit Agreement
Interest Expense under the credit agreement													1,644	$ 736
Term Loan
Aggregate amounts of term loan	35,000
Interest Expense under the credit agreement													294
Carrying value of notes payable					0								0				$ 80
Interest expense related to amortization					80								80
Accrued interest					0								$ 0
Accrued Interest Due	5,000
Line of Credit
Aggregate under revolving credit facility																			14,000
Subordinate
Percentage of interest paid													10.00%
Percentage of Paid in kind													4.00%
Revolving Credit Facility
Aggregate amounts of term loan	30,000
Revolving Credit Facility \| SVB
Letter of credit sub facility																				$ 30,000
Aggregate under revolving credit facility					26,484								$ 26,484
Future revolving borrowings					$ 3,516								$ 3,516
Description of line of credit facility													(i) a rate per annum equal to the greater of the prime rate and the federal funds rate effective for such day plus 0.50%, plus (ii) an applicable margin of either 0.50% or 1.50% depending on the Company’s liquidity ratio for the immediately preceding 30-day period;
Interest rate applicable to borrowings					2.00%								2.00%
Revolving Credit Facility \| Term Loan
Aggregate amounts of term loan	$ 5,000
Eastward fund LLC
Aggregate amounts of term loan																			$ 20,000
Line of Credit Facility, Frequency of Payment and Payment Terms													The ML Agreement requires monthly payments of $122 for months 1 through 24 and $452 for months 25- through 60, however, in an event of default, as defined in ML Agreement, the additional interest rate on all unpaid amounts due will be 1.5% and the loan will become due upon written notice.
Additional percentage of outstanding principal																		3.00%
Prepayment fees																		2.00%
Percentage of final payment fee		16.50%							16.50%					16.50%				6.50%
Annual effective interest rate																		15.00%
Common Class A
Warrant deemed net exercised					302,434								302,434			4,100,000
Common Class A \| Warrant [Member]
Warrant purchase													473,011
Common stock per share					$ 2.53								$ 2.53
Warrant deemed net exercised					905,774								905,774

Capitalized Leases - Future Lease Payments (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
2019	$ 9,573
2020	4,308
2021	4,308
2022	4,737
Total	22,926
Less amount representing interest	(5,271)
Present value of minimum lease payments	17,655
Less current maturities	(7,501)	$ (5,369)
Long-term portion	$ 10,154	$ 12,390

Capitalized Leases - Additional Information (Detail) - USD ($) $ in Thousands	1 Months Ended
	Jan. 31, 2013	Dec. 31, 2018	Dec. 31, 2017
Dan Road Associates
Capital lease monthly rental payments	$ 87
Capital lease rental arrears		$ 4,174	$ 3,950
Percentage of increase in monthly rental payment of capital lease	10.00%
Description of lessee leasing arrangements, capital leases	The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.
85 Dan Road Associates
Capital lease monthly rental payments	$ 70
Percentage of increase in monthly rental payment of capital lease	10.00%
Description of lessee leasing arrangements, capital leases	The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.
65 Dan Road Associates
Capital lease monthly rental payments	$ 57
Percentage of increase in monthly rental payment of capital lease	10.00%
Description of lessee leasing arrangements, capital leases	The lease terminates on December 31, 2022 with yearly renewals for a five-year period. Rent receipts and payments and the right to use the asset and lease obligation have been eliminated in the consolidated financial statements through May 31, 2017.

Stockholders Equity - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands				1 Months Ended	12 Months Ended
	Dec. 10, 2018	Dec. 10, 2018	Aug. 17, 2018	Mar. 24, 2017	Dec. 31, 2018	Dec. 31, 2017
Common Shares, Shares Authorized					400,000,000	81,200,000
Common shares, par value (in dollar per share)					$ 0.0001	$ 0.0001
Proceeds from issue of warrants		$ 46,000
Conversion of Stock, Shares Converted		6,502,679
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs			$ 270		$ 270
Put Options Exercise Price Prior to Second Aniversary				$ 9.28
Put options exercise price at closing				9.28
Accretion Expense					0	$ 423
Proceeds from equity financing, net of issuance costs			$ 46,000
Put Option Shares Back Price				$ 9.28
Current Liability
Redeemable common stock, Carrying amount					6,762
NuTech Medical
Business acquisition equity interest number of shares issued				3,642,746
Accretion Expense					$ 0	$ 423
Fair value of common share				$ 3.45
Common Class A
Common Shares, Shares Authorized					400,000,000
Common shares, par value (in dollar per share)					$ 0.0001
Shares Issued During Period, Shares, New Issues	9,022,741		6,538,732
Warrants outstanding	4,100,000	4,100,000			302,434
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range, Number of Exercisable Options					33,432,421	8,229,517
Fair value of common share				$ 8.69
Redeemable common stock, Carrying amount					$ 6,762
Common Class A \| NuTech Medical
Business acquisition equity interest number of shares issued				728,549	2,185,647
Common Class B
Common Shares, Shares Authorized					20,000,000
Common shares, par value (in dollar per share)					$ 0.0001
Conversion of Stock, Shares Converted		1,390,993
Preferred Stock
Common Shares, Shares Authorized					1,000,000
Common shares, par value (in dollar per share)					$ 0.0001

Warrants - Schedule of Outstanding Warrants to Purchase Common Stock (Detail) - $ / shares	1 Months Ended		12 Months Ended
	Dec. 31, 2018	Apr. 12, 2016	Dec. 31, 2018	Dec. 31, 2017	Dec. 10, 2018	Apr. 28, 2017	Aug. 31, 2015	Aug. 31, 2013	Nov. 03, 2010
Warrants, Date exercisable	Apr. 30, 2021
Warrants, Number of shares issuable	17,732,700		17,732,700	1,561,485
Warrant Exercisable at November 3, 2010
Warrants, Date exercisable			Nov. 03, 2010	Nov. 03, 2010
Warrants, Number of shares issuable	109,620		109,620	109,620					109,620
Warrants, Exercise price	$ 3.95		$ 3.95	$ 3.95					$ 3.95
Warrants, Exercisable for			Common Stock	Common Stock
Warrants, Classification			Equity	Equity
Warrants, Expiration			Later of 8/31/2019 or upon repayment of the notes payable	Later of 8/31/2019 or upon repayment of the notes payable
Warrant Exercisable at August 31, 2013
Warrants, Date exercisable			Aug. 31, 2013	Aug. 31, 2013
Warrants, Number of shares issuable	36,540		36,540	36,540				36,540
Warrants, Exercise price	$ 3.95		$ 3.95	$ 3.95				$ 3.95
Warrants, Exercisable for			Common Stock	Common Stock
Warrants, Classification			Equity	Equity
Warrants, Expiration			Later of 8/31/2019 or upon repayment of the notes payable	Later of 8/31/2019 or upon repayment of the notes payable
Warrant Exercisable at August 31, 2015
Warrants, Date exercisable			Aug. 31, 2015	Aug. 31, 2015
Warrants, Number of shares issuable	36,540		36,540	36,540			36,540
Warrants, Exercise price	$ 3.95		$ 3.95	$ 3.95			$ 3.95
Warrants, Exercisable for			Common Stock	Common Stock
Warrants, Classification			Equity	Equity
Warrants, Expiration			Later of 8/31/2019 or upon repayment of the notes payable	Later of 8/31/2019 or upon repayment of the notes payable
Warrant Exercisable at April 12, 2016
Warrants, Date exercisable		Apr. 12, 2021		Apr. 12, 2016
Warrants, Number of shares issuable		905,774		905,774
Warrants, Exercise price		$ 3.58		$ 3.58
Warrants, Exercisable for				Common Stock
Warrants, Classification				Liability
Warrants, Expiration				April 12, 2021
Warrant Exercisable at April 27, 2017
Warrants, Date exercisable				Apr. 27, 2017
Warrants, Number of shares issuable				473,011		473,011
Warrants, Exercise price				$ 2.53		$ 2.53
Warrants, Exercisable for				Common Stock
Warrants, Classification				Equity
Warrants, Expiration				Earlier of 4/27/2027 or three years from the effective date of the Company’s filing of an initial underwritten and sale of securities registration statement
Avista Investment Warrant
Warrants, Date exercisable			Dec. 10, 2018
Warrants, Number of shares issuable	2,050,000		2,050,000		4,100,000
Warrants, Exercise price	$ 11.50		$ 11.50		$ 11.50
Warrants, Exercisable for			Common Stock
Warrants, Classification			Equity
Warrants, Expiration			December 10, 2023
Avista Merger Warrant
Warrants, Date exercisable			Dec. 10, 2018
Warrants, Number of shares issuable	15,500,000		15,500,000		31,000,000
Warrants, Exercise price	$ 11.50		$ 11.50		$ 11.50
Warrants, Exercisable for			Common Stock
Warrants, Classification			Equity
Warrants, Expiration			December 10, 2023

Warrants - Additional information (Detail) - USD ($) $ / shares in Units, $ in Thousands		1 Months Ended				12 Months Ended
	Apr. 12, 2016	Dec. 31, 2018	Apr. 28, 2017	Apr. 12, 2016	Aug. 31, 2015	Dec. 31, 2018	Dec. 31, 2017	Dec. 10, 2018	Aug. 31, 2013	Nov. 03, 2010
Warrants outstanding		17,732,700				17,732,700	1,561,485
Risk-free interest rate						2.73%	2.05%
Expected dividend yield						0.00%	0.00%
Expected volatility						42.00%	45.70%
Expected term (in years)				5 years	2 years	5 years 10 months 20 days	6 years 3 months
Warrants, Date exercisable		Apr. 30, 2021
Common stock, shares issued		91,261,412				91,261,412	66,983,138
Warrant Exercisable at November 3, 2010
Warrants outstanding		109,620				109,620	109,620			109,620
Warrants, Exercise price		$ 3.95				$ 3.95	$ 3.95			$ 3.95
Fair value of warrants										$ 97
Warrants, Date exercisable						Nov. 03, 2010	Nov. 03, 2010
Warrant Exercisable at August 31, 2013
Warrants outstanding		36,540				36,540	36,540		36,540
Warrants, Exercise price		$ 3.95				$ 3.95	$ 3.95		$ 3.95
Fair value of warrants									$ 9
Warrants, Date exercisable						Aug. 31, 2013	Aug. 31, 2013
Warrant Exercisable at August 31, 2015
Warrants outstanding		36,540			36,540	36,540	36,540
Warrants, Exercise price		$ 3.95			$ 3.95	$ 3.95	$ 3.95
Fair value of warrants					$ 9
Risk-free interest rate					1.74%
Expected dividend yield					0.00%
Expected volatility					43.49%
Warrants, Date exercisable						Aug. 31, 2015	Aug. 31, 2015
Warrant Exercisable at April 12, 2016
Warrants outstanding	905,774			905,774			905,774
Warrants, Exercise price	$ 3.58			$ 3.58			$ 3.58
Fair value of warrants	$ 464			$ 464
Risk-free interest rate	1.22%
Expected dividend yield	0.00%
Expected volatility	41.36%
Warrants, Date exercisable				Apr. 12, 2021			Apr. 12, 2016
Common stock, shares issued								444,041
Loss recognized on fair value of warrant						$ 469	$ 1,037
Warrant Exercisable at April 27, 2017
Warrants outstanding			473,011				473,011
Warrants, Exercise price			$ 2.53				$ 2.53
Warrants, Date exercisable							Apr. 27, 2017
Equity securities			$ 958
Chance of initial underwritten			40.00%
Expected volatility, minimum			44.81%
Expected volatility, maximum			57.51%
Risk-free interest rate, minimum			1.73%
Risk-free interest rate, maximum			2.35%
Warrant Exercisable at April 27, 2017 \| Minimum
Expected term (in years)			4 years 3 months
Warrant Exercisable at April 27, 2017 \| Maximum
Expected term (in years)			10 years
Warrant Exercisable at April 27, 2017 \| Common Class A [Member]
Common stock, shares issued								302,443
Avista Investment Warrant
Warrants outstanding		2,050,000				2,050,000		4,100,000
Warrants, Exercise price		$ 11.50				$ 11.50		$ 11.50
Warrants, Date exercisable						Dec. 10, 2018
Avista Merger Warrant
Warrants outstanding		15,500,000				15,500,000		31,000,000
Warrants, Exercise price		$ 11.50				$ 11.50		$ 11.50
Warrants, Date exercisable						Dec. 10, 2018

Stock Options - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Common stock options outstanding	7,266,715	7,150,214
Common stock options granted	248,567
Weighted average grant-date fair value	$ 2.39	$ 1.62
Fair value of option vested	$ 963	$ 1,070
Unrecognized stock compensation expense	$ 1,733
Share-based compensation expected to be recognized over a weighted-average period	2 years 9 months 7 days
Exercise of stock options	55,402
Secured Debt	$ 635	635
Number of Shares Issues as Collateral for Secured Debt	675,990
2018 Stock Incentive Plan
Stock option expiration period	10 years
2018 Stock Incentive Plan \| Minimum
Stock option granted vesting period	4 years
2018 Stock Incentive Plan \| Maximum
Stock option granted vesting period	5 years
2003 Stock Incentive Plan
Stock option expiration period	10 years
2003 Stock Incentive Plan \| Selling, General and Administrative Expenses
Share-based compensation expense	$ 1,075	$ 919	$ 473
Common Class A \| Executive Officer
Exercise of stock options	7,176,715
Common Class A \| 2018 Stock Incentive Plan
Common stock options authorized	9,198,996
Common stock options outstanding	90,000
Common Class A \| 2003 and 2018 Stock Incentive Plan
Common stock options granted	248,567	895,194

Stock Options - Schedule of Fair Value of Stock Options Granted to Employees and Directors (Detail) - $ / shares	1 Months Ended		12 Months Ended
	Apr. 12, 2016	Aug. 31, 2015	Dec. 31, 2018	Dec. 31, 2017
Risk-free interest rate			2.73%	2.05%
Expected term (in years)	5 years	2 years	5 years 10 months 20 days	6 years 3 months
Expected volatility			42.00%	45.70%
Expected dividend yield			0.00%	0.00%
Exercise price			$ 5.99	$ 3.45
Fair value of common share			$ 5.82	$ 3.45

Stock Options - Summary of Stock Option Activity (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Number of Shares Outstanding	7,150,214
Number of Shares Granted	248,567
Number of Shares Cancelled / forfeited	(76,664)
Number of Shares Exercised	(55,402)
Number of Shares Outstanding	7,266,715	7,150,214
Number of Shares Options Exercisable	5,396,880
Number of Shares Options vested or expected to vest	6,948,699
Weighted Average Exercise Price Outstanding	$ 1.77
Weighted Average Exercise Price Granted	5.99
Weighted Average Exercise Price Cancelled / forfeited	1.55
Weighted Average Exercise Price Exercised
Weighted Average Exercise Price Outstanding	1.91	$ 1.77
Weighted Average Exercise Price Options Exercisable	1.53
Weighted Average Exercise Price Options Vested or Expected to Vest	$ 1.82
Weighted Average Remaining Contractual Term (in years) Outstanding	6 years 6 months	6 years 8 months 12 days
Weighted Average Remaining Contractual Term (in years) Options Exercisable	5 years 2 months 16 days
Weighted Average Remaining Contractual Term (in years) Options Vested or Expected to Vest	5 years 9 months 4 days
Aggregate Intrinsic Value Outstanding	$ 33,976	$ 24,581
Aggregate Intrinsic Value Options Exercisable	27,280
Aggregate Intrinsic Value Options Vested or Expected to Vest	$ 33,096

Royalties - Additional Information (Detail) - USD ($)	1 Months Ended		12 Months Ended
Royalties - Additional Information (Detail) - USD ($)	Apr. 30, 2019	Jul. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
NuTech Medical
Consulting service and royalty payment term			15 years
NuTech Medical \| Selling, General and Administrative Expenses
Royalty expense			$ 77,000	$ 25,000
License Agreement with Pharmaceutical Company
Royalty expense			253,000	292,000	$ 287,000
License Agreement with University
Royalty expense			0	0
License Agreement with University \| Accrued expense
Accrued royalties			1,187,000	1,187,000
License Agreement with Third Party
Maintainance cost of underlying patents		$ 200,000
License Agreement with Third Party \| Scenario Forecast
Additional payment for maintainance cost of patents	$ 150,000
License Agreement with Third Party \| Selling, General and Administrative Expenses
Royalty expense			$ 2,059,000	$ 3,122,000

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Federal corporate income tax rate	21.00%	35.00%	35.00%
Tax adjustment provision		$ 19,761
Operating loss carryforwards research and development credit	$ 878
Deferred tax assets valuation allowance	47,186	32,971
Decrease in valuation allowance	14,215
Net deferred tax asset, AMT credit	238
Unrecognized tax benefits	$ 3,722	3,801	$ 3,802
Description of tax benefits upon ultimate settlement	The tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement.
Income tax penalities and interest expense	$ 209	$ 159
Percentage of alternative minimum tax deferred tax asset reclasified	50.00%
Domestic Tax Authority
Operating loss carryforwards	$ 165,256
Domestic Tax Authority \| Minimum
Operating loss carryforwards expiration term	Dec. 31, 2019
Tax credit carryforward expiration term	Dec. 31, 2019
Domestic Tax Authority \| Maximum
Operating loss carryforwards expiration term	Dec. 31, 2038
Tax credit carryforward expiration term	Dec. 31, 2038
State and Local Jurisdiction
Operating loss carryforwards	$ 56,991
State and Local Jurisdiction \| Minimum
Operating loss carryforwards expiration term	Dec. 31, 2020
State and Local Jurisdiction \| Maximum
Operating loss carryforwards expiration term	Dec. 31, 2038

Income Taxes - Schedule of Components of Income Tax Expense (Benefit) (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current tax expense
Federal									$ (212)
State									101	$ 214	$ 65
Foreign									9	62
Total current tax expense (benefit)									(102)	276	65
Deferred tax expense (benefit)
Federal									212	(6,401)
State										(900)
Foreign									(26)
Total deferred tax expense (benefit)									186	(7,301)
Total income tax expense (benefit)	$ 2	$ 27	$ 27	$ 28	$ (233)	$ 47	$ (156)	$ (6,683)	$ 84	$ (7,025)	$ 65

Income Taxes - Component of Company's Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Net operating loss carryforwards
Federal	$ 34,707	$ 26,725
State	3,208	1,327
Foreign	26
Capitalized research and development		101
Other	12,219	8,706
Stock-based compensation	29	293
Fresh start and intangible assets acquired	(2,765)	(3,757)
Net deferred tax assets before valuation allowance	47,424	33,395
Valuation allowance	(47,186)	(32,971)
Net deferred tax assets	$ 238	$ 424

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Detail)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
U.S. federal statutory income tax rate	21.00%	35.00%	35.00%
Tax reform act		(134.40%)
State income taxes, net of federal benefit	(18.40%)	147.50%	(30.90%)
Foreign rate differential	(3.90%)	3.00%	(3.60%)
Research and development tax credits	3.50%	2.30%	2.50%
Nondeductible expenses	(2.30%)	(6.80%)	(3.20%)
Noncontrolling interest		2.20%
Uncertain tax position reserves	(0.10%)	(0.50%)	(0.20%)
Effective income tax rate	(0.20%)	48.30%	(0.40%)

Income Taxes - Schedule of Unrecognized Tax Benefits Roll Forward (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Gross balance at beginning of year	$ 3,486	$ 3,663	$ 3,417
Additions based on tax positions related to the current period	157	231	325
Reductions for tax positions of prior years	(357)	(408)	(79)
Gross balance at end of year	$ 3,286	$ 3,486	$ 3,663

Net Loss Per Share - Basic and diluted net loss per share (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Numerator:
Net loss	$ (9,255)	$ (13,078)	$ (20,010)	$ (22,488)	$ (4,428)	$ (5,403)	$ (242)	$ 1,685	$ (64,831)	$ (7,525)	$ (14,766)
Less: Net income attributable to non-controlling interests							$ 273	$ 590		863	2,221
Less: Accretion of redeemable common shares										423
Net loss attributable to Organogenesis Holdings Inc									$ (64,831)	$ (8,811)	$ (16,987)
Denominator:
Weighted average common shares outstanding — basic and diluted	76,952,174	69,496,279	66,361,998	64,320,931					69,318,456	63,876,767	63,196,067
Net loss per share — basic and diluted	$ (0.12)	$ (0.19)	$ (0.30)	$ (0.35)					$ (0.94)	$ (0.14)	$ (0.27)