Financial instruments

Foreign Currency Forward Contracts Designated as Cash Flow Hedges

The Company uses derivative instruments for risk management purposes. Foreign currency forward contracts are used to manage foreign currency transaction exposure. These derivative instruments are designated as cash flow hedges and are recognized at fair value. The effective portion of the gains or losses on derivatives is reported as a component of other comprehensive loss and thereafter is recognized in the consolidated statement of income in the period or periods during which the hedged transaction affects earnings. Gains and losses on the derivatives representing either hedge ineffectiveness or hedge components excluded from the assessment of effectiveness, if any, are recognized in the consolidated statement of income in the period in which such gains and losses occur.

Non-designated Foreign Currency Forward Contracts

During the third quarter 2015, the Company began using foreign currency forward contracts as part of its strategy to manage exposure related to near term foreign currency denominated monetary assets and liabilities. These currency forward contracts are not designated as cash flow, fair value or net investment hedges; therefore, the changes in fair value of these currency forward contracts are recognized in the consolidated statements of income as a selling, general and administrative expense. The Company enters into foreign currency forward contracts for periods consistent with its currency translation exposures, which generally approximate one month. For the years ended December 31, 2016 and 2015, the Company recognized a loss related to non-designated foreign currency forward contracts of $2.3 million and $1.5 million, respectively.

The following table presents the locations in the consolidated balance sheet and fair value of derivative instruments as of December 31, 2016 and 2015:



	December 31, 2016		December 31, 2015
	Fair Value
	(Dollars in thousands)
Asset derivatives:
Designated foreign currency forward contracts	$	667	$	285
Non-designated foreign currency forward contracts	490		44
Prepaid expenses and other current assets	1,157		329
Total asset derivatives	1,157		329
Liability derivatives:
Designated foreign currency forward contracts	2,139		807
Non-designated foreign currency forward contracts	118		491
Other current liabilities	2,257		1,298
Total liability derivatives	$	2,257	$	1,298

The total notional amount for all open foreign currency forward contracts designated as cash flow hedges as of December 31, 2016 and 2015 was $101.8 million and $49.5 million, respectively. The total notional amount for all open non-designated foreign currency forward contracts as of December 31, 2016 and 2015 was $73.4 million and $69.1 million, respectively. All open foreign currency forward contracts as of December 31, 2016 have durations of twelve months or less.

The following table provides information as to the gains and losses attributable to derivatives that were designated as cash flow hedges and reported in other comprehensive income (loss) (“OCI”) for the years ended December 31, 2016, 2015 and 2014:



	After Tax Gain (Loss) Recognized in OCI
	2016		2015			2014
	(Dollars in thousands)
Foreign currency exchange contracts	$	67	$	(2,491	)	$	—

See Note 11 for information on the location and amount of gains and losses attributable to derivatives that were reclassified from accumulated other comprehensive income (loss) (“AOCI”) to expense (income), net of tax.

For the years ended December 31, 2016, 2015 and 2014, there was no ineffectiveness related to the Company’s hedging derivatives.

Concentration of Credit Risk

Concentrations of credit risk with respect to trade accounts receivable is generally limited due to the Company’s large number of customers and their diversity across many geographic areas. However, a portion of the Company’s trade accounts receivable outside the United States include sales to government-owned or supported healthcare systems in several countries which are subject to payment delays. Payment is dependent upon the creditworthiness of the healthcare systems in those countries and the financial stability of their economies.

In the ordinary course of business, the Company grants non-interest bearing trade credit to its customers on normal credit terms. In an effort to reduce its credit risk, the Company (i) establishes credit limits for all of its customer relationships, (ii) performs ongoing credit evaluations of its customers’ financial condition, (iii) monitors the payment history and aging of its customers’ receivables, and (iv) monitors open orders against an individual customer’s outstanding receivable balance.

An allowance for doubtful accounts is maintained for trade accounts receivable based on the Company's historical collection experience and expected collectability of accounts receivable, considering the length of time an account is outstanding, the financial position of the customer and information provided by credit rating services. The adequacy of this allowance is reviewed each reporting period and adjusted as necessary. The allowance for doubtful accounts was $8.6 million and $8.0 million at December 31, 2016 and 2015, respectively. The current portion of the allowance for doubtful accounts at December 31, 2016 and 2015 of $2.0 million and $2.0 million, respectively, was reported within accounts receivable, net. The allowance for doubtful accounts on receivables outstanding for greater than one year at December 31, 2016 and 2015 of $6.6 million and $6.0 million, respectively, is recognized in other assets.

Certain of the Company’s customers, particularly in Greece, Italy, Portugal and Spain have extended or delayed payments for products and services already provided, raising collectability concerns regarding the Company’s trade accounts receivable from these customers. As a result, the Company continues to closely monitor the allowance for doubtful accounts with respect to these customers and uses other risk mitigation strategies such as selling receivables. The aggregate net current and long-term trade accounts receivable for customers in Greece, Italy, Spain and Portugal and the percentage of the Company’s total net current and long-term trade accounts receivable represented by the net current and long-term trade accounts receivable for customers in those countries at December 31, 2016 and 2015 are as follows:



	December 31, 2016			December 31, 2015
	(Dollars in thousands)
Current and long-term trade accounts receivable (net of allowances of $7.7 million and $7.2 million in 2016 and 2015, respectively) in Greece, Italy, Spain and Portugal ⁽¹⁾	$	51,098		$	62,272
Percentage of total net current and long-term trade accounts receivables	19.3		%	23.9		%

(1) The long-term portion of trade accounts receivable, net from customers in Greece, Italy, Spain and Portugal at December 31, 2016 and 2015 was $2.7 million and $8.1 million, respectively. In January 2017, the Company sold $16.1 million of receivables outstanding with publicly funded hospitals in Italy for $16.0 million.

For the years ended December 31, 2016, 2015 and 2014, net revenues from customers in Greece, Italy, Spain and Portugal were $125.3 million, $126.2 million and $150.5 million, respectively.