You are given a text that consists of multiple sentences. Your task is to perform abstractive summarization on this text. Use your understanding of the content to express the main ideas and crucial details in a shorter, coherent, and natural sounding text. 
Text: I'd also like to call your attention to supplemental slides related to our 2021 outlook posted on our website in the Investor Relations section.
The company has explained some of these risks and uncertainties in its SEC filings included in the Risk Factors section of its annual report under Form 10-K and quarterly reports on Form 10-Q.
Additionally, in our discussion today, we will reference certain non-GAAP financial measures.
Today, I'm joined by Ed Pesicka, our President and Chief Executive Officer; and Andy Long, our Executive Vice President and Chief Financial Officer.
This effort and focus has reinforced our position in the healthcare industry as a trusted partner by delivering on our mission of Empowering our Customers to Advance Healthcare.
In addition, I am extremely pleased to be here today and report another strong quarter and close out of a record year.
The strong performance in the quarter as well as the full year was a result of the successful execution and implementation of the key initiatives discussed during the previous quarterly earnings calls, which included two major items: one, infrastructure investments, with a focus on current and long-term profitable growth; and two, operational improvements, with a focus on enhancing the customer experience and increasing operating efficiencies.
Starting with our Global Products segment, let me remind you of the infrastructure investments and operational improvements we shared previously during the past year.
At a high level, we expanded our manufacturing output to align with the volume commitments of our customers.
Here are just a few examples of these investments and operational improvements: one, the installation of new N95 production lines in our U.S.-based manufacturing facilities; two, we added nonwoven fabric manufacturing in our Lexington, North Carolina facility; three, we continued to expand our isolation and surgical gown production capacity; and four, we optimized the operational process to maximize output of the production lines.
These investments and operational improvements enabled us to strengthen our position as one of the world's largest vertically integrated manufacturer of healthcare PPE.
We manufacture a full range of healthcare PPE categories and subcategories, primarily manufactured in the Americas.
These products are manufactured in our factories with our teammates, with our technology, with our fabric, with our patents, with our processes and with our quality and regulatory oversight.
And then they're delivered through our network of distribution centers, with our teammates and our technologies.
Along those lines, let me remind you of the infrastructure investments and operational improvements we shared previously during the past year related to our Global Solutions segment.
One, we expanded our low-unit-of-measure warehouse infrastructure system.
Two, we improved our inventory planning processes and algorithms.
Three, we enhanced our data management service offering through QSight and the launching of myOM.
We improved our B2B and B2C offerings in our home healthcare business.
And lastly, we optimized the operational process to continue to improve our controllable service metrics.
The combination of these investments and operational improvements in our Global Products and our Global Solutions segment continue to strengthen our position in supporting our customers across the entire value chain, with our products and our distribution network delivering what is needed to both the hospital as well as the home, while utilizing our services and data management to increase customer efficiency.
The compelling results in Q4 and the full year of 2020 were driven by these investments and operational improvements, along with the dedication of our teammates and our overall commitment to enhancing the customer experience.
Let me now share a few items from Q4 that validate our solid results.
One, we achieved an increase of nearly 400% in adjusted net income per share compared to the fourth quarter in 2019.
Two, we realized an increase of more than 200% in adjusted operating income versus the fourth quarter of the prior year.
Three, we expanded our Q4 adjusted operating margins by 340 basis points versus the prior year.
Four, we launched and successfully executed an upsized follow-on equity offering of nearly $200 million.
Five, we reduced the debt by over $300 million in the fourth quarter.
Six, and specifically related to Global Solutions segment, we grew revenue by 5% sequentially from Q3 to Q4, while maintaining industry-leading service levels.
Seven, specifically related to Global Products segment, we grew revenue by 21% sequentially from Q3 to Q4.
And since the beginning of the year, we manufactured record levels of PPE with approximately five billion units produced, with materials manufactured in our American factories or Owens & Minor-owned facilities.
Eight, we generated operating cash flow of $71 million as a result of the increased earnings and working capital improvements.
And lastly, we continued to make investments in infrastructure, service and technology.
As you can tell, the fourth quarter was a remarkable close to 2020.
It is, in fact, an extension of our track record of strong performance during the entire year.
Here are some of the highlights from the full year of 2020.
One, for the full year, adjusted earnings per share increased 265% from $0.62 to $2.26.
Two, we continued the trend of recording year-over-year gross margin expansion, with gross margin expanding by 285 basis points.
Three, we more than doubled our operating cash flow to $339 million as a result of increased earnings and working capital improvements.
Four, we paid down debt by $534 million during the year, and it should be noted that we have reduced debt by more than $700 million over the past seven quarters.
Five, we achieved year-over-year gross margin expansion in every quarter of 2020, making it seven consecutive quarters of year-over-year gross margin expansion.
Six, we generated positive operating cash flow in every quarter of 2020, also making it seven consecutive quarters of positive operating cash flow.
Next, we delivered year-over-year adjusted earnings per share growth on a constant currency basis in every quarter of 2020, making it five consecutive quarters of year-over-year adjusted earnings per share growth on a constant currency basis.
And finally, we reached a milestone in the COVID-19 fight, with nearly 12 billion units of PPE delivered during the year.
Look, I'm extremely pleased with our incredible results in 2020, which signify our stellar operating performance across the board.
It is our Americas owned and operated facilities, along with the strong distribution network, that provides Owens & Minor with the unique ability to support the entire value chain.
This differentiates us and puts us in a strong position for long-term profitable growth.
Let me now shift to 2021 and focus on the areas that will shape the year and the future of Owens & Minor.
These areas of focus will be investments, operational improvements and financial strength.
Let me begin with financial strength.
During 2020, we significantly deleveraged our balance sheet, implemented sustainable operational improvements and made investments for growth.
We expect 2021 to be an extension of these actions, enabling continued deleveraging of the balance sheet and profit improvement.
As a result of the deleveraging achieved in 2020, we now have greater latitude to make investments in our business for future growth.
So moving on to investments.
We will focus our investments on both organic and inorganic growth.
Our investment strategy will remain disciplined, and we'll continue to focus on infrastructure, technology and operational improvements.
Our organic growth investments will consist of: one, product portfolio expansion within our PPE, surgical infection and prevention categories and subcategories; two, product portfolio expansion outside of our PPE, surgical infection and prevention categories and subcategories; three, expansion into new verticals that utilize our product portfolio and expanded product portfolio; four, enhanced technology, utilizing the data and services we provide to our customers; five, harnessing our enterprisewide offerings to further enhance our customer experience; and six, complete the build-out of our continuous improvement team.
Related to inorganic growth investments, our focus will be primarily on portfolio and end-market expansions.
Let me now discuss operational improvements.
We have begun the implementation of the Owens & Minor business system that is an enterprisewide business discipline consisting of the following: one, continuous improvement, continuous improvement, which is focused on delivering an enhanced customer experience while providing efficiency, improved output and financial achievements; two, standard management systems, which is based on definable metrics that will be measured and evaluated; and finally, program management, which will be utilized for alignment and execution of our strategic priorities and key initiatives.
The Owens & Minor business system is the next step in the formalization of the actions utilized over the past two years to significantly improve our medical distribution service levels, to increase our manufacturing output to record levels, to develop and implement new technology and to deliver our strong performance.
Let me now close with our 2021 outlook.
First, we expect a strong momentum from Q4 to carry into 2021 related to the demand for our manufactured PPE.
Secondly, we expect elective procedures to continue to improve throughout the year.
And finally, we expect continued increase in demand for our home healthcare business, which is positioned well in one of the fastest-growing healthcare market segments.
As I have discussed earlier, we had a strong fourth quarter and successful 2020.
And I'm immensely proud of our accomplishments and the dedication of the Owens & Minor teammates.
And we expect this momentum to continue into 2021.
It is clear that our robust operational execution, combined with strategic investments, have fueled increased output and improved efficiency across the entire business, thus enabling us to better serve our customers.
Continuing with this approach as a foundation of our strategy, we are well positioned to address the needs of healthcare for years to come based on our strong value proposition.
Accordingly, I am pleased to state that we expect 2021 adjusted earnings per share to be in the range of $3 to $3.50.
Today, I'll review our fourth quarter and full year financial results as well as the key drivers for our better-than-expected quarterly and annual performance.
Later in my remarks, I'll share details regarding our expectations for 2021.
Clearly, we finished 2020 in a very strong fashion, with good revenue growth in the fourth quarter and exceptional increases in operating income and earnings per share.
I'll elaborate on each of these next.
For the quarter, revenue was $2.4 billion compared to $2.2 billion for the prior year.
This represents 8% growth and was driven by greater sales of PPE across both segments as well as growth in sales in our home healthcare business line and stabilization of the Medical Distribution business.
Elective procedures were better than expected, but overall continue to trail pre-pandemic levels.
Gross margin in the fourth quarter was 16.9%, an improvement of 390 basis points over prior year as a result of higher-margin sales from our Global Products segment, driven by continuing PPE demand as well as an improved operating efficiency.
For the full year, gross margin was up 285 basis points to 15.1%.
Distribution, selling and administrative expense of $283 million in the current quarter was $29 million higher than in the fourth quarter of 2019 as a result of top line growth and ongoing investments across all business lines, net of productivity gains.
Interest expense of $17 million in the fourth quarter was down 23% or $5 million versus the same period in the prior year.
For the full year, interest expense was lower by 15% or $15 million.
These improvements are the result of continued reduction in debt, along with lower base rates and utilization of our accounts receivable securitization program.
Our strong execution in serving our customers, along with very high demand for PPE, growth in home healthcare and productivity gains across the company, led to very strong bottom line results.
On a GAAP basis, income from continuing operations for the quarter was $51 million or $0.72 a share, and $88 million or $1.39 per share for the full year.
Adjusted net income in the fourth quarter was $80 million, and adjusted earnings per share was $1.14, about a fivefold increase compared to the prior year.
For the full year, adjusted income from continuing operations was $144 million, which equates to an adjusted earnings per share of $2.26, a significant increase from the $0.62 in 2019.
Foreign currency impact on earnings per share for the fourth quarter was $0.06 favorable, and for full year 2020, it was $0.08 favorable.
Next, I'll discuss our fourth quarter highlights by segment.
Global Solutions revenue was $1.95 billion compared to $1.94 billion in the fourth quarter of last year.
This slight increase in revenue was due to growth in our home healthcare business, coupled with higher levels of PPE sold through Medical Distribution, partially offset by the negative impact of COVID-19 on elective procedures versus the prior year.
The typical seasonal growth in this segment was muted by the pandemic.
Operating income for the segment was $22 million compared to $19 million last year.
Despite the negative impact of COVID-19, growth in home healthcare and our productivity and efficiency gains helped drive nice growth in bottom line operating results, particularly in the back half of the year.
In our Global Products segment, net revenue in the fourth quarter was $575 million compared to $363 million last year, an increase of 58%, which was driven by growth in volume of PPE sales, slightly offset by the impact of lower elective procedures.
Global Products operating income for the quarter was $100 million, more than a fourfold increase versus the $22 million in the prior year's fourth quarter.
Higher revenue through capacity expansions for PPE products, productivity initiatives, favorable product mix and improved fixed cost leverage, as we ramped up production throughout the year, all contributed to the very strong improvement in performance.
Foreign currency impact was favorable on a year-over-year basis by $5.4 million.
Moving now to cash flow, the balance sheet and capital structure.
In the quarter, we generated $71 million of operating cash flow.
And for the full year, we generated $339 million of operating cash flow, which was more than two times the prior year.
Increased profitability and disciplined working capital management were the primary drivers of the progress in this area.
The strong cash flow was achieved despite our investment in a seasonal inventory build to ensure continuity of supply for our customers.
We expect cash flow to continue to be strong in 2021.
During the course of 2020, we accomplished several milestones in our financial strategy.
We strategically divested Movianto for $133 million to remain focused on our core assets and used the proceeds from the sale to pay down debt.
We entered into an accounts receivable securitization program to provide additional lower-cost financing that enhances our financial flexibility.
We issued new equity in an upsized offering, netting $190 million to strengthen our balance sheet.
And finally, we fully retired our 2021 notes with cash, further reducing our debt.
As a result, total debt was $1.03 billion at December 31, reflecting a significant reduction of 34% or $534 million during the year.
As we exit 2020, our balance sheet is in very good shape, and our leverage is down to around three times EBITDA.
Going forward, we intend to further deleverage the balance sheet, while we continue to reinvest in our businesses for future growth.
In fact, in early January, we paid off the remainder of our term A loans.
The work we did during the course of 2020 by deploying cash generated by the business to pay down debt, while maintaining ample liquidity, has helped to create a strong foundation to execute our growth strategy.
Our success was recently rewarded with another credit upgrade by Moody's.
We plan to further strengthen that foundation in 2021.
Turning to guidance for the year.
Given the complexity and uncertainty of the markets we serve, I'd like to provide you with as much color as possible as I walk you through the assumptions that went into developing our guidance range.
Starting with the top line.
We expect revenue to be in the range of $9.2 billion to $9.7 billion, which is expected to be driven by several factors.
The throughput from PPE-related capacity expansions will continue to benefit 2021.
To date, demand for PPE remains very high, and we believe a great deal of runway remains due to post-COVID changes in practices and protocols in the healthcare industry.
Also, throughout 2021, we will remain focused on driving productivity and increasing operating efficiency through existing and incremental capacity.
New patient capture and growth from existing customers at Byram, our home healthcare business, will drive growth as investments toward improving B2B and B2C offerings pay off.
Also, revenue will benefit from the number of elective procedures returning to pre-pandemic levels in the second half of the year.
We assume there will not be a repeat of shutdowns in elective procedures as we saw in Q2 of 2020.
It's critically important to understand the final component of our revenue growth projection.
During 2020, continuing into 2021, significant cost increases from glove producers are translating to higher-end user prices in the market.
This is particularly true for the portion of gloves we don't produce in our own facilities.
To date, we have successfully passed through these cost increases, which are reflected on the revenue line and should be noted for their extraordinary impact.
Our revenue forecast for 2021 includes a glove cost pass-through in the range of $300 million to $500 million.
However, there will be minimal bottom line impact resulting from this revenue lift.
Gross margin rate is expected to be in the range of 14.9% to 15.4% in 2021 as we continue to expand our breadth and scale.
The gross margin rate will be negatively impacted by the pass-through of glove cost increases as I just described.
Distribution, selling and administrative expense is expected to trend higher than last year.
Our ongoing investments in infrastructure, technology and services to enhance the customer experience, along with volume, is fueling this increase and should be partially self-funded with ongoing productivity efforts.
With substantially lower debt, our interest expense will follow suit.
We'll continue our drive to reduce leverage and plan to be in the range of two to 3 times.
As a result, interest expense is expected to be between $60 million and $65 million for the year.
Let me talk about the market dynamics that frame our projection for 2021.
Based on our current line of sight, the 2020 trend of demand-supply imbalances in the PPE market are expected to continue in 2021.
Looking ahead, we expect to benefit from PPE supply contracts that are multiyear in duration.
We're increasingly confident that the post-pandemic demand for PPE will land above historic usage, but clearly below peak pandemic levels.
It's also very important to understand the expected calendarization of earnings in 2021.
The dynamics that helped drive our strong fourth quarter results remain in place heading into 2021.
Given this momentum carrying into Q1, we do not expect to see the typical pattern of earnings throughout the year.
Specifically, we expect Q1 earnings to be more in line with the back half of 2020.
Please note that these key modeling assumptions for full year 2021 have been summarized on supplemental slides filed with the SEC on Form 8-K earlier today and posted to the Investor Relations section of our website.
While I look back on our performance in 2020, it's one where we showcased our ability to adapt to changing customer needs and deliver really strong results.
I also see a track record of consistently improving financial results that have positioned us well for the future.

user
q4 adjusted earnings per share $1.14.
q4 gaap earnings per share $0.72.
expects adjusted net income for 2021 to be in a range of $3.00 to $3.50 per share.

assistant