Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2019	Feb. 18, 2020	Jun. 30, 2019
Cover page.
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2019
Document Transition Report	false
Entity File Number	0-26224
Entity Registrant Name	INTEGRA LIFESCIENCES HOLDINGS CORP
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0317849
Entity Address, Address Line One	1100 Campus Road
Entity Address, Postal Zip Code	08540
Entity Address, City or Town	Princeton
Entity Address, State or Province	NJ
City Area Code	609
Local Phone Number	275-0500
Title of 12(b) Security	Common Stock, Par Value $.01 Per Share
Trading Symbol	IART
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Shell Company	false
Entity Public Float			$ 3,945.6
Entity Common Stock, Shares Outstanding (in shares)		84,442,804
Documents Incorporated by Reference	Certain portions of the registrant’s definitive proxy statement relating to its scheduled May 13, 2020 Annual Meeting of Stockholders are incorporated by reference in Part III of this report.
Amendment Flag	false
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Total revenue, net	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Costs and expenses:
Cost of goods sold	564,681,000	571,496,000	435,511,000
Research and development	79,573,000	78,041,000	63,455,000
In-process research and development	64,916,000	0	0
Selling, general and administrative	687,599,000	690,746,000	624,096,000
Intangible asset amortization	27,028,000	21,160,000	20,370,000
Total costs and expenses	1,423,797,000	1,361,443,000	1,143,432,000
Operating income	93,760,000	110,998,000	44,804,000
Interest income	10,779,000	2,800,000	255,000
Interest expense	(53,957,000)	(64,683,000)	(35,019,000)
Other income, net	9,522,000	8,288,000	1,345,000
Income before income taxes	60,104,000	57,403,000	11,385,000
Provision (benefit) for income taxes	9,903,000	(3,398,000)	(53,358,000)
Net income per share	$ 50,201,000	$ 60,801,000	$ 64,743,000
Basic (in dollars per share)	$ 0.59	$ 0.73	$ 0.84
Diluted (in dollars per share)	$ 0.58	$ 0.72	$ 0.82
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	85,637	82,857	76,897
Diluted (in shares)	86,494	83,999	79,121

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement of Comprehensive Income [Abstract]
Net income	$ 50,201,000	$ 60,801,000	$ 64,743,000
Other comprehensive income (loss), before tax:
Change in foreign currency translation adjustments	(174,000)	(19,159,000)	37,454,000
Unrealized gain (loss) on derivatives
Unrealized derivative (loss) gain arising during period	(13,671,000)	11,709,000	(3,425,000)
Less: Reclassification adjustments for gains included in net income	14,865,000	13,400,000	2,958,000
Unrealized loss on derivatives	(28,536,000)	(1,691,000)	(6,383,000)
Defined benefit pension plan - net (loss) arising during period	(8,973,000)	(643,000)	(57,000)
Total other comprehensive income (loss), before tax	(37,683,000)	(21,493,000)	31,014,000
Income tax benefit (expense) related to items in other comprehensive loss	6,724,000	(143,000)	2,333,000
Total other comprehensive income (loss), net of tax	(30,959,000)	(21,636,000)	33,347,000
Comprehensive income, net of tax	$ 19,242,000	$ 39,165,000	$ 98,090,000

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current Assets:
Cash and cash equivalents	$ 198,911	$ 138,838
Trade accounts receivable, net of allowances of $4,303 and $3,719	275,296	265,737
Inventories, net	316,054	280,347
Prepaid expenses and other current assets	67,907	90,160
Total current assets	858,168	775,082
Property, plant and equipment, net	337,404	300,112
Right of use asset - operating leases	94,530
Intangible assets, net	1,031,591	1,079,496
Goodwill	954,280	926,475
Deferred tax assets	12,623	6,805
Other assets	14,644	19,917
Total assets	3,303,240	3,107,887
Current Liabilities:
Current portion of borrowings under senior credit facility	45,000	22,500
Current portion of lease liability - operating leases	12,253
Accounts payable, trade	113,090	76,050
Contract liabilities	4,772	3,764
Accrued compensation	79,385	75,693
Accrued expenses and other current liabilities	76,809	84,545
Total current liabilities	331,309	262,552
Long-term borrowings under senior credit facility	1,198,561	1,210,513
Long-term borrowings under securitization facility	104,500	121,200
Lease liability - operating leases	97,504
Deferred tax liabilities	36,553	57,778
Other liabilities	118,077	80,048
Total liabilities	1,886,504	1,732,091
Commitments and contingencies (Refer to Note 15)
Stockholders’ Equity:
Preferred Stock; no par value; 15,000 authorized shares; none outstanding	0	0
Common stock; $0.01 par value; 240,000 authorized shares; 88,735 and 88,044 issued at December 31, 2019 and 2018, respectively	887	880
Additional paid-in capital	1,213,620	1,192,601
Treasury stock, at cost; 2,865 and 2,881 shares at December 31, 2019 and 2018, respectively	(119,943)	(120,615)
Accumulated other comprehensive loss	(76,402)	(45,443)
Retained earnings	398,574	348,373
Total stockholders’ equity	1,416,736	1,375,796
Total liabilities and stockholders’ equity	$ 3,303,240	$ 3,107,887

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Trade accounts receivable, allowances	$ 4,303	$ 3,719
Preferred Stock, par value (in dollars per share)	$ 0
Preferred Stock, authorized shares (in shares)	15,000,000	15,000,000
Preferred Stock, outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	240,000,000	240,000,000
Common stock, shares issued (in shares)	88,735,000	88,044,000
Treasury stock, shares (in shares)	2,865,000	2,881,000

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
OPERATING ACTIVITIES:
Net income	$ 50,201,000	$ 60,801,000	$ 64,743,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	109,462,000	110,730,000	88,945,000
Non-cash in-process research and development expense	64,916,000	0	0
Non-cash impairment charges	5,764,000	4,941,000	3,290,000
Deferred income tax benefit	(19,046,000)	(8,184,000)	(67,304,000)
Share-based compensation	21,255,000	20,779,000	21,550,000
Amortization of debt issuance costs	5,390,000	6,270,000	2,722,000
Non-cash lease expense	5,060,000
Non-cash lease expense		0	0
Realized loss on sale of short-term investments	0	0	2,287,000
Loss on disposal of property and equipment	1,821,000	1,385,000	6,989,000
Gain on divestiture of business	0	0	(2,645,000)
Change in fair value of contingent consideration and others	1,119,000	1,214,000	(4,710,000)
Changes in assets and liabilities, net of business acquisitions:
Accounts receivable	(9,428,000)	(17,021,000)	(89,698,000)
Inventories	(43,308,000)	8,300,000	99,000
Prepaid expenses and other current assets	13,071,000	3,933,000	(33,808,000)
Other non-current assets	13,156,000	1,052,000	(914,000)
Accounts payable, accrued expenses and other current liabilities	14,666,000	3,588,000	95,321,000
Contract liabilities	(607,000)	1,504,000	3,874,000
Other non-current liabilities	(2,059,000)	391,000	23,803,000
Net cash provided by operating activities	231,433,000	199,683,000	114,544,000
INVESTING ACTIVITIES:
Proceeds from sale of short-term investments	0	0	16,951,000
Proceeds from note receivable	752,000	910,000	483,000
Cash used in business acquisitions, net of cash acquired	(30,509,000)	26,704,000	(1,241,946,000)
Acquired in-process research and development	(64,995,000)	0	0
Purchases of property and equipment	(69,537,000)	(77,741,000)	(43,503,000)
Proceeds from sales of property and equipment	37,000	422,000	293,000
Proceeds from divestiture of business	0	0	46,387,000
Net proceeds on swaps designated as net investment hedges	1,584,000	0	0
Net cash used in investing activities	(162,668,000)	(49,705,000)	(1,221,335,000)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	236,900,000	171,200,000	1,307,000,000
Payments on debt	(246,100,000)	(660,000,000)	(117,000,000)
Net cash paid for contingent consideration	0	(38,196,000)	(4,661,000)
Proceeds from the issuance of common stock, net of issuance costs	0	349,590,000	0
Debt issuance costs	0	(5,037,000)	(19,043,000)
Proceeds from exercised stock options	6,948,000	9,392,000	9,774,000
Cash taxes paid in net equity settlement	(6,514,000)	(7,821,000)	(7,123,000)
Net cash provided by (used in) financing activities	(8,766,000)	(180,872,000)	1,168,947,000
Effect of exchange rate changes on cash and cash equivalents	74,000	(5,203,000)	10,724,000
Net increase (decrease) in cash and cash equivalents	60,073,000	(36,097,000)	72,880,000
Cash and cash equivalents at beginning of period	138,838,000	174,935,000	102,055,000
Cash and cash equivalents at end of period	$ 198,911,000	$ 138,838,000	$ 174,935,000

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($)	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income (Loss)	Retained Earnings
Balance in AOCL Beginning of Year at Dec. 31, 2016	$ 839,667,000	$ 777,000	$ (123,051,000)	$ 798,652,000	$ (57,154,000)	$ 220,443,000
Beginning Balance, shares (in shares) at Dec. 31, 2016		77,666,000
Beginning Balance, Treasury Stock, shares (in shares) at Dec. 31, 2016			(2,946,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	64,743,000					64,743,000
Other comprehensive income (loss), net of tax	33,347,000				33,347,000
Issuance of common stock through employee stock purchase plan	509,000			509,000
Issuance of common stock through employee stock purchase plan (in shares)		12,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	2,138,000	$ 8,000	$ 1,407,000	723,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)		788,000	19,000
Exercise of warrants		$ 28,000		(28,000)
Exercise of warrants (in shares)		2,840,000
Share-based compensation	21,902,000			21,902,000
Balance in AOCL End of Year at Dec. 31, 2017	962,306,000	$ 813,000	$ (121,644,000)	821,758,000	(23,807,000)	285,186,000
Ending Balance, shares (in shares) at Dec. 31, 2017		81,306,000
Ending Balance, Treasury Stock, shares (in shares) at Dec. 31, 2017			(2,927,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	60,801,000					60,801,000
Other comprehensive income (loss), net of tax	(21,636,000)				(21,636,000)
Issuance of common stock through employee stock purchase plan	553,000			553,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	1,086,000	$ 4,000	$ 1,030,000	52,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)		700,000	46,000
Equity offering	349,589,000	$ 60,000		349,529,000
Equity offering (in shares)		6,038,000
Share-based compensation	20,712,000	$ 3,000		20,709,000
Balance in AOCL End of Year at Dec. 31, 2018	$ 1,375,796,000	$ 880,000	$ (120,615,000)	1,192,601,000	(45,443,000)	348,373,000
Ending Balance, shares (in shares) at Dec. 31, 2018		88,044,000
Ending Balance, Treasury Stock, shares (in shares) at Dec. 31, 2018	(2,881,000)		(2,881,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 50,201,000					50,201,000
Other comprehensive income (loss), net of tax	(30,959,000)				(30,959,000)
Issuance of common stock through employee stock purchase plan	716,000			716,000
Issuance of common stock through employee stock purchase plan (in shares)		17,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	(282,000)	$ 7,000	$ 672,000	(961,000)
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)		674,000	16,000
Share-based compensation	21,264,000			21,264,000
Balance in AOCL End of Year at Dec. 31, 2019	$ 1,416,736,000	$ 887,000	$ (119,943,000)	$ 1,213,620,000	$ (76,402,000)	$ 398,574,000
Ending Balance, shares (in shares) at Dec. 31, 2019		88,735,000
Ending Balance, Treasury Stock, shares (in shares) at Dec. 31, 2019	(2,865,000)		(2,865,000)

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

BASIS OF PRESENTATION

These financial statements and the accompanying notes are prepared in accordance with accounting principles generally accepted in the United States of America and conform to Regulation S-X under the Securities Exchange Act of 1934, as amended.

PRINCIPLES OF CONSOLIDATION

The consolidated financial statements include the accounts of the Company and its subsidiaries, all of which are wholly owned. All intercompany accounts and transactions are eliminated in consolidation. See Note 4, Acquisitions and Pro Forma Results, for details of new subsidiaries included in the consolidation.

USE OF ESTIMATES

The preparation of consolidated financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent liabilities, and the reported amounts of revenues and expenses. Significant estimates affecting amounts reported or disclosed in the consolidated financial statements include allowances for doubtful accounts receivable and sales returns and allowances, net realizable value of inventories, valuation of intangible assets and in-process research and development ("IPR&D"), amortization periods for acquired intangible assets, discount rates and estimated projected cash flows used to value and test impairments of long-lived assets and goodwill, estimates of projected cash flows, depreciation and amortization periods for long-lived assets, computation of taxes, valuation allowances recorded against deferred tax assets, the valuation of stock-based compensation, valuation of pension assets and liabilities, valuation of derivative instruments, and valuation of debt instruments and loss contingencies. These estimates are based on historical experience and on various other assumptions that are believed to be reasonable under the current circumstances. Actual results could differ from these estimates.

RECLASSIFICATIONS

Certain amounts from the prior year's financial statements have been reclassified in order to conform to the current year's presentation.

CASH AND CASH EQUIVALENTS

The Company considers all short-term, highly liquid investments purchased with original maturities of three months or less to be cash equivalents. These investments are carried at cost, which approximates fair value.

TRADE ACCOUNTS RECEIVABLE AND ALLOWANCES FOR DOUBTFUL ACCOUNTS RECEIVABLE

Trade accounts receivable are recorded at the invoiced amount and do not bear interest. The Company grants credit to customers in the normal course of business, but generally does not require collateral or any other security to support its receivables.

The Company evaluates the collectability of accounts receivable based on a combination of factors. In circumstances where a specific customer is unable to meet its financial obligations to the Company, a provision to the allowances for doubtful accounts is recorded against amounts due to reduce the net recognized receivable to the amount that is reasonably expected to be collected. For all other customers, a provision to the allowances for doubtful accounts is recorded based on factors including the length of time the receivables are past due, the current business environment and the Company's historical experience. Provisions to the allowances for doubtful accounts are recorded to selling, general and administrative expenses. Account balances are charged off against the allowance when it is probable that the receivable will not be recovered. Provision for doubtful accounts net of recoveries, associated with accounts receivable, included in selling, general and administrative expense, were $2.1 million, $0.6 million, and $2.0 million for the years ended December 31, 2019, 2018 and 2017, respectively.

INVENTORIES

Inventories, consisting of purchased materials, direct labor and manufacturing overhead, are stated at the lower of cost, the value determined by the first-in, first-out method, or net realizable value. Inventories consisted of the following:



	December 31,
	2019	2018
	(In thousands)
Finished goods	201,870	$	179,885
Work in process	48,333	47,715
Raw materials	65,851	52,747
Total inventories, net	316,054	$	280,347

At each balance sheet date, the Company evaluates inventories for excess quantities, obsolescence or shelf life expiration. This evaluation includes analysis of historical sales levels by product, projections of future demand, the risk of technological or competitive obsolescence for products, general market conditions, a review of the shelf life expiration dates for products, as well as the feasibility of reworking or using excess or obsolete products or components in the production or assembly of other products that are not obsolete or for which there are not excess quantities in inventory. To the extent that management determines there are excess or obsolete inventory or quantities with a shelf life that is too near its expiration for the Company to reasonably expect that it can sell those products prior to their expiration, the Company adjusts the carrying value to estimated net realizable value.

The Company capitalizes inventory costs associated with certain products prior to regulatory approval, based on management's judgment of probable economic benefit. The Company could be required to expense previously capitalized costs related to pre-approval inventory upon a change in such judgment, due to, among other potential factors, a denial or delay of approval by necessary regulatory bodies or a decision by management to discontinue the related development program. No such amounts were capitalized at December 31, 2019 or 2018.

PROPERTY, PLANT AND EQUIPMENT

Property, plant and equipment are stated at historical cost less accumulated depreciation and any impairment charges. The Company provides for depreciation using the straight-line method over the estimated useful lives of the assets. Leasehold improvements are amortized over the lesser of the lease term or the useful life. The cost of major additions and improvements is capitalized, while maintenance and repair costs that do not improve or extend the lives of the respective assets are charged to operations as incurred. The cost of computer software developed or obtained for internal use is accounted for in accordance with the Accounting Standards Codification 350-40, Internal-Use Software.

Property, plant and equipment balances and corresponding lives were as follows:



	December 31,
	2019			2018			Useful Lives
	(In thousands)
Land	$	1,476		$	1,837
Buildings and building improvements	16,262			20,472			5-40 years
Leasehold improvements	114,941			105,063			1-20 years
Machinery and production equipment	155,313			143,921			3-20 years
Surgical instrument kits	33,104			31,231			4-5 years
Information systems and hardware	138,398			129,962			1-7 years
Furniture, fixtures, and office equipment	22,145			17,731			1-15 years
Construction-in-progress	140,366			105,075
Total	622,005			555,292
Less: Accumulated depreciation	(284,601		)	(255,180		)
Property, plant and equipment, net	$	337,404		$	300,112

Depreciation expense associated with property, plant and equipment was $42.6 million, $44.1 million, and $36.1 million for the years ended December 31, 2019, 2018 and 2017, respectively.

CAPITALIZED INTEREST

The interest cost on capital projects, including facilities build-out and internal use software, is capitalized and included in the cost of the project. Capitalization commences with the first expenditure for the project and continues until the project is substantially complete and ready for its intended use. When no debt is incurred specifically for a project, interest is capitalized on project

expenditures using the weighted average cost of the Company's outstanding borrowings. For the years ended December 31, 2019 and 2018, respectively, the Company capitalized $3.1 million and $2.3 million of interest expense into property, plant and equipment.

ACQUISITIONS

Results of operations of acquired companies are included in the Company’s results of operations as of the respective acquisition dates. Acquired businesses are accounted for using the acquisition method of accounting, which requires that assets acquired and liabilities assumed be recorded at fair value, with limited exceptions. Any excess of the purchase price over the fair value of the net assets acquired is recorded as goodwill. Transaction costs and costs to restructure the acquired Company are expensed as incurred. The operating results of the acquired business are reflected in the consolidated financial statements after the date of acquisition. Acquired in-process research and development (“IPR&D”) is recognized at fair value and initially characterized as an indefinite-lived intangible asset, irrespective of whether the acquired IPR&D has an alternative future use. Contingent consideration is recognized at the estimated fair value on the acquisition date. Subsequent changes to the fair value of contingent payments are recognized in selling, general and administrative expense in consolidated statements of operations. Contingent payments related to acquisitions consist of development, regulatory, and commercial milestone payments, in addition to sales-based payments, and are valued using discounted cash flow techniques. The fair value of development, regulatory, and commercial milestone payments reflects management’s expectations of the probability of payment and increases or decreases as the probability of payment or expectation of timing of payments changes. The fair value of sales-based payments is based upon probability-weighted future revenue estimates and increases or decreases as revenue estimates or expectation of timing of payments changes.

If the acquired net assets do not constitute a business under the acquisition method of accounting, the transaction is accounted for as an asset acquisition and no goodwill is recognized. In an asset acquisition, the amount allocated to acquired IPR&D with no alternative future use is charged to expense at the acquisition date. Payments that would be recognized as contingent consideration in a business combination are expensed when probable in an asset acquisition. Refer to Note 4, Acquisitions and Pro Forma Results for more information.

GOODWILL AND OTHER INTANGIBLE ASSETS

The excess of the cost over the fair value of net assets of acquired businesses is recorded as goodwill. Goodwill is not subject to amortization but is reviewed for impairment at the reporting unit level annually, or more frequently if impairment indicators arise. The Company's assessment of the recoverability of goodwill is based upon a comparison of the carrying value of goodwill with its estimated fair value. The Company reviews goodwill for impairment in the third quarter every year in accordance with ASC Topic 350 and whenever events or changes in circumstances indicate the carrying value of goodwill may not be recoverable. Refer to Note 7, Goodwill and Other Intangibles for more information.

The Company has two reportable segments with three underlying reporting units. Refer to Note 16, Segment and Geographic Information for more information on reportable segments.

When the Company acquires a business, the assets acquired, including IPR&D, and liabilities assumed are recorded at their respective fair values as of the acquisition date. The Company's policy defines IPR&D as the fair value of those projects for which the related products have not received regulatory approval and have no alternative future use. Determining the fair value of intangible assets, including IPR&D, acquired as part of a business combination requires the Company to make significant estimates. These estimates include the amount and timing of projected future cash flows, the discount rate used to discount those cash flows to present value, the assessment of the asset’s life cycle, and the consideration of legal, technical, regulatory, economic, and competitive risks. The fair value assigned to other intangible assets is determined by estimating the future cash flows of each project or technology and discounting the net cash flows back to their present values. The discount rate used is determined at the time of measurement in accordance with accepted valuation methodologies.

IPR&D acquired in a business combination is capitalized as an indefinite-lived intangible asset. Development costs incurred after the acquisition are expensed as incurred. Upon receipt of regulatory approval, the indefinite-lived intangible asset is then accounted for as a finite-lived intangible asset and amortized on a straight-line basis or accelerated basis, as appropriate, over its estimated useful life. If the research and development project is subsequently abandoned, the indefinite-lived intangible asset is charged to expense. IPR&D acquired outside of a business combination is expensed immediately.

Due to the uncertainty associated with research and development projects, there is risk that actual results will differ materially from the original cash flow projections and that the research and development project will result in a successful commercial product. The risks associated with achieving commercialization include, but are not limited to, delay or failure to obtain regulatory approvals to conduct clinical trials, delay or failure to obtain required market clearances, delays or issues with patent issuance, or validity and litigation.

Other intangible assets include patents, trademarks, purchased technology, and supplier and customer relationships. Identifiable intangible assets are initially recorded at fair market value at the time of acquisition generally using an income or cost approach. The Company capitalizes costs incurred to renew or extend the term of recognized intangible assets and amortizes those costs over their expected useful lives.

LONG-LIVED ASSETS

Long-lived assets held and used by the Company, including property, plant and equipment, intangible assets, and leases are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. For purposes of evaluating the recoverability of long-lived assets to be held and used, a recoverability test is performed using projected undiscounted net cash flows applicable to the long-lived assets. If an impairment exists, the amount of such impairment is calculated based on the estimated fair value of the asset. Impairments to long-lived assets to be disposed of are recorded based upon the difference between the carrying value and the fair value of the applicable assets.

INTEGRA FOUNDATION

The Company may periodically make contributions to the Integra Foundation, Inc. The Integra Foundation was incorporated in 2002 exclusively for charitable, educational, and scientific purposes and qualifies under IRC 501(c)(3) as an exempt private foundation. Under its charter, the Integra Foundation engages in activities that promote health, the diagnosis and treatment of disease, and the development of medical science through grants, contributions and other appropriate means. The Integra Foundation is a separate legal entity and is not a subsidiary of the Company; therefore, its results are not included in these consolidated financial statements. The Company contributed $0.3 million, $0.8 million and $0.5 million to the Integra Foundation during the years ended December 31, 2019, 2018 and 2017, respectively. These contributions were recorded in selling, general, and administrative expense.

DERIVATIVES

The Company develops, manufactures, and sells medical devices globally, and its earnings and cash flows are exposed to market risk from changes in interest rates and currency exchange rates. The Company addresses these risks through a risk management program that includes the use of derivative financial instruments and operates the program pursuant to documented corporate risk management policies. All derivative financial instruments are recognized in the financial statements at fair value in accordance with the authoritative guidance. Under the guidance, for those instruments that are designated and qualify as hedging instruments, the hedging instrument must be designated as a fair value hedge, cash flow hedge, or a hedge of a net investment in a foreign operation, based on the exposure being hedged. The accounting for changes in the fair value of a derivative instrument depends on whether it has been designated and qualifies as part of a hedging relationship and, further, on the type of hedging relationship. The Company's derivative instruments do not subject its earnings or cash flows to material risk, and gains and losses on these derivatives generally offset losses and gains on the item being hedged. The Company has not entered into derivative transactions for speculative purposes and from time to time, the Company may enter into derivatives that are not designated as hedging instruments in order to protect itself from currency volatility due to intercompany balances.

All derivative instruments are recognized at their fair values as either assets or liabilities on the balance sheet. The Company determines the fair value of its derivative instruments, using the framework prescribed by the authoritative guidance, by considering the estimated amount the Company would receive to sell or transfer these instruments at the reporting date and by taking into account: expected forward interest rates, currency exchange rates, the creditworthiness of the counterparty for assets, and its creditworthiness for liabilities. In certain instances, the Company utilizes a discounted cash flow model to measure fair value. Generally, the Company uses inputs that include quoted prices for similar assets or liabilities in active markets, other observable inputs for the asset or liability and inputs derived principally from, or corroborated by, observable market data by correlation or other means. The Company has classified all of its derivative assets and liabilities within Level 2 of the fair value hierarchy because observable inputs are available for substantially the full term of its derivative instruments. The Company classifies derivatives designated as hedges in the same category as the item being hedged for cash flow presentation purposes.

The Company entered into a foreign currency forward contract that is not designated as a hedging instrument for accounting purposes. This contract is recorded at fair value, with the changes in fair value recognized into other income, net on the consolidated financial statements. Refer to Note 6, Derivative Instruments for more information.

FOREIGN CURRENCY

All assets and liabilities of foreign subsidiaries which have a functional currency other than the U.S. dollar are translated at the rate of exchange at year-end, while elements of the income statement are translated at the average exchange rates in effect during the year. The net effect of these translation adjustments is shown as a component of accumulated other comprehensive income (loss). These currency translation adjustments are not currently adjusted for income taxes as they relate to permanent investments in non-U.S. subsidiaries. Foreign currency transaction loss of $0.3 million, $1.7 million and $2.9 million are reported in other income, net in the statements of operations, for the year ended December 31, 2019, 2018 and 2017, respectively.

INCOME TAXES

Income taxes are accounted for by using the asset and liability method. Deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. A valuation allowance is provided when it is more likely than not that some portion

or all of the deferred tax assets will not be realized. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period when the change is enacted.

The Company recognizes a tax benefit from an uncertain tax position only if it is more likely than not to be sustained upon examination based on the technical merits of the position. Reserves are established for positions that don't meet this recognition threshold. The reserve is measured as the largest amount of benefit determined on a cumulative probability basis that the Company believes is more likely than not to be realized upon ultimate settlement of the position. These reserves are classified as long-term liabilities in the consolidated balance sheets of the Company, unless the reserves are expected to be paid in cash during the next twelve months, in which case they are classified as current liabilities. The Company also records interest and penalties accrued in relation to uncertain tax benefits as a component of income tax expense.

While the Company believes it has identified all reasonably identifiable exposures and the reserve it has established for identifiable exposures is appropriate under the circumstances, it is possible that additional exposures exist and that exposures may be settled at amounts different than the amounts reserved. It is also possible that changes in facts and circumstances could cause the Company to either materially increase or reduce the carrying amount of its tax reserve.

The Company continues to indefinitely reinvest substantially all of its foreign earnings. The current provisional analysis indicates that the Company has sufficient U.S. liquidity, including borrowing capacity, to fund foreseeable U.S. cash needs without requiring the repatriation of foreign cash. The Tax Cuts and Jobs Act (the “2017 Tax Act”), enacted in December 2017, imposed a toll tax on a deemed repatriation of undistributed earnings of foreign subsidiaries. One time or unusual items that may impact the ability or intent to keep the foreign earnings and cash indefinitely reinvested include significant U.S. acquisitions, loans from a foreign subsidiary, changes in tax laws.

On December 22, 2017, the SEC staff issued Staff Accounting Bulletin No. 118 to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the 2017 Tax Act. The Company recognized the provisional tax impacts related to deemed repatriated earnings and the revaluation of deferred tax assets and liabilities and included these amounts in its consolidated financial statements for the year ended December 31, 2017. The Company applied the guidance of SAB No. 118 when accounting for the enactment date effects of the 2017 Tax Act in 2017 and throughout 2018. The Company finalized its calculations and completed its accounting for the income tax effect of the 2017 Tax Act in December 2018.

REVENUE RECOGNITION

On January 1, 2018, the Company adopted Topic 606 using the modified retrospective method applied to all contracts which were not completed as of January 1, 2018. Results of operations for the reporting periods after January 1, 2018 are presented under Topic 606, while prior period amounts are not adjusted and continue to be reported in accordance with Topic 605, Revenue Recognition. The adoption of Topic 606 resulted in an increase to the opening retained earnings of $1.9 million, which was recorded net of taxes as of January 1, 2018 to reflect the change in timing of the recognition of revenue related to the Company's private label business from point in time to over time during the manufacturing process and goods in transit for which control was transferred to customers at the time of shipment. The total assets and liabilities increased by $7.1 million and $5.2 million, respectively, as of January 1, 2018.

Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services.

Total revenue, net, includes product sales, product royalties and other revenues, such as fees received from services.

For products shipped with FOB shipping point terms, the control of the product passes to the customer at the time of shipment. For shipments in which the control of the product is transferred when the customer receives the product, the Company recognizes revenue upon receipt by the customer. Certain products that the Company produces for private label customers have no alternative use and the Company has a right of payment for performance to date. Revenues from those products are recognized over the period that the Company manufactures these products, which is typically one to three months. The Company uses the input method to measure the manufacturing activities completed to date, which depicts the progress of the Company's performance obligation of transferring control of goods being manufactured for private label customers.

A portion of the Company's product revenue is generated from consigned inventory maintained at hospitals and distributors, and also from inventory physically held by field sales representatives. For these types of products sales, the Company retains control until the product has been used or implanted, at which time revenue is recognized.

Revenues from sale of products and services are evidenced by either a contract with the customer or a valid purchase order and an invoice which includes all relevant terms of sale. For product sales, invoices are generally issued upon the transfer of control (or upon the completion of the manufacturing in the case of the private label transactions recognized over time) and are typically payable 30 days after the invoice date. The Company performs a review of each specific customer's creditworthiness and ability to pay prior to acceptance as a customer. Further, the Company performs periodic reviews of its customers' creditworthiness prospectively. Refer to Note 3, Revenue From Contracts With Customers for more information.

RESEARCH AND DEVELOPMENT

Research and development costs, including salaries, depreciation, consultant and other external fees, and facility costs directly attributable to research and development activities, are expensed in the period in which they are incurred.

EMPLOYEE TERMINATION BENEFITS

The Company does not have a written severance plan, and it does not offer similar termination benefits to affected employees in all restructuring initiatives. Accordingly, in situations where minimum statutory termination benefits must be paid to the affected employees, the Company records employee severance costs associated with these restructuring activities in accordance with the authoritative guidance for non-retirement post-employment benefits. Charges associated with these activities are recorded when the payment of benefits is probable and can be reasonably estimated. In all other situations where the Company pays out termination benefits, including supplemental benefits paid in excess of statutory minimum amounts and benefits offered to affected employees based on management's discretion, the Company records these termination costs in accordance with the authoritative guidance for ASC Topic 712 Compensation-Nonretirement Benefits and ASC Topic 420 One-time Employee Termination Benefits.

The timing of the recognition of charges for employee severance costs other than minimum statutory benefits depends on whether the affected employees are required to render service beyond their legal notification period in order to receive the benefits. If affected employees are required to render service beyond their legal notification period, charges are recognized over the future service period. Otherwise, charges are recognized when management has approved a specific plan and employee communication requirements have been met.

STOCK-BASED COMPENSATION

The Company applies the authoritative guidance for stock-based compensation. This guidance requires companies to recognize the expense related to the fair value of their stock-based compensation awards. Stock-based compensation expense for stock option awards are based on the grant date fair value using the binomial distribution model. The Company recognizes compensation expense for stock option awards, restricted stock awards, performance stock awards and contract stock awards over the requisite service period of the award. All excess tax benefits and taxes and tax deficiencies from stock-based compensation are included in provision for income taxes in the consolidated statement of operations. Refer to Note 9, Stock-based Compensation for more information.

PENSION BENEFITS

The Company maintains defined benefit pension plans that cover certain employees in Austria, France, Japan, Germany and Switzerland. Various factors are considered in determining the pension liability, including the number of employees expected to be paid their salary levels and years of service, the expected return on plan assets, the discount rate used to determine the benefit obligations, the timing of benefit payments and other actuarial assumptions.

Retirement benefit plan assumptions are reassessed on an annual basis or more frequently if changes in circumstances indicate a re-evaluation of assumptions are required. The key benefit plan assumptions are the discount rate and expected rate of return on plan assets. The discount rate is based on average rates on bonds that matched the expected cash outflows of the benefit plans. The expected rate of return is based on historical and expected returns on the various categories of plan assets.

The Company uses the corridor approach in measuring the amount of net periodic benefit pension cost to recognize each period. The corridor approach defers all actuarial gains and losses resulting from variances between actual results and actuarial assumptions. Those unrecognized gains and losses are amortized when the net gains and losses exceed 10% of the greater of the market-related value of plan assets or the projected benefit obligation at the beginning of the year. The amount in excess of the corridor is amortized over the average remaining service period to retirement date of active plan participants.

CONCENTRATION OF CREDIT RISK

Financial instruments, which potentially subject the Company to concentrations of credit risk, consist principally of cash and cash equivalents, which are held at major financial institutions, investment-grade marketable debt securities and trade receivables.

The Company's products are sold on an uncollateralized basis and on credit terms based upon a credit risk assessment of each customer. A portion of the Company's trade receivables to customers outside the United States includes sales to foreign distributors, who then sell to government owned or supported healthcare systems.

None of the Company's customers accounted for 10% or more of the consolidated net sales during the years ended December 31, 2019, 2018 and 2017.

RECENT ACCOUNTING PRONOUNCEMENTS

In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) (the New Lease Standard). The New Lease Standard requires that lessees recognize virtually all of its leases on the balance sheet by recording a right-of-use asset and lease liability (other than leases that meet the definition of a "short-term lease"). This update became effective for all annual periods and interim reporting periods beginning after December 15, 2018.

The Company adopted the New Lease Standard as of January 1, 2019 using a modified retrospective transition. Under this method, financial results reported in periods prior to January 1, 2019 are unchanged. The Company elected the ‘package of practical expedients’ which permits the Company not to reassess the prior conclusions about lease identification, lease classification and initial direct costs under the new standard. The Company also elected the use-of-hindsight practical expedient. As most of the leases do not provide an implicit rate, the Company used the collateralized incremental borrowing rate based on the information available at the lease implementation date in determining the present value of the lease payments. The adoption of the New Lease Standard had an initial impact on the consolidated balance sheet due to the recognition of $76.4 million of lease liabilities with corresponding right-of-use assets ("ROU") of $67.3 million for operating leases. The difference between lease liabilities and right-of-use assets is primarily attributed to unamortized lease incentives which is amortized over the term of each respective lease. Refer to Note 11, Leases and Related Party Leases for more information.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The Company will adopt ASU 2016-13 effective January 1, 2020 utilizing a modified retrospective method of transition. The adoption of this guidance will not have a significant impact on the Company's consolidated financial statements and related disclosures.

In August 2018, the FASB issued ASU No. 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under the new guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The Company will adopt ASU 2018-15 effective January 1, 2020 utilizing a prospective method of transition. The adoption of this guidance will not have a significant impact on the Company's consolidated financial statements and related disclosures.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes: Simplifying the Accounting for Income Taxes intended to simplify the accounting for income taxes by eliminating certain exceptions related to the approach for intraperiod tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. The new guidance also simplifies aspects of the accounting for franchise taxes and enacted changes in tax laws or rates and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The standard is effective for annual periods beginning after December 15, 2020 and interim periods within, with early adoption permitted. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The Company is currently assessing the impact of this standard on the financial condition and results of operations.

There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.

SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION

Cash paid for interest during the years ended December 31, 2019, 2018 and 2017 was $48.9 million (net of $3.1 million that was capitalized into construction in progress), $58.3 million (net of $2.3 million that was capitalized into construction in progress) and $32.3 million (net of $1.1 million that was capitalized into construction in progress), respectively.

Cash paid for income taxes, net of refunds, for the years ended December 31, 2019, 2018 and 2017 was $16.2 million, $10.4 million and $14.6 million, respectively.

NON-CASH INVESTING AND FINANCING ACTIVITIES

During the fourth quarter of 2019, the Company achieved the first developmental milestone which triggered a $5.0 million obligation to be paid to former shareholders of Rebound. In addition, the Company recorded $5.0 million as in-process research and development expense in the consolidated statements of operations. The obligation was included in accrued liabilities at December 31, 2019 in the consolidated balance sheets. The milestone was paid during the first quarter of 2020.

Property and equipment purchases included in liabilities at December 31, 2019, 2018 and 2017 were $11.0 million, $5.4 million and $7.8 million, respectively.

During the year ended December 31, 2017, the Company issued 2.8 million shares of common stock due to the exercise of 8.7 million warrants associated with convertible notes issued in 2011.

REVENUES FROM CONTRACTS WITH CUSTOMERS

12 Months Ended

Dec. 31, 2019

Revenue from Contract with Customer [Abstract]

REVENUES FROM CONTRACTS WITH CUSTOMERS

Summary of Accounting Policies on Revenue Recognition

Performance Obligations

The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers.

Significant Judgments

Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant.

The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract.

The Company's return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days.

The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the goods or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers.

Contract Asset and Liability

Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet.

Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability.

The following table summarized the changes in the contract asset and liability balances for the year ended December 31, 2019:



		Total
	(amounts in thousands)
Contract Asset
Contract asset, January 1, 2019		$	4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset		(4,193		)
Contract asset, net of transferred to trade receivables on contracts during the period		8,680
Contract asset, December 31, 2019		$	8,680

Contract Liability
Contract liability, January 1, 2019		$	12,716
Recognition of revenue included in beginning of year contract liability		(5,613		)
Contract liability, net of revenue recognized on contracts during the period		4,872
Foreign currency translation		(29		)
Contract liability, December 31, 2019		$	11,946

At December 31, 2019, the short-term portion of the contract liability of 4.8 million and the long-term portion of 7.1 million were included in accrued expenses and other current liabilities and other liabilities in the consolidated balance sheet.

As of December 31, 2019, the Company is expected to recognize revenue of approximately $4.8 million in 2020, $2.8 million in 2021, $1.9 million in 2022, $0.8 million in 2023, $0.5 million in 2024, and $1.2 million thereafter.

Shipping and Handling Fees

The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in the cost of goods sold.

Product Warranties

Certain of the Company's medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet.

Taxes Collected from Customers

The Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer.

Disaggregated Revenue

The following table presents revenues disaggregated by the major sources of revenues for years-ended December 31, 2019, 2018 and 2017 (amounts in thousands):



	Year Ended December 31, 2019		Year Ended December 31, 2018		Year Ended December 31, 2017
	(amounts in thousands)
Neurosurgery	707,011		684,148		446,994
Precision Tools and Instruments	289,195		$	279,781	$	273,307
Total Codman Specialty Surgical	996,206		963,929		720,301

Wound Reconstruction	322,739		311,565		274,398
Extremity Orthopedics	90,082		90,588		93,546
Private Label	108,530		106,359		99,991
Total Orthopedics and Tissue Technologies	521,351		508,512		467,935
Total revenue	$	1,517,557	$	1,472,441	$	1,188,236

See Note 16, Segment and Geographical Information, for details of revenues based on the location of the customer.

Effect of Adoption of ASC Topic 606

On January 1, 2018, the Company adopted Topic 606 using the modified retrospective method. Results of operations for the reporting periods after January 1, 2018 are presented under Topic 606, while prior period amounts are not adjusted and continue to be reported in accordance with Topic 605, Revenue Recognition.

The adoption of Topic 606 resulted in an increase to the opening retained earnings of $1.9 million, which was recorded net of taxes as of January 1, 2018 to reflect the change in timing of the recognition of revenue related to the Company's private label business from point in time to over time during the manufacturing process and goods in transit for which control was transferred to customers at the time of shipment. Total assets and liabilities increased by $7.1 million and $5.2 million, respectively, as of January 1, 2018.

The impact of adoption of Topic 606 to the Company's consolidated statement of operations for the year ended December 31, 2018 was as follows:



	Year Ended December 31, 2018
	As Reported			Excluding Impact of Topic 606
	(Amounts in thousands)
Statement of Operations
Total revenue, net	$	1,472,441		$	1,468,075
Cost of goods sold	571,496			570,028
Income tax benefit	(3,398		)	(4,119		)
Net income	60,801			58,624

ACQUISITIONS AND PRO FORMA RESULTS

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

ACQUISITIONS AND PRO FORMA RESULTS

Arkis BioSciences Inc.

On July 29, 2019, the Company acquired Arkis BioSciences Inc. ("Arkis") for an acquisition purchase price of $30.9 million (the "Arkis Acquisition") plus contingent consideration of up to $25.5 million, that may be payable based on the successful completion of certain development and commercial milestones. The contingent consideration had an acquisition date fair value of $13.1 million. Arkis was a privately-held company that marketed the CerebroFlo® external ventricular drainage (EVD) catheter with Endexo® technology, a permanent additive designed to reduce the potential for catheter obstruction due to thrombus formation.

Assets Acquired and Liabilities Assumed at Fair Value

The Arkis Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination to be recognized at their fair values as of the acquisition date. As of December 31, 2019, certain amounts relating to tax related matters have not been finalized. The finalization of these matters could result in changes to goodwill.

The following table summarizes the fair values of the assets acquired and liabilities assumed at the acquisition date:



	Preliminary Valuation as of December 31, 2019		Weighted Average Life
	(Dollars in thousands)
Cash	$	90
Other current assets	751
Property, plant and equipment	159
Deferred Tax Assets	1,535
Intangible assets:
CerebroFlo developed Technology	20,100		15 years
Enabling technology license	1,980		14 years
Goodwill	27,600
Total assets acquired	52,215

Accounts Payable, accrued expenses and other liabilities	2,926
Contingent consideration	13,100
Deferred tax liabilities	5,305
Net assets acquired	$	30,884

Intangible Assets

The estimated fair value of the intangible assets was determined using the income approach, which is a valuation technique that provides an estimate of the fair value of an asset based on market participant expectations of the cash flows an asset would generate over its remaining useful life. Some of the more significant assumptions inherent in the development of those asset valuations include the estimated net cash flows for each year for each asset (including net revenues, cost of sales, R&D costs, selling and marketing costs, and working capital/contributory asset charges), the appropriate discount rate to select in order to

measure the risk inherent in each future cash flow stream, the assessment of each asset’s life cycle, and competitive trends impacting the asset and each cash flow stream.

The Company used a discount rate of 14.5% to arrive at the present value for the acquired intangible assets to reflect the rate of return a market participant would expect to earn and incremental commercial uncertainty in the cash flow projections. No assurances can be given that the underlying assumptions used to prepare the discounted cash flow analysis will not change. For these and other reasons, actual results may vary significantly from estimated results.

Goodwill

The Company allocated goodwill related to the Arkis Acquisition to the Codman Specialty Surgical segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. One of the key factors that contributes to the recognition of goodwill, and a driver for the Company's acquisition of Arkis, is the planned expansion of the Endexo technology with the existing products within the Codman Specialty Surgical segment. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

Contingent Consideration

The Company determines the acquisition date fair value of contingent consideration obligations based on a probability-weighted income approach derived from revenue estimates and a probability assessment with respect to the likelihood of achieving contingent obligations. The fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined using the fair value concepts in ASC 820. The resultant probability-weighted cash flows are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligation will be revalued to estimated fair value and changes in fair value will be reflected as income or expense in our consolidated statement of operations. Changes in the fair value of the contingent consideration obligations may result from changes in discount periods and rates, changes in the timing and amount of revenue estimates and changes in probability assumptions with respect to the likelihood of achieving the various contingent payment obligations. Adverse changes in assumptions utilized in the contingent consideration fair value estimates could result in an increase in the contingent consideration obligation and a corresponding charge to operating results.

As part of the acquisition, the Company is required to pay the former shareholders of Arkis up to $25.5 million based on the timing of certain development milestones of $10 million and commercial sales milestones of $15.5 million, respectively. The Company used a probability weighted income approach to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specified milestone. The Company estimated the fair value of the contingent consideration to be $13.1 million at the acquisition date. The estimated the fair value as of December 31, 2019 was $14.2 million. This amount is included in other liabilities at December 31, 2019 in the consolidated balance sheets of the Company.

Deferred Tax Liabilities

Deferred tax liabilities result from identifiable intangible assets’ fair value adjustments. These adjustments create excess book basis over tax basis which is tax-effected by the statutory tax rates of applicable jurisdictions.

The pro forma results are not presented for this acquisition as they are not material.

Rebound Therapeutics Corporation

On September 9, 2019, the Company acquired Rebound Therapeutics Corporation (“Rebound”), developers of a single-use medical device known as the AURORA Surgiscope® System ("Aurora") which enables minimally invasive access, using optics and illumination, for visualization, diagnostic and therapeutic use in neurosurgery (the “Rebound transaction”). Under the terms of the Rebound transaction, the Company made an upfront payment of $67.1 million and are committed to pay up to $35.0 million of contingent development milestones upon achievement of certain regulatory milestones. The acquisition of Rebound was primarily concentrated in one single identifiable asset and thus, for accounting purposes, the Company has concluded that the acquired assets do not meet the accounting definition of a business. The initial payment was allocated primarily to Aurora, resulting in a $59.9 million in-process research and development expense. The balance of approximately $7.2 million, which included $2.1 million of cash and cash equivalents and a net deferred tax asset of $4.2 million, was allocated to the remaining net assets acquired. The deferred tax asset primarily resulted from a federal net operating loss carry forward.

During the fourth quarter of 2019, the Company achieved the first developmental milestone which triggered a $5.0 million obligation to be paid to former shareholders of Rebound. The Company recorded $5.0 million as in-process research and development expense in the consolidated statements of operations. The obligation was included in accrued expenses and other current liabilities at December 31, 2019 in the consolidated balance sheets. The milestone was paid during the first quarter of 2020.

Integrated Shoulder Collaboration, Inc.

On January 4, 2019, the Company entered into a licensing agreement with Integrated Shoulder Collaboration, Inc ("ISC"). Under the terms of the agreement, the Company paid ISC $1.7 million for the exclusive, worldwide license to commercialize its short stem and stemless shoulder system. A patent related to short stem and stemless shoulder systems was issued to ISC during the first quarter of 2019. ISC is eligible to receive royalties on sales of the short stem and stemless shoulder system. The Company has the option to acquire ISC at a date four years subsequent to the first commercial sale, which becomes mandatory upon the achievement of a certain sales thresholds of the short stem and stemless shoulder system, for an amount not to exceed $80.0 million. The transaction was accounted for as an asset acquisition as the Company concluded that it acquired primarily one asset. The total upfront payment of $1.7 million was expensed as a component of research and development expense and the future milestone and option payments will be recorded if the corresponding events become probable.

Johnson & Johnson's Codman Neurosurgery Business

On February 14, 2017, the Company entered into a binding offer letter (the “Offer Letter”) with DePuy Synthes, Inc., a Delaware corporation (“DePuy Synthes”), a wholly-owned subsidiary of Johnson & Johnson, pursuant to which Integra made a binding offer to acquire certain assets, and assume certain liabilities, of Johnson & Johnson’s Codman neurosurgery business (the “Codman Acquisition”). The assets and liabilities subject to the proposed Codman Acquisition relate to the research, development, manufacturing, marketing, distribution and sale of certain products used in connection with neurosurgery procedures. The purchase price for the Codman Acquisition was $1.014 billion.

The Codman Acquisition was accounted for using the acquisition method of business combination under ASC 805, Business Combinations. This method requires that assets acquired and liabilities assumed in a business combination be recognized at their fair values as of the acquisition date. During the third quarter of 2018, the Company completed the purchase accounting for the Codman Acquisition.

In connection with the closing of the Codman Acquisition, the Company and DePuy Synthes entered into certain additional ancillary agreements, including transition services agreements, a transition manufacturing services agreement and certain other customary agreements. Amounts accrued and due to DePuy Synthes as of December 31, 2019 and 2018 were $2.1 million and $22.8 million, respectively.

The revenue and net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it has been integrated into the Company's operations.

The following table summarizes the final fair values of the assets acquired and liabilities assumed at the acquisition date and reflects measurement period adjustments subsequent to the acquisition date:



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Inventory	74,962
Assets held for sale	30,813
Other current assets	8,202
Property, plant and equipment	41,339
Intangible assets:
Codman corporate trade name	162,900		Indefinite
Completed technology	375,200		22 years
Goodwill	342,322
Total assets acquired	1,035,738
Accrued expenses	1,730
Pension liabilities	19,917
Net assets acquired	$	1,014,091

During 2018, the Company received cash of $26.7 million from DePuy Synthes related to working capital adjustments, which was recorded within investing activities on the consolidated statements of cash flows.

The Company recorded measurement period adjustments to goodwill totaling $4.0 million. During the first half of 2018, the Company adjusted goodwill by $3.2 million because of working capital adjustments of $6.2 million that were offset by inventory adjustments of $3.0 million. During the third quarter 2018, the Company adjusted goodwill by $0.8 million after finalizing the valuation step up of property, plant and equipment of $5.5 million. The adjustment for property, plant and equipment was offset by completed technology intangible asset adjustments of $4.7 million.

During the first three quarters of 2018, the Company paid $15.9 million for inventory that was included in the initial purchase accounting. The payment was included within financing activities on the consolidated statements of cash flows.

The Company recorded $17.3 million in cost of goods sold related to fair value inventory purchase accounting adjustments for the year ended December 31, 2018.

Goodwill was allocated to the Codman Specialty Surgical segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. Goodwill recognized as a result of the acquisition is generally deductible for income tax purposes.

In the fourth quarter of 2017, the Company wrote-off construction in progress of $6.3 million related to a project acquired from Codman Neurosurgery that the Company decided to discontinue after the Codman Acquisition.

Derma Sciences

On February 24, 2017, the Company executed the Agreement and Plan of Merger (the "Merger Agreement") under which the Company acquired all of the outstanding shares of Derma Sciences, Inc., a Delaware corporation ("Derma Sciences") for an aggregate purchase price of approximately $210.8 million, including payment of certain of Derma Sciences' closing expenses and settlement of stock-based compensation plans of $4.8 million and $4.3 million, respectively. The purchase price consisted of a cash payment to the former shareholders of Derma Sciences of approximately $201.7 million upon the closing of the transaction.

Derma Sciences is a tissue regeneration company focused on advanced wound and burn care that offers products to help manage chronic and hard-to-heal wounds, especially those resulting from diabetes and poor vascular functioning.

The revenue and net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it has been integrated into the Company's operations.

The Derma Sciences acquisition was accounted for using the acquisition method of business combination under ASC 805, Business Combinations. This method requires that assets acquired and liabilities assumed in a business combination be recognized at their fair values as of the acquisition date.

The following table summarizes the final fair values of the assets acquired and liabilities assumed at the acquisition date and reflects purchase accounting adjustments subsequent to the acquisition date:



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Cash and cash equivalents	$	16,512
Short-term investments	19,238
Accounts receivable	8,949
Inventory	17,977
Prepaid expenses and other current assets	4,369
Property, plant and equipment	4,311
Intangible assets:
Customer relationship	78,300		14 years
Trademarks/brand names	13,500		15 years
Completed technology	11,600		14 years
Non-compete agreement	280		1 year
Goodwill	73,765
Deferred tax assets	14,524
Other assets	101
Total assets acquired	263,426
Accounts payable	4,560
Accrued expenses and other current liabilities	7,409
Contingent liability	37,174
Other liabilities	3,805
Net assets acquired	$	210,478

Goodwill related to the Derma Sciences acquisition was allocated to the Orthopedics and Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is not deductible for income tax purposes. During the first quarter of 2018, the Company completed its purchase accounting of Derma Sciences.

Short-term Investments

Short-term investments recognized at the acquisition date of Derma Sciences are investments in equity and debt securities including certificates of deposit purchased with an original maturity greater than three months which are deposited in various U.S. financial institutions and are fully insured by the Federal Deposit Insurance Corporation. The Company considers securities with original maturities of greater than 90 days to be available for sale securities. Securities under this classification are recorded at fair value and unrealized gains and losses are recorded within accumulated other comprehensive income. The estimated fair value of the available for sale securities is determined based on quoted market prices. The Company evaluates securities with unrealized losses to determine whether such losses, if any, are other than temporary. Short-term investments are classified as Level 1 in fair value hierarchy. Fair values of short-term investments are determined using the unadjusted quoted prices in active markets for identical assets or liabilities that the Company has the ability to access at the balance sheet date.

In the second quarter of 2017, the Company sold the acquired short-term investments and recognized a realized loss of $2.3 million included in other income, net in the consolidated statement of operations.

Deferred Taxes

The acquired deferred taxes of $14.5 million include a deferred tax asset of $39.7 million related to a federal net operating loss which the Company expects to utilize against income in future periods and a deferred tax asset of $16.4 million related to intangibles acquired by Derma Sciences in previous periods, offset by a deferred tax liability of $41.1 million for new intangibles for which the Company will not receive a tax benefit and deferred tax liability $0.5 million related to various deferred items. In the second quarter of 2017, the Company decreased the preliminary estimated value of the net deferred tax assets by $1.5 million to reflect adjustments to preliminary estimated fair values of assets and liabilities acquired. In fourth quarter of 2017, the Company decreased the preliminary value of the deferred tax asset by $3.3 million to reflect returns filed for periods prior to the acquisition date and adjustments for expected effective state tax rates.

United States Food and Drug Administration ("FDA") Untitled Letter

On June 22, 2015, the FDA issued an Untitled Letter (the "Untitled Letter") alleging that BioD morselized amniotic membrane based products do not meet the criteria for regulation as human cellular tissue-based products (“HCT/Ps”) solely under Section 361 of the Public Health Service Act and that, as a result, BioD would need a biologics license to lawfully market those morselized products. Since the issuance of the Untitled Letter, BioD and more recently, the Company have been in discussion with the FDA to communicate its disagreement with the FDA’s assertion that certain products are more than minimally manipulated. The FDA has not changed its position that certain of the BioD acquired products are not eligible for marketing solely under Section 361.

In November 2017, the FDA issued the final guidance document related to human tissue titled, “Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use” (the “HCT/P Final Guidance”). The HCT/P Final Guidance maintains the FDA’s position that products such as the Company’s morselized amniotic membrane tissue-based products do not meet the criteria for regulation solely as HCT/Ps. In addition, the FDA articulated a risk-based approach to enforcement and, while some uses for amniotic membrane tissue-based products would enjoy as much as thirty-six months of enforcement discretion, other high risk uses could be subject to immediate enforcement action. The Company does not believe the uses for its amniotic membrane tissue-based products fall into the high-risk category. As of February 21, 2020, the Company has not received any further notice of enforcement action from the FDA regarding its morselized amniotic tissue-based products. Nonetheless, the Company can make no assurances that the FDA will continue to exercise its enforcement discretion with respect to the Company’s amniotic membrane tissue-based products, and any potential action of the FDA could have a financial impact regarding the sales of such products. The Company has been evaluating and is considering regulatory approval pathways for its morselized amniotic membrane tissue-based products.

Revenues from BioD morselized amniotic material-based products for the year ended December 31, 2019 were less than 1.0% of consolidated revenues.

Contingent Consideration

The Company assumed contingent consideration incurred by Derma Sciences, Inc. ("Derma Sciences") related to its acquisitions of BioD and the intellectual property related to Medihoney products. The Company accounted for the contingent liabilities by recording their fair value on the date of the acquisition based on a probability weighted income approach. The Company has paid $33.3 million related to the aforementioned contingent liabilities. One contingent liability remains which relates to net sales of Medihoney products exceeding certain amounts defined in the agreement between the Company and Derma Sciences. The potential maximum undiscounted payment amounts to $3.0 million. The estimated fair value as of December 31, 2019 and December 31, 2018 was $0.2 million included in other liabilities, in the consolidated balance sheets.

Pro Forma Results (unaudited)

The following unaudited pro forma financial information summarizes the results of operations for the years ended December 31, 2017 for the acquisitions of Codman Neurosurgery, Derma Sciences and divestiture to Natus, which were completed by the Company during 2017 had been completed as of the beginning of 2017. The pro forma results are based upon certain assumptions and estimates, and they give effect to actual operating results prior to the acquisitions and adjustments to reflect (i) the change in interest expense, depreciation expense, intangible asset amortization and fair value inventory step-up, (ii) timing of recognition for certain expenses that will not be recurring in the post-acquisition period, which includes $2.9 million incurred by Derma Sciences prior to acquisition and $24.9 million incurred by Integra, (iii) gain from the sale of business of $2.6 million related to the Divestiture to Natus, and (iv) income taxes at a rate consistent with the Company’s statutory rate at the date of the acquisitions. No effect has been given to other cost reductions or operating synergies. As a result, these pro forma results do not necessarily represent results that would have occurred if the acquisitions had taken place on the basis assumed above, nor are they indicative of the results of future combined operations.



	Year Ended December 31, 2017
	(Pro forma)
	(In thousands except per share amounts)
Total revenue from continuing operations	$	1,428,491
Net income from continuing operations	$	81,730

Basic earnings per share from continuing operations	$	1.06

Divestiture to Natus

On September 8, 2017, to facilitate the acquisition of the Codman Neurosurgery Business, the Company and certain of its subsidiaries entered into an asset purchase agreement (the “Divestiture Agreement”) with Natus Medical Incorporated (“Natus”), pursuant to which the Company agreed to divest its Camino® Intracranial Pressure monitoring and the U.S. rights to its fixed pressure shunts

businesses within its Codman Specialty Surgical segment together with certain neurosurgery assets acquired as part of the Codman Acquisition, which includes Codman U.S. dural graft implant, external ventricular drainage catheter and cerebrospinal fluid collection systems businesses (the “Divestiture”). The Divestiture Agreement was entered into in connection with the review of the Codman Acquisition by the Federal Trade Commission and the antitrust authority of Spain.

On October 6, 2017, upon the terms and subject to the conditions of the Divestiture Agreement, the Divestiture was completed and Natus paid an aggregate purchase price of $46.4 million.

Assets and liabilities divested consisted of the following as of October 6, 2017 (amounts in thousands):



Inventories	$	8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets divested	$	43,180

Deferred revenue	$	1,082
Accrued compensation	209
Total liabilities divested	$	1,291

Assets held for sale includes assets and liabilities related to U.S. dural graft implant, external ventricular drainage catheters and cerebrospinal fluid collection systems businesses acquired as part of acquisition of Codman Neurosurgery.

The transitional supply agreement with Natus requires the Company to provide to Natus certain assets defined in the transitional supply agreement upon termination. The Company recognized a liability of $1.3 million, included in other liabilities in consolidated balance sheet, related to estimated cost of assets to be provided to Natus upon termination of transitional supply agreement.

The Divestiture does not represent a strategic shift that will have a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method. The Company recognized a gain on sale of business of $2.6 million included in other income, net in its consolidated statement of operations for the year ended December 31, 2017.

DEBT

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

DEBT

Fifth Amended and Restated Senior Credit Agreement

On May 3, 2018, the Company entered into the fifth amendment and restatement (the "May 2018 Amendment") of its Senior Credit Facility (the "Senior Credit Facility") with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The May 2018 Amendment extended the maturity date to May 3, 2023 and decreased the applicable rate, as described below. The Company continues to have the aggregate principal amount of $2.2 billion available to it through the following facilities:


i.	a $900.0 million Term Loan facility; and


ii.	a $1.3 billion revolving credit facility, which includes a $60.0 million sublimit for the issuance of standby letters of credit and a $60.0 million sublimit for swingline loans.

In connection with the May 2018 Amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) was modified to the following:



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of May 2018 Amendment through March 31, 2019		5.50 : 1.00
June 30, 2019 through March 31, 2020		5.00 : 1.00
June 30, 2020 through March 31, 2021		4.50 : 1.00
June 30, 2021 and thereafter		4.00 : 1.00

Borrowings under the Senior Credit Facility bear interest, at the Company's option, at a rate equal to the following:


i.	the Eurodollar Rate (as defined in the amendment and restatement) in effect from time to time plus the applicable rate (ranging from 1.00% to 1.75%), or


ii.	the highest of:


1.	the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50%, or plus the applicable rate (ranging from 0% to 0.75%),


2.	the prime lending rate of Bank of America, N.A. plus the applicable rate (ranging from 0% to 0.75%), and


3.	the one-month Eurodollar Rate plus 1.00% plus the applicable rate (ranging from 0% to 0.75%).

The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA at the time of the applicable borrowing).

The Company will also pay an annual commitment fee (ranging from 0.15% to 0.35%), based on the Company’s consolidated total leverage ratio, on the amount available for borrowing under the revolving credit facility.

At December 31, 2019 and 2018, there was $375.0 million and $345.0 million outstanding, respectively, under the revolving portion of the Senior Credit Facility at a weighted average interest rate of 3.2% and 4.0%, respectively. At December 31, 2019 and 2018, there was $877.5 million and $900.0 million outstanding under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 3.2% and 3.9%, respectively.

The Senior Credit Facility is collateralized by substantially all of the assets of the Company’s U.S. subsidiaries, excluding intangible assets. The Senior Credit Facility is subject to various financial and negative covenants and at December 31, 2019 the Company was in compliance with all such covenants. The Company capitalized $4.2 million of incremental financing costs in 2018 in connection with the modifications of the Senior Credit Facility.

Contractual repayments of the Term Loan component of Senior Credit Facility are due as follows:



Year-ended December 31, 2019	Principal Repayment
	(In thousands)
2020	$	45,000
2021	56,250
2022	67,500
2023	708,750
	$	877,500

The outstanding balance of revolving credit component of the Senior Credit Facility is due on May 3, 2023.

Securitization Facility

During the fourth quarter of 2018, the Company entered into an accounts receivable securitization facility (the "Securitization Facility") under which accounts receivable of certain domestic subsidiaries are sold on a non-recourse basis to a special purpose entity (“SPE”), which is a bankruptcy-remote, consolidated subsidiary of the Company. Accordingly, the assets of the SPE are not available to satisfy the obligations of the Company or any of its subsidiaries. From time to time, the SPE may finance such accounts receivable with a revolving loan facility secured by a pledge of such accounts receivable. The amount of outstanding borrowings on the Securitization Facility at any one time is limited to $150.0 million. The Securitization Facility agreement is for an initial three-year term and may be extended. The agreement governing the Securitization Facility contains certain covenants and termination events. An occurrence of an event of default or a termination event under this Securitization Facility may give rise to the right of its counterparty to terminate this facility. At December 31, 2019, the Company was in compliance with the covenants, and none of the termination events had occurred. The Company had $104.5 million and $121.2 million of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 2.8% and 3.4% as of December 31, 2019 and 2018, respectively.

The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit facility and Term Loan component at December 31, 2019 were approximately $381.1 million and $889.9 million, respectively. The fair value of the outstanding borrowing of the Securitization facility at December 31, 2019 was approximately $105.8 million. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly and are other than active market observable inputs that reflect unadjusted quoted prices for identical assets or liabilities.

Letters of credit outstanding as of December 31, 2019 and 2018 totaled $0.8 million and $0.6 million, respectively. There were no amounts drawn as of December 31, 2019.

DERIVATIVE INSTRUMENTS

12 Months Ended

Dec. 31, 2019

Derivative Instruments and Hedging Activities Disclosure [Abstract]

DERIVATIVE INSTRUMENTS

Interest Rate Hedging

The Company’s interest rate risk relates to U.S. dollar denominated variable interest rate borrowings. The Company uses interest rate swap derivative instruments to manage earnings and cash flow exposure resulting from changes in interest rates. These interest rate swaps apply a fixed interest rate on a portion of our expected LIBOR-indexed floating-rate borrowings.

The Company held the following interest rate swaps as of December 31, 2019 (dollar amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Assets (Liabilities)
3-month USD LIBOR	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	(2	)
1-month USD LIBOR	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	12
1-month USD LIBOR	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(581	)
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(2,880	)
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(2,880	)
1-month USD LIBOR	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(3,517	)
1-month USD LIBOR	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(1,778	)
1-month USD LIBOR	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(6,595	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(5,750	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(5,747	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(5,807	)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(4,930	)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(4,691	)
Total interest rate derivatives designated as cash flow hedge	$	1,325,000						(45,145	)

The Company held the following interest rate swaps as of December 31, 2018 (dollar amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Assets (Liabilities)
3-month USD LIBOR	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	$	410
3-month USD LIBOR	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	415
1-month USD LIBOR	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	418
3-month USD LIBOR	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	619
1-month USD LIBOR	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	1,287
1-month USD LIBOR	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	1,246
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1,491
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1,460
1-month USD LIBOR	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	418
1-month USD LIBOR	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	162
1-month USD LIBOR	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	2,076
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(2,594		)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(2,551		)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(2,568		)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(797		)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(873		)
Total interest rate derivatives designated as cash flow hedges	$	1,475,000						$	619

The Company has designated these derivative instruments as cash flow hedges. The Company assesses the effectiveness of these derivative instruments and has recorded the changes in the fair value of the derivative instrument designated as a cash flow hedge as unrealized gains or losses in accumulated other comprehensive loss (“AOCL”), net of tax, until the hedged item affected earnings, at which point any gain or loss was reclassified to earnings. If the hedged cash flow does not occur, or if it becomes probable that it will not occur, the Company will reclassify the remaining amount of any gain or loss on the related cash flow hedge recorded in AOCL to interest expense at that time.

During the period ended December 31, 2019, interest rate swaps with an aggregate notional amount of $150 million matured.

Foreign Currency Hedging

From time to time the Company enters into foreign currency hedge contracts intended to protect the U.S. dollar value of certain forecasted foreign currency denominated transactions. The Company assesses the effectiveness of the contracts that are designated as hedging instruments. The changes in fair value of foreign currency cash flow hedges are recorded in AOCL, net of tax, until the hedged item affects earnings. Once the related hedged item affects earnings, the Company reclassifies amounts recorded in AOCL to earnings. If the hedged forecasted transaction does not occur, or if it becomes probable that it will not occur, the Company will reclassify the amount of any gain or loss on the related cash flow hedge to earnings at that time. For contracts not designated as hedging instruments, the changes in fair value of the contracts are recognized in other income (expense), net in the consolidated statements of operation, along with the offsetting foreign currency gain or loss on the underlying assets or liabilities.

The success of the Company’s hedging program depends, in part, on forecasts of certain activity denominated in foreign currency. The Company may experience unanticipated currency exchange gains or losses to the extent that there are differences between forecasted and actual activities during periods of currency volatility. In addition, changes in currency exchange rates related to any unhedged transactions may affect earnings and cash flows.

On November 28, 2017, the Company entered into a foreign currency forward contract, with a notional amount of $8.9 million to mitigate the foreign currency exchange risk related to a certain intercompany loan denominated in Swiss Francs ("CHF"). The contract is not designated as a hedging instrument. The foreign currency forward contract was settled on September 28, 2018. For the years ended December 31, 2018 and 2017, the Company recognized a $0.2 million loss and a $0.1 million gain, respectively, from the change in fair value of the contract, which was included in other income (expense), net in the consolidated statement of operations.

Cross-Currency Rate Swaps

On October 2, 2017, the Company entered into cross currency swap agreements to convert a notional amount of $300.0 million equivalent to 291.2 million of CHF denominated intercompany loans into U.S. dollars. The CHF denominated intercompany loans were the result of the purchase of intellectual property by a subsidiary in Switzerland as part of the Codman Acquisition. The objective of these cross-currency swaps is to reduce volatility of cash flows associated with changes in the foreign currency exchange rate. Under the terms of these contracts, which have been designated as cash flow hedges, the Company will make interest payments in Swiss Francs and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in Swiss Francs and receive U.S. dollars from the counterparties.

The Company held the following cross-currency rate swaps designated as cash flow hedges as of December 31, 2019 (dollar amounts in thousands):



						2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	32,355	$	(101	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	33,333	$	(101	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(119		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(119		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(289		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(289		)

Total						$	(509	)

During the year ended December 31, 2019, the Company settled cross-currency swaps designated as cash flow hedges of an intercompany loan with an aggregate notional amount of $66.7 million. The original maturity dates were October 2, 2020,

however, as the intercompany loan settlement was consummated, the cross-currency swap was settled simultaneously. As a result of the settlements, the Company recorded a loss of $0.4 million in other income, net in the consolidated statement of operations.

The Company held the following cross-currency rate swaps as of December 31, 2018 (dollar amounts in thousands):



						2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(215	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(215	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(422		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(422		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(2,193		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(2,193		)

Total						$	(2,830	)

The cross- currency swaps are carried on the consolidated balance sheet at fair value, and changes in the fair values are recorded as unrealized gains or losses in AOCL. For the years ended December 31, 2019 and 2018, the Company recorded a loss of $4.0 million and gain $2.2 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gains or losses recognized on the intercompany loan.

For the years ended December 31, 2019 and 2018, the Company recorded gains of $9.3 million and $9.1 million, respectively, in AOCL related to change in fair value of the cross-currency swaps.

For the years ended December 31, 2019 and 2018, the Company recorded gains of $7.0 million and $7.9 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated gain that is expected to be reclassified to other income, net from AOCL as of December 31, 2019 within the next twelve months is $4.9 million. As of December 31, 2019, the Company does not expect any gains or losses will be reclassified into earnings as a result of the discontinuance of these cash flow hedges because the original forecasted transaction will not occur.

Net Investment Hedges

The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk from its international operations through foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business. On October 1, 2018, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries.

The Company held the following cross-currency rate swaps designated as net investment hedges as of December 31, 2019 and December 31, 2018, respectively (dollar amounts in thousands):



						December 31, 2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—	EUR	44,859	2,459
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	52,000	2,459

Pay EUR	October 3, 2018	September 30, 2023	—	EUR	51,760	3,087
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	3,087

Pay EUR	October 3, 2018	September 30, 2025	—	EUR	38,820	2,032
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,032

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(154		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	(154		)

Pay CHF	October 3, 2018	September 30, 2025	—	CHF	165,172	1,221
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	1,221

Total						$	8,645



						December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—	EUR	70,738	1,359
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	82,000	1,359

Pay EUR	October 3, 2018	September 30, 2023	—	EUR	51,760	(421		)
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	(421		)

Pay EUR	October 3, 2018	September 30, 2025	—	EUR	38,820	(150		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	(150		)

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	2,360
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	2,360

Pay CHF	October 3, 2018	September 30, 2025	—	CHF	165,172	(3,780		)
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(3,780		)

Total						$	(632	)

During the year ended December 31, 2019, the Company settled a cross-currency swap designated as a net-investment hedge of with an aggregate notional amount of $30.0 million. The original termination date was September 30, 2021. As a result of the settlement, the Company recorded a gain of $1.6 million in AOCL.

The cross-currency swaps were carried on the consolidated balance sheet at fair value, and changes in the fair values were recorded as unrealized gains or losses in AOCL. For the year ended December 31, 2019 and 2018, the Company recorded a gain of $20.5 million and $1.7 million, respectively, in AOCL related to the change in fair value of the cross-currency swaps.

For the year ended December 31, 2019 and 2018, the Company recorded a gain of $9.6 million and $2.4 million, respectively, in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated gain that is expected to be reclassified to interest income from AOCL as of December 31, 2019 within the next twelve months is $8.0 million.

Counterparty Credit Risk

The Company manages its concentration of counterparty credit risk on its derivative instruments by limiting acceptable counterparties to a group of major financial institutions with investment grade credit ratings, and by actively monitoring their credit ratings and outstanding positions on an ongoing basis. Therefore, the Company considers the credit risk of the counterparties to be low. Furthermore, none of the Company’s derivative transactions are subject to collateral or other security arrangements, and none contain provisions that depend upon the Company’s credit ratings from any credit rating agency.

Fair Value of Derivative Instruments

The Company has classified all of its derivative instruments within Level 2 of the fair value hierarchy because observable inputs are available for substantially the full term of the derivative instruments. The fair values of the interest rate swaps and cross-currency swaps were developed using a market approach based on publicly available market yield curves and the terms of the swap. The Company performs ongoing assessments of counterparty credit risk.

The following table summarizes the fair value and presentation in the consolidated balance sheet for derivatives designated as hedging instruments:



	Fair Value as of December 31,
	2019		2018
Location on Balance Sheet ⁽¹⁾:	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap⁽²⁾	$	12	$	4,654
Cross-currency swap	5,032		7,615
Net Investment Hedges
Cross-currency swap	$	7,952	$	8,888
Other assets
Cash Flow Hedges
Interest rate swap⁽²⁾	—		5,350
Net Investment Hedges
Cross-currency swap	$	3,465	$	1,774
Total Derivatives designated as hedges — Assets	$	16,461	$	28,281

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	$	6,635	$	—
Cross-currency swap	101		—
Other liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	38,522		9,385
Cross-currency swap	5,440		10,445
Net Investment Hedges
Cross-currency swap	$	2,772	$	11,294
Total Derivative designated as hedges — Liabilities	$	53,470	$	31,124


⁽¹⁾	The Company classifies derivative assets and liabilities as current based on the cash flows expected to be incurred within the following 12 months.


⁽²⁾	At December 31, 2019 and 2018, the total notional amounts related to the Company’s interest rate swaps were $1.3 billion and $1.5 billion, respectively.

The following presents the effect of derivative instruments designated as cash flow hedges and net investment hedges on the accompanying consolidated statements of operations during the years ended December 31, 2019 and 2018:



	Balance in AOCL Beginning of Year			Amount of Gain (Loss) Recognized in AOCL			Amount of Gain (Loss) Reclassified from AOCL into Earnings		Balance in AOCL End of Year			Location in Statements of Operations
	(In thousands)
Year Ended December 31, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(43,493	)	$	2,271	$	(45,145	)	Interest expense
Cross-currency swap	(6,190		)	9,334			2,967		177			Other income, net
Net Investment Hedges
Cross-currency swap	(632		)	20,488			9,627		10,229			Interest income
	$	(6,203	)	$	(13,671	)	$	14,865	$	(34,739	)
Year Ended December 31, 2018
Cash Flow Hedges
Interest rate swap	$	592		$	924		$	897	$	619		Interest expense
Cross-currency swap	(5,104		)	9,062			10,148		(6,190		)	Other income, net
Net Investment Hedges
Cross-currency swap	—			1,723			2,355		(632		)	Interest income
	$	(4,512	)	$	11,709		$	13,400	$	(6,203	)

GOODWILL AND OTHER INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

The Company tests goodwill for impairment by either performing a qualitative evaluation or a quantitative test.

The qualitative evaluation is an assessment of factors including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass the qualitative assessment for its three reporting units and perform a quantitative test. The assumptions used in evaluating goodwill for impairment are subject to change and are tracked against historical results by management.

The quantitative test estimates the fair value of its three reporting units using a discounted cash flow model, which incorporates significant estimates and assumptions made by management which, by their nature, are characterized by uncertainty. Inputs used to fair value the Company's reporting units are considered inputs of the fair value hierarchy. For Level 3 measurements, significant increases or decreases in long-term growth rates or discount rates in isolation or in combination could result in a significantly lower or higher fair value measurement. The key assumptions impacting the valuation included the following:


•	The reporting unit's financial projections, which are based on management's assessment of regional and macroeconomic variables, industry trends and market opportunities, and the Company's strategic objectives and future growth plans.

•

The projected terminal value for the reporting unit, which represents the present value of projected cash flows beyond the last period in the discounted cash flow analysis. The terminal value reflects the Company's assumptions related to long-term growth rates and profitability, which are based on several factors, including local and macroeconomic variables, market opportunities, and future growth plans.

•

The discount rate used to measure the present value of the projected future cash flows is set using a weighted-average cost of capital method that considers market and industry data as well as the Company's specific risk factors that are likely to be considered by a market participant. The weighted-average cost of capital is the Company's estimate of the overall after-tax rate of return required by equity and debt holders of a business enterprise.

The Company elected to perform a qualitative analysis for its three reporting units as of July 31, 2019. The Company determined, after performing qualitative analysis, that there was no evidence that it is more likely than not that the fair value of any identified reporting unit was less that the carrying amounts, therefore, it was not necessary to perform a quantitative impairment test.

Changes in the carrying amount of goodwill in 2019 and 2018 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at January 1, 2018	$	634,767		$	303,138		$	937,905
Codman acquisition measurement period adjustments	(3,964		)	—			(3,964		)
Foreign currency translation	(5,043		)	(2,423		)	(7,466		)
Goodwill at December 31, 2018	$	625,760		$	300,715		$	926,475
Arkis Acquisition	27,600			—			27,600
Foreign currency translation	140			65			205
Goodwill at December 31, 2019	$	653,500		$	300,780		$	954,280

Other Intangible Assets

The components of the Company's identifiable intangible assets were as follows:



	Weighted Average Life	December 31, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	880,623	$	(213,702	)	$	666,921
Customer relationships	12 years	222,575		(119,393		)	103,182
Trademarks/brand names	28 years	103,873		(28,514		)	75,359
Codman trade name	Indefinite	163,126		—			163,126
Supplier relationships	27 years	34,721		(17,947		)	16,774
All other⁽¹⁾	4 years	10,869		(4,640		)	6,229
		$	1,415,787	$	(384,196	)	$	1,031,591



	Weighted Average Life	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman trade name	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other⁽¹⁾	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496


(1)	At December 31, 2019 and 2018, all other included IPR&D of $1.0 million, which was indefinite-lived.

The company tests intangible assets with indefinite lives for impairment annually in the third quarter in accordance with ASC Topic 350. The Company elected to bypass the qualitative evaluation for its Codman tradename intangible asset and perform a quantitative test during the third quarter of 2019. In performing this test, the Company utilized a range of projected sales growth rates, a royalty rate of 5.0%, a range of tax rates between 17.4-20.7%, and a discount rate of 12.5%. The assumptions used in evaluating the Codman tradename for impairment are subject to change and are tracked against historical results by management. Based on the results of the quantitative test, the Company recorded no impairment to the Codman tradename intangible asset.

Product rights and other definite-lived intangible assets are tested periodically for impairment in accordance with ASC Topic 360 when events or changes in circumstances indicate that an asset’s carrying value may not be recoverable. The impairment testing involves comparing the carrying amount of the asset or asset group to the forecasted undiscounted future cash flows. In the event the carrying value of the asset exceeds the undiscounted future cash flows, the carrying value is considered not recoverable and an impairment exists. An impairment loss is measured as the excess of the asset’s carrying value over its fair value, calculated using discounted future cash flows. The computed impairment loss is recognized in the period that the impairment occurs.

During the second quarter of 2019, a contract manufacturing customer of the private label product line received a notification from the FDA ordering them to remove their product from the market. The Company recorded an impairment charge of $5.8 million in intangible asset amortization in the consolidated statement of operations related to the customer relationship intangible asset acquired from TEI Biosciences, Inc. and TEI Medical Inc. (collectively "TEI") due to revised future projections based on the contract termination.

During the third quarter of 2018, the Company recorded an impairment charge of $4.9 million in cost of goods sold related to completed technology assets acquired from Koby Ventures II, L.P dba Metasurg ("Metasurg Technology") due to recent contract negotiations and revised future projections. Metasurg Technology is included in the Orthopedic and Tissue Technology segment. Of the total impairment charge of $4.9 million, $2.5 million was related to an out-of-period adjustment included in the twelve months ended December 31, 2018. The out-of-period adjustment is attributed to the timing of performing the impairment test based on the contract termination associated with the intangible asset. The Company determined that the adjustment was not

material to the consolidated financial statements for any previously reported annual or interim period and the adjustment to correct the misstatements is not material to the period ended December 31, 2018.

During the third quarter of 2017, the Company recorded an impairment charge of $3.3 million in cost of goods sold related to completed technology assets acquired from Tarsus Medical, Inc. ("Tarsus Technology"), since the underlying product will no longer be sold. Tarsus Technology was included in the Orthopedic and Tissue Technology segment.

Amortization expense (including amounts reported in cost of product revenues, but excluding any possible future amortization associated with acquired IPR&D) for the years ended December 31, 2019, 2018 and 2017 was $72.8 million, $71.6 million and $52.8 million, respectively. Annual amortization expense is expected to approximate $74.6 million in 2020, $64.1 million in 2021, $60.6 million in 2022, $59.7 million in 2023, $58.9 million in 2024 and $547.7 million thereafter. Amortization of product technology based intangible assets totaled $45.8 million, $50.4 million and $35.7 million for the years ended December 31, 2019, 2018 and 2017, respectively, and is presented by the Company within cost of goods sold.

STOCK-BASED COMPENSATION

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

STOCK-BASED COMPENSATION

Stock-based compensation expense - all related to employees and members of the Board of Directors - recognized under the authoritative guidance was as follows:



	Years Ended December 31,
	2019		2018		2017
	(In thousands)
Selling, general and administrative	$	19,153	$	18,721	$	19,785
Research and development	1,785		1,609		1,273
Cost of goods sold	317		449		492
Total stock-based compensation expense	21,255		20,779		21,550
Total estimated tax benefit related to stock-based compensation expense	9,420		10,430		15,448
Net effect on net income	$	11,835	$	10,349	$	6,102

EMPLOYEE STOCK PURCHASE PLAN

The purpose of the Employee Stock Purchase Plan (the “ESPP”) is to provide eligible employees of the Company with the opportunity to acquire shares of common stock at periodic intervals by means of accumulated payroll deductions. The ESPP is a non-compensatory plan. Under the ESPP, a total of 3.0 million shares of common stock are reserved for issuance. These shares will be made available either from the Company’s authorized but unissued shares of common stock or from shares of common stock reacquired by the Company as treasury stock. At December 31, 2019, 2.0 million shares remain available for purchase under the ESPP. During the years ended December 31, 2019, 2018 and 2017, the Company issued 12,531 shares, 16,721 shares and 12,168 shares under the ESPP for $0.7 million, $0.7 million and $0.6 million, respectively.

EQUITY AWARD PLANS

As of December 31, 2019, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under three plans, the 2000 Equity Incentive Plan (the “2000 Plan”), the 2001 Equity Incentive Plan (the “2001 Plan”), and the 2003 Equity Incentive Plan (the “2003 Plan,” and collectively, (the “Plans”)).

In May 2010 and May 2017, the stockholders of the Company approved amendments to the 2003 Plan to increase by 3.5 million and 1.7 million, respectively, the number of shares of common stock that may be issued under the 2003 Plan. The Company has reserved 4.0 million shares under each of the 2000 Plan and the 2001 Plan, and 14.7 million shares under the 2003 Plan. The Plans permit the Company to grant incentive and non-qualified stock options, stock appreciation rights, restricted stock, contract stock, performance stock, or dividend equivalent rights to designated directors, officers, employees and associates of the Company.

Stock options issued under the Plans become exercisable over specified periods, generally within four years from the date of grant for officers and employees, and within one year from the date of the grant for members of the Board of Directors. The awards generally expire eight years from the grant date for employees and from six to ten years for directors and certain executive officers. Restricted stock issued under the Plans vests ratably over specified periods, generally three years after the date of grant.

Stock Options

The Company values stock option grants using the binomial distribution model. Management believes that the binomial distribution model is preferable to the Black-Scholes model because it is a more flexible model that gives consideration to the impact of non-transferability and vesting provisions in valuing employee stock options.

In determining the value of stock options granted, the Company considered that it has never paid cash dividends and does not currently intend to pay cash dividends, and thus has assumed a 0% dividend yield. Expected volatilities are based on the historical volatility of the Company’s stock price. The expected life of stock options is estimated based on historical data on exercise of stock options, post-vesting forfeitures and other factors to estimate the expected term of the stock options granted. The risk-free interest rates are derived from the U.S. Treasury yield curve in effect on the date of grant for instruments with a remaining term similar to the expected life of the options. The Company accounts for forfeitures as they occur.

The following weighted-average assumptions were used in the calculation of fair value:



	Years Ended December 31,
	2019	2018	2017
Dividend yield	0%	0%	0%
Expected volatility	28%	28%	30%
Risk free interest rate	2.51%	2.79%	2.18%
Expected life of option from grant date	7 years	8 years	8 years

The following table summarizes the Company’s stock option activity.



			Weighted Average Exercise Price		Weighted Average Contractual Term in Years	Aggregate Intrinsic Value

	Shares
Stock Options	(In thousands)					(In thousands)
Outstanding at January 1, 2019	1,448		$	27.91	—	—
Granted	203		55.91
Exercised	(350	)	17.83
Forfeited or Expired	(17	)	46.52
Outstanding at December 31, 2019	1,284		$	34.83	4.03	$	30,128
Vested or expected to vest at December 31, 2019	1,284		$	34.83	4.03	$	30,128
Exercisable at December 31, 2019	961		$	28.49	3.15	$	28,639

The Company recognized $3.0 million, $2.6 million and $3.0 million in expense related to stock options during the years ended December 31, 2019, 2018 and 2017, respectively. The intrinsic value of options exercised for the years ended December 31, 2019, 2018 and 2017 were $14.6 million, $16.9 million and $16.2 million, respectively. The weighted average grant date fair value of options granted during the years ended December 31, 2019, 2018 and 2017 was $18.74, $21.78 and $16.95, respectively. Cash received from option exercises and employee stock purchase plan was $6.9 million, $9.4 million and $9.8 million, for the years

ended December 31, 2019, 2018 and 2017, respectively. The realized tax benefit from options exercised were $3.0 million, $3.1 million and $6.2 million for the years ended December 31, 2019, 2018 and 2017, respectively.

As of December 31, 2019, there was approximately $4.5 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately two years.

Awards of Restricted Stock, Performance Stock and Contract Stock

The following table summarizes the Company’s awards of restricted stock, performance stock and contract stock for the year ended December 31, 2019.




	Restricted Stock Awards				Performance Stock and Contract Stock Awards
	Shares		Weighted Average Grant Date Fair Value Per Share		Shares		Weighted Average Grant Date Fair Value Per Share


	(In thousands)				(In thousands)
Unvested, January 1, 2019	417		$	48.97	85		45.56
Granted	303		55.41		157		55.86
Adjustments for performance achievement related to award target	—		—		19		50.36
Cancellations	(59	)	50.31		(27	)	—
Performance stock awards vested in 2018 and released in 2019	—				273		42.94
Released	(201	)	46.08		(175	)	56.03
Vested but not released	—		—		(140	)	50.36
Unvested, December 31, 2019	460		$	54.31	192		55.38

The Company recognized $18.1 million, $18.1 million and $18.5 million in expense related to such awards during the years ended December 31, 2019, 2018 and 2017, respectively. The total fair market value of shares vested and released in 2019, 2018 and 2017 was $21.1 million, $24.8 million and $22.2 million, respectively. Vested awards include shares that have been fully earned but had not been delivered as of December 31, 2019.

Performance stock awards have performance features associated with them. Performance stock, restricted stock and contract stock awards generally have requisite service periods of three years. The fair value of these awards is being expensed on a straight-line basis over the vesting period.

As of December 31, 2019, there was approximately $23.4 million of total unrecognized compensation costs related to unvested restricted stock, performance stock and contract stock awards. These costs are expected to be recognized over a weighted-average period of approximately two years.

At December 31, 2019, there are approximately 0.5 million vested Restricted Units and 0.1 million vested performance share units held by various employees for which the related shares have not yet been issued. The final determination of the number of shares to be issued is made by the Company's Compensation Committee of the Board of Directors which is is contingent upon achieving certain revenue and organic revenue growth performance metric.

At December 31, 2019, there were approximately 2.5 million shares available for grant under the Plans.

The Company capitalized into inventory, share based compensation costs of $0.3 million, $0.4 million and $0.5 million for the years ended December 31, 2019, 2018 and 2017, respectively. Such share-based compensation was recognized as cost of goods sold when related inventory was sold.

RETIREMENT BENEFIT PLANS

12 Months Ended

Dec. 31, 2019

Retirement Benefits [Abstract]

RETIREMENT BENEFIT PLANS

DEFINED BENEFIT PLANS

The Company has various defined benefit plans which covers certain employees in Austria, France, Japan, Germany and Switzerland.

Net periodic benefit costs for the Company’s defined benefit pension plans for the years ended December 31, 2019 and 2018 included the following (amounts in thousands):



	Year ended December 31,
	2019			2018
Service cost	$	3,815		$	2,704
Interest cost	517			351
Expected return on plan assets	(1,047		)	(944		)
Amortization of prior service cost (credit)	(259		)	—
Recognized actuarial losses	65			8
Settlements	602			—
Net period benefit cost	$	3,693		$	2,119

The following weighted average assumptions were used to develop net periodic pension benefit costs and the actuarial present values of projected pension benefit obligations for the years ended December 31, 2019 and 2018, respectively:



	As of December 31,
	2019		2018
Discount rate	0.40	%	1.00	%
Expected return on plan assets	3.33	%	3.40	%
Rate of compensation increase	2.25	%	1.70	%

The Company’s discount rates are determined by considering current yield curves representing high quality, long-term fixed income instruments. The resulting discount rates are consistent with the duration of plan liabilities. In 2019 and 2018, the discount rates were prescribed as the current yield on corporate bonds with an average rating of AA or AAA of equivalent currency and term to the liabilities. The expected returns on plan assets represent the average rate of return expected to be earned on plan assets over the period the benefits included in the benefit obligation are to be paid. In developing the expected rates of return, the Company considers returns of historical market data as well as actual returns on the plan assets. Using this reference information, the long-term return expectations for each asset category are developed according to the allocation among those investment categories.

The assessment is determined using projections from external financial sources, long-term historical averages, actual returns by asset class and the various asset class allocations by market.

The following sets forth the change in projected benefit obligations and the change in plan assets for the years ended December 31, 2019 and 2018 and a reconciliation of the funded status at December 31, 2019 and 2018, respectively (amounts in thousands):



	Year ended December 31,
	2019			2018
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	52,542		$	47,661
Interest cost	517			351
Service cost	3,815			2,704
Actuarial loss	12,188			762
Plan amendments	(3,133		)	—
Plan settlements	(2,664		)	—
Employee contribution	899			641
Premiums paid	(395		)	—
Benefit payment	(635		)	(1,483		)
Plans transferred in	3,199			2,280
Effect of foreign currency exchange rates	639			(374		)
Projected benefit obligations, end of year	$	66,972		$	52,542

	Year ended December 31,
	2019			2018
Change In Plan Assets
Plan assets at fair value, beginning of year	$	31,103		$	26,943
Actual return on plan assets	(152		)	1,802
Employer contributions	2,189			1,720
Employee contributions	899			641
Plan settlements	(2,645		)	—
Benefits paid	(635		)	(1,463		)
Premiums paid	(395		)	—
Plans transferred in	—			1,589
Effect of foreign currency exchange rates	406			(129		)
Plan assets at fair value, end of year	$	30,770		$	31,103



	Year ended December 31,
	2019		2018
Reconciliation Of Funded Status
Fair value of plan assets	$	30,770	$	31,103
Benefit obligations	66,972		52,542
Unfunded benefit obligations	$	36,202	$	21,439

The unfunded benefit obligations are included in other liabilities in the consolidated balance sheets at December 31, 2019 and 2018, respectively.

During the periods ended December 31, 2019 and 2018, the Company had net losses of $9.0 million and $0.6 million, respectively, recognized within accumulated other comprehensive loss that has not been recognized as a component of net periodic benefit cost. The loss recognized during the period ended December 31, 2019, is primarily attributed to a change in the discount rate used to estimate the projected benefit obligation for defined benefit plans which cover certain employees in Switzerland. The combined accumulated benefit obligations for the defined benefit plans was $61.1 million and $49.6 million as of December 31, 2019 and 2018, respectively.

Unrecognized gains and losses are amortized over the average remaining future service for each plan. For plans with no active employees, they are amortized over the average life expectancy. The amortization of gains and losses is determined by using a 10% corridor of the greater of the market value of assets or the accumulated benefit obligation. Total unamortized gains and losses in excess of the corridor are amortized over the average remaining future service.

Prior service costs/benefits for the pension plans are amortized over the average remaining future service of plan participants at the time of the plan amendment.

The net plan assets of the pension plans are invested in common trusts. Common trusts are classified as Level 2 in fair value hierarchy. The fair value of common trusts is valued at net asset value based on the fair values of the underlying investments of the trusts as determined by the sponsor of the trusts. The investment strategy of the Company's defined benefit plans is both to meet the liabilities of the plans as they fall due and to maximize the return on invested assets within appropriate risk profile.

The investment strategy for the Company’s defined benefit plans is both to meet the liabilities of the plans as they fall due and to maximize the return on invested assets within appropriate risk tolerances. The benefit plans in Austria, France and Germany had no assets at December 31, 2019.

As of December 31, 2019, no plan assets are expected to be returned to the Company in the next twelve months.

The following table is the summary of expected future benefit payments (in thousands):



2020	$	1,702
2021	1,743
2022	1,499
2023	1,650
2024	2,115
Next five years	10,157

As of December 31, 2019, contributions expected to be paid to the plan in 2020 is $2.1 million.

DEFINED CONTRIBUTION PLANS

The Company also has various defined contribution savings plans that cover substantially all employees in the United States, Belgium, Canada, France, Japan, Netherlands, the U.K. and Puerto Rico. The Company matches a certain percentage of each employee’s contributions as per the provisions of the plans. Total contributions by the Company to the plans were $8.6 million, $8.1 million and $7.2 million for the years ended December 31, 2019, 2018 and 2017, respectively.

LEASES AND RELATED PARTY LEASES

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

LEASES AND RELATED PARTY LEASES

The Company leases administrative, manufacturing, research and distribution facilities and vehicles through operating lease agreements. The Company has no finance leases as of December 31, 2019. Many of the Company's leases include both lease (e.g., fixed payments including rent) and non-lease components (e.g., common-area or other maintenance costs). For vehicles, the Company has elected the practical expedient to group lease and non-lease components.

Most facility leases include one or more options to renew. The exercise of lease renewal options is typically at the Company's sole discretion, therefore, the majority of renewals to extend the lease terms are not included in the ROU assets and lease liabilities as they are not reasonably certain of exercise. The Company regularly evaluates renewal options and when they are reasonably certain of exercise, the renewal period is included in the lease term.

As most of the Company's leases do not provide an implicit rate, the Company uses a collateralized incremental borrowing rate based on the information available at the lease commencement date in determining the present value of the lease payments.

Total operating lease expense for the year ended December 31, 2019 was $19.6 million, which includes $0.3 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases at December 31, 2019 were as follows:



	December 31, 2019
	(In thousands, except lease term and discount rate)
ROU assets	$	94,530

Current lease liabilities	12,253
Non-current lease liabilities	97,504
Total lease liabilities	$	109,757

Weighted average remaining lease term (in years):
Leased facilities	12.8 years
Leased vehicles	2.6 years

Weighted average discount rate:
Leased facilities	5.4		%
Leased vehicles	3.2		%

Supplemental cash flow information related to leases was as follows for the year ended December 31, 2019 (in thousands):



	December 31, 2019
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	11,469

ROU assets obtained in exchange for lease liabilities:
Operating leases	41,423

Future minimum lease payments under operating leases at December 31, 2019 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2020	296		12,100		12,396
2021	296		12,951		13,247
2022	296		13,753		14,049
2023	296		11,386		11,682
2024	296		11,060		11,356
Thereafter	1,428		91,235		92,663
Total minimum lease payments	$	2,908	$	152,485	$	155,393
Less: Imputed interest					$	45,636
Total lease liabilities					109,757
Less: Current lease liabilities					12,253
Long-term lease liabilities					97,504

There were no future minimum lease payments under finance leases at December 31, 2019.

During 2018, the Company entered into an operating lease with a term of 18 years for a new corporate headquarters in Princeton, NJ. The lease commenced during the second quarter of 2019 and the Company recorded a ROU asset and lease liability of $35.6 million.

Future minimum lease payments under operating leases at December 31, 2018 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	296	$	16,472	$	16,768
2020	296		13,510		13,806
2021	296		12,197		12,493
2022	296		12,937		13,233
2023	296		10,707		11,003
Thereafter	1,724		100,675		102,399
Total minimum lease payments	$	3,204	$	166,498	$	169,702

Total operating lease expense for the year ended December 31, 2018 was $16.3 million and included 0.3 million, in related party lease expense.

There were no future minimum lease payments under capital leases at December 31, 2018.

Related Party Leases

The Company also leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a corporation whose shareholders are trusts, whose beneficiaries include family members of the Company’s principal owner and former Chairman and director. The term of the current lease agreement is through October 31, 2032 at an annual rate of approximately $0.3 million per year. The current lease agreement also provides (i) a 5-year renewal option for the Company to extend the lease from November 1, 2032 through October 31, 2037 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2037 through October 31, 2042 at the fair market rental rate of the premises.

INCOME TAXES

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

INCOME TAXES

Income (Loss) before income taxes consisted of the following:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
United States operations	$	(38,359	)	$	(21,218	)	$	(32,640	)
Foreign operations	98,463			78,621			44,025
Total	$	60,104		$	57,403		$	11,385

The 2017 U.S. Tax Act was signed into law on December 22, 2017. The 2017 Tax Act made significant changes to the previous tax law. Included among the numerous changes were a reduction of the federal statutory rate from 35% to 21%, limitations on the deductibility of interest expense and executive compensation, and the elimination of certain tax deductions. Additionally, the 2017 Tax Act imposed a one–time repatriation tax on accumulated foreign subsidiaries' untaxed foreign earnings (the "Toll Tax").

The Toll Tax, a one–time tax on deemed repatriated foreign earnings which were not previously taxed, is paid over an eight–year period beginning in 2018. The Company's total Toll Tax liability, as finalized in 2018, was $4.5 million.

The 2017 Tax Act also implemented a territorial tax system and included base erosion provisions on non-U.S. earnings, which subjects certain foreign earnings to additional taxation as global intangible low-taxed income (“GILTI”). These provisions were effective on January 1, 2018. Upon further analysis of the 2017 Tax Act during 2018, the Company elected to account for GILTI as a period cost in the year the tax is incurred.

Deferred tax assets and liabilities are measured at the enacted tax rate expected to apply when they are realized or settled. During 2017, the Company recognized a provisional benefit of $43.4 million from the remeasurement of the Company's net deferred tax liabilities at the reduced rate of 21%. The Company finalized the remeasurement of its net deferred tax liabilities, as a result of the reduced rate, as of December 31, 2018.

The Company finalized its calculations and completed its accounting for the income tax effect of the 2017 Tax Act in December of 2018.

A reconciliation of the U.S. Federal statutory rate to the Company’s effective tax rate is as follows:



	Years Ended December 31,
	2019		2018		2017
Federal statutory rate	21.0	%	21.0	%	35.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	1.0	%	(0.4	)%	(17.0	)%
Foreign operations	(20.0	)%	(21.8	)%	(112.7	)%
Excess tax benefits from stock compensation	(5.6	)%	(7.8	)%	(57.9	)%
Charitable contributions	(0.6	)%	(1.2	)%	(10.6	)%
Nondeductible meals and entertainment	1.5	%	1.6	%	8.8	%
Intercompany profit in inventory	1.2	%	6.2	%	11.6	%
Nondeductible facilitative costs	0.8	%	—	%	22.5	%
Changes in valuation allowances	0.2	%	0.2	%	8.0	%
Uncertain tax positions	0.2	%	0.4	%	(4.6	)%
Research and development credit	(2.9	)%	(2.6	)%	(13.2	)%
Return to provision	1.7	%	(2.9	)%	(4.3	)%
Global intangible low-taxed income ("GILTI")	7.6	%	3.5	%	—	%
Nondeductible executive compensation	3.0	%	1.6	%	—	%
Carryback of Federal net operating loss ("NOL")	0.1	%	(3.7	)%	—	%
Other	0.4	%	—	%	0.8	%
Swiss tax holiday	(15.7	)%	—	%	—	%
In-process research and development	22.7	%	—	%	—	%
Reduction of book gain on sale of assets	—	%	—	%	(4.6	)%
Tax reform — Toll Tax	—	%	—	%	48.1	%
Tax reform — remeasurement of deferred tax assets and liabilities	—	%	—	%	(378.6	)%
Effective tax rate	16.5	%	(5.9	)%	(468.7	)%

Our effective tax rate was 16.5% for the year ended December 31, 2019, compared to (5.9)% for the year ended December 31, 2018. The 2019 annual effective tax rate increased over 2018 due to the acquisition of Rebound, resulting in $64.9 million of non-deductible in–process research and development expense, which had a $13.6 million tax effect on the U.S. federal rate. This increase in the annual rate was offset by a tax benefit of $9.4 million ($0.11 per share) related to a federal tax holiday in Switzerland, which was finalized during 2019. Additionally, 2018 had $1.1 million of additional benefit pertaining to excess stock–based compensation deductions and $2.1 million of benefit from a federal net operating loss carryback, which does not repeat in 2019.

During 2019, the Company's foreign operations generated a $5.7 million decrease in income tax expense when compared with 2018, because of geographic and business mix of taxable earnings and losses, among other factors. The 2019 foreign effective tax rate is 3.5%, compared to 11.6% in 2018. The Company's foreign tax rate is primarily based upon statutory rates and is also impacted by the tax holiday in Switzerland, described below.

During 2019, the Company finalized negotiations related to tax holidays in Switzerland, on a federal, cantonal, and communal level. The Company received a federal tax credit in Switzerland of $12.1 million ($0.14 per share), which may be used over a seven-year period, ending in 2024. The Company also received a reduction in its rate for the cantonal and communal level taxes during the third quarter of 2019, pursuant to tax reform in Switzerland.

During 2018, the Company's foreign operations generated a $3.1 million increase in income tax expense when compared with 2017, because of the geographic and business mix of taxable earnings and losses, among other factors. The 2018 foreign effective tax rate is 11.6%, a decrease of approximately 2.0% over the rate in 2017. The Company's foreign tax rate is primarily based upon statutory rates.

The provision for income taxes consisted of the following:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Current:
Federal	$	14,597		$	(3,880	)	$	6,644
State	3,447			1,609			1,233
Foreign	10,905			7,057			6,069
Total current	$	28,949		$	4,786		$	13,946
Deferred:
Federal	(10,889		)	(7,202		)	(66,466		)
State	(666		)	(3,048		)	(758		)
Foreign	(7,491		)	2,066			(80		)
Total deferred	$	(19,046	)	$	(8,184	)	$	(67,304	)
Provision for income taxes	$	9,903		$	(3,398	)	$	(53,358	)

The income tax effects of significant temporary differences that give rise to deferred tax assets and liabilities, shown before jurisdictional netting, are presented below:



	December 31,
	2019			2018
	(In thousands)
Assets:
Doubtful accounts	$	2,426		$	1,507
Inventory related items	39,548			28,245
Tax credits	19,134			9,072
Accrued vacation	3,206			2,761
Accrued bonus	6,017			5,515
Stock compensation	8,347			10,093
Deferred revenue	1,805			2,173
Net operating loss carryforwards	37,418			33,350
Capitalization of research and development expenses	9,781			—
Unrealized foreign exchange loss	8,105			1,405
Charitable contributions carryforward	235			1,994
Others	5,900			8,835
Total deferred tax assets	141,922			104,950
Less valuation allowance	(9,865		)	(6,973		)
Deferred tax assets after valuation allowance	$	132,057		$	97,977
Liabilities:
Intangible and fixed assets	(150,879		)	(144,861		)
Others	(5,108		)	(4,089		)
Total deferred tax liabilities	$	(155,987	)	$	(148,950	)
Total net deferred tax liabilities	$	(23,930	)	$	(50,973	)

The deferred tax assets and liabilities are measured based on the enacted tax rates that apply in years in which the temporary differences are expected to be realized or incurred. The Company remeasured its deferred tax assets and liabilities as a result of the 2017 Tax Act, using a provisional estimate under SAB No. 118 during 2017. The primary impact of the re-measurement was a decrease in the net deferred tax liability for the reduction of the U.S. statutory income tax rate from 35.0% to 21.0%. There were no material changes to the provisional amounts when the amounts were finalized in December of 2018.

At December 31, 2019, the Company had net operating loss carryforwards of $130.1 million for federal income tax purposes, $37.5 million for foreign income tax purposes and $42.8 million for state income tax purposes to offset future taxable income. The majority of the federal net operating loss carryforwards expire through 2037, while $18.9 million have an indefinite carry forward period. For foreign net operating loss carryforwards, $1.3 million expire through 2024, $0.9 million expire through 2025, and the remaining $35.3 million have an indefinite carry forward period. The state net operating loss carryforwards expire through 2036.

A valuation allowance of $9.9 million, $7.0 million and $8.0 million is recorded against the Company’s gross deferred tax assets of $141.9 million, $105.0 million, and $96.5 million recorded at December 31, 2019, 2018 and 2017, respectively.

The valuation allowance relates to deferred tax assets for certain items that will be deductible for income tax purposes under very limited circumstances and for which the Company believes it will not satisfy the more likely than not threshold for realization of the associated tax benefit. In the event that the Company determines that it would be able to realize more or less than the recorded amount of net deferred tax assets, an adjustment to the deferred tax asset valuation allowance would be recorded in the period such a determination is made.

The Company’s valuation allowance increased by $2.9 million, decreased by $1.0 million and increased by $4.4 million at December 31, 2019, 2018 and 2017, respectively. The 2019 overall increase in the valuation allowance primarily resulted from certain assets from the Rebound and Arkis acquisitions.

As of December 31, 2019, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed to be indefinitely reinvested. Such taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. As such, the Company has determined the tax impact of repatriating these earnings would not be material as of December 31, 2019.

A reconciliation of the beginning and ending amount of uncertain tax benefits is as follows:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Balance, beginning of year	$	676		$	424		$	754
Gross increases:
Current year tax positions	53			273			402
Prior years' tax positions	—			—			—
Gross decreases:
Prior years' tax positions	—			—			(777		)
Statute of limitations lapses	—			(21		)	(17		)
Other	(53		)	—			62
Balance, end of year	$	676		$	676		$	424

Approximately $0.7 million of the balance at December 31, 2019 relates to uncertain tax positions that, if recognized, would affect the annual effective tax rate. There are no amounts within the balance of uncertain tax positions at December 31, 2019 related to tax positions for which it is reasonably possible that the amounts could be reduced during the twelve months following December 31, 2019.

The Company recognizes interest and penalties relating to uncertain tax positions in income tax expense. The Company recognized a minimal benefit for the years ended December 31, 2019, 2018 and 2017. The Company had minimal interest and penalties accrued for the years ended December 31, 2019 and 2018 and 2017.

The Company files Federal income tax returns, as well as multiple state, local and foreign jurisdiction tax returns. The Company is no longer subject to examinations of its U.S. consolidated Federal income tax returns by the IRS through fiscal year 2015. All significant state and local matters have been concluded through fiscal 2014. All significant foreign matters have been settled through fiscal 2012.

COMMITMENTS AND CONTINGENCIES

12 Months Ended

Dec. 31, 2019

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

In consideration for certain technology, manufacturing, distribution, and selling rights and licenses granted to the Company, the Company has agreed to pay royalties on sales of certain products that it sells. The royalty payments that the Company made under these agreements were not significant for any of the periods presented.

The Company is subject to various claims, lawsuits and proceedings in the ordinary course of the Company's business, including claims by current or former employees, distributors and competitors and with respect to its products and product liability claims, lawsuits and proceedings, some of which have been settled by the Company. In the opinion of management, such claims are either adequately covered by insurance or otherwise indemnified, or are not expected, individually or in the aggregate, to result in a material, adverse effect on the Company's financial condition. However, it is possible that the Company's results of operations, financial position and cash flows in a particular period could be materially affected by these contingencies.

The Company accrues for loss contingencies when it is deemed probable that a loss has been incurred and that loss is estimable. The amounts accrued are based on the full amount of the estimated loss before considering insurance proceeds and do not include an estimate for legal fees expected to be incurred in connection with the loss contingency. The Company consistently accrues legal fees expected to be incurred in connection with loss contingencies as those fees are incurred by outside counsel as a period cost.

Contingent Consideration

The Company determined the fair value of contingent consideration during the twelve-month period ended December 31, 2019 and 2018 to reflect the change in estimate, additions, payments, transfers and the time value of money during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the year ended December 31, 2019 and 2018 is as follows (in thousands):



Year Ended December 31, 2019	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 4)		Contingent Consideration Liability Related to Acquisition of Derma Sciences (See Note 4)		Location in Financial Statements
	Long-term		Long-term
Balance as of January 1, 2019	$	—	$	230
Additions from acquisition of Arkis	13,100		—
Payments	—		—
Loss from change in fair value of contingent consideration liabilities	1,110		—		Research and development
Balance as of December 31, 2019	$	14,210	$	230



Year Ended December, 2018	Contingent Consideration Liabilities Related to Acquisition of Derma Sciences (See Note 4)						Contingent Consideration Liability Related to Acquisition of Confluent Surgical, Inc.			Location in Financial Statements
	Short-term			Long-term			Short-term
Balance as of January 1, 2018	$	315		$	1,387		$	22,478
Transfers from long-term to current portion	1,387			(1,387		)	—
Payments	(2,000		)	—			(24,000		)
Loss from change in fair value of contingent consideration liabilities	298			230			1,522			Selling, general and administrative
Balance as of December 31, 2018	$	—		$	230		$	—

Confluent Surgical

On January 15, 2014, the Company acquired all outstanding shares of Confluent Surgical, Inc., ("Confluent Surgical"). The purchase price included contingent consideration. The potential maximum undiscounted contingent consideration of $30.0 million consisted of $25.0 million upon obtaining certain U.S. governmental approvals (the "U.S. Contingent Consideration") and $5.0 million upon obtaining certain European governmental approvals, both related to the completion of the transition of the Confluent Surgical business. The fair values of contingent consideration related to the acquisition of Confluent Surgical were estimated using a discounted cash flow model using a discount rate of 2.2%. During the first quarter of 2018, the Company received the U.S. governmental approvals and adjusted the related contingent consideration liability to $19.0 million, which the Company paid in April 2018. During the third quarter of 2018, the Company received certain European governmental approvals. The Company paid the remaining $5.0 million of contingent consideration related to Confluent Surgical in October of 2018.

SEGMENT AND GEOGRAPHIC INFORMATION

12 Months Ended

Dec. 31, 2019

Segment Reporting [Abstract]

SEGMENT AND GEOGRAPHIC INFORMATION

The Company internally manages two global reportable segments and reports the results of its businesses to its chief operating decision maker. The two reportable segments and their activities are described below.

•

The Codman Specialty Surgical segment includes (i) the Neurosurgery business, which sells a full line of products for neurosurgery and neuro critical care such as tissue ablation equipment, dural repair products, cerebral spinal fluid management devices, intracranial monitoring equipment, and cranial stabilization equipment and (ii) the precision tools and instruments business, which sells more than 40,000 instrument patterns and surgical and lighting products to hospitals, surgery centers, dental, podiatry, and veterinary offices.


•	The Orthopedics and Tissue Technologies segment includes such offerings as skin and wound repair, bone and joint fixation implants in the upper and lower extremities, bone grafts, and nerve and tendon repair products.

The Corporate and other category includes (i) various executive, finance, human resource, information systems and legal functions, (ii) brand management, and (iii) share-based compensation costs.

The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions, and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by reportable segment for the years ended December 31, 2019, 2018 and 2017 are as follows:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	996,206		$	963,929		$	720,301
Orthopedics and Tissue Technologies	521,351			508,512			467,935
Total revenues	$	1,517,557		$	1,472,441		$	1,188,236
Segment Profit
Codman Specialty Surgical	$	395,019		$	363,336		$	292,971
Orthopedics and Tissue Technologies	144,638			149,510			129,697
Segment profit	539,657			512,846			422,668
Amortization	(27,028)			(21,160)			(20,370)
Corporate and other	(418,869		)	(380,688		)	(357,494		)
Operating income	$	93,760		$	110,998		$	44,804

The Company does not allocate any assets to the reportable segments. No asset information is reported to the chief operating decision maker and disclosed in the financial information for each segment.

The Company attributes revenue to geographic areas based on the location of the customer. Total revenue, net and long-lived assets (tangible) by major geographic area are summarized below:



	United States*		Europe		Asia Pacific		Rest of the World		Consolidated
	(In thousands)
Total revenue, net:
2019	$	1,077,379	$	197,468	$	157,391	$	85,319	$	1,517,557
2018	1,045,887		201,354		144,253		80,947		1,472,441
2017	894,260		150,147		80,636		63,193		1,188,236
Total long-lived assets:
2019	$	383,652	$	47,325	$	8,598	$	7,143	$	446,718
2018	280,382		32,679		3,765		3,203		320,029

* Includes long-lived assets in Puerto Rico.

SUBSEQUENT EVENTS

12 Months Ended

Dec. 31, 2019

Subsequent Events [Abstract]

SUBSEQUENT EVENTS

Sixth Amended and Restated Senior Credit Agreement

On February 3, 2020, the Company entered into an the sixth amendment and restatement (the "February 2020 Amendment") of its credit agreement with a syndicate of lending banks. The sixth amended and restated credit agreement makes an aggregate principal amount of up to approximately $2.2 billion available to the Company through the following facilities: (i) a $877.5 million term loan facility (decreased from $900 million), and (ii) a $1.3 billion revolving credit facility, which includes a $60 million sublimit for the issuance of standby letters of credit and a $60 million sublimit for swingline loans. The sixth amendment and restatement extends the credit facility’s maturity date from May 3, 2023 to February 3, 2025. The first mandatory repayment under the term loan portion of the sixth amended and restated credit agreement is due June 30, 2021.

In connection with the February 2020 Amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants was modified to the following:



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

First fiscal quarter ending after the Closing Date through June 30, 2022		5.00 to 1.00
September 30, 2022 through June 30, 2023		4.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter		4.00 to 1.00

Convertible Notes

On February 4, 2020, the Company offered and sold in a private placement $575.0 million of 0.5% convertible notes due in 2025. Upon conversion, the Notes may be settled in shares of Company's common stock, cash or a combination of cash and shares of the common stock, at the election of the Company. The initial conversion rate is 13.5739 shares of common stock per $1,000 principal amount of Notes. In connection with the offering of the Notes, the Company entered into privately negotiated convertible note hedge transactions. These transactions are expected generally to reduce potential dilution to the Company's common stock upon conversion of the Notes. The Company also entered into warrant transactions with the option counterparties. The warrant transactions could separately have a dilutive effect on the Company's common stock if the market price exceeds the strike price of the warrants. The Company intends to use:


•	Approximately $59.7 million of the net proceeds from the offering to pay the cost of the convertible note hedge transactions (after such cost is partially offset by the proceeds from the sale of the warrant transactions).

•

$100.0 million of the net proceeds from the offering to repurchase shares of the Company's stock. This includes up to approximately $7.6 million from certain purchasers of the convertible notes in conjunction with the closing of the offering. $92.4 million of the proceeds will be used to repurchase shares through an accelerated share repurchase transaction ("ASR"). Total shares repurchased through February 21, 2020 were 1,438,615.

•

The remainder of the net proceeds for general corporate purposes, which may include repayment of a portion of the indebtedness under the Company's Senior Credit Facility. On February 10, 2020, the Company repaid $315.0 million of principal on the revolving portion of its Senior Credit Facility.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Basis Of Presentation

BASIS OF PRESENTATION

Principles Of Consolidation

PRINCIPLES OF CONSOLIDATION

Use Of Estimates

USE OF ESTIMATES

Reclassifications

RECLASSIFICATIONS

Certain amounts from the prior year's financial statements have been reclassified in order to conform to the current year's presentation.

Cash And Cash Equivalents

CASH AND CASH EQUIVALENTS

Trade Accounts Receivable And Allowances For Doubtful Accounts Receivable

TRADE ACCOUNTS RECEIVABLE AND ALLOWANCES FOR DOUBTFUL ACCOUNTS RECEIVABLE

Inventories

INVENTORIES



	December 31,
	2019	2018
	(In thousands)
Finished goods	201,870	$	179,885
Work in process	48,333	47,715
Raw materials	65,851	52,747
Total inventories, net	316,054	$	280,347

Property, Plant And Equipment

PROPERTY, PLANT AND EQUIPMENT

Capitalized Interest

CAPITALIZED INTEREST

expenditures using the weighted average cost of the Company's outstanding borrowings.

Acquisitions

ACQUISITIONS

Goodwill And Other Intangible Assets

GOODWILL AND OTHER INTANGIBLE ASSETS

The Company has two reportable segments with three underlying reporting units. Refer to Note 16, Segment and Geographic Information for more information on reportable segments.

LONG-LIVED ASSETS

INTEGRA FOUNDATION

DERIVATIVES

FOREIGN CURRENCY

INCOME TAXES

or all of the deferred tax assets will not be realized. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period when the change is enacted.

Revenue Recognition

REVENUE RECOGNITION

Total revenue, net, includes product sales, product royalties and other revenues, such as fees received from services.

Performance Obligations

Significant Judgments

Shipping and Handling Fees

Research And Development

RESEARCH AND DEVELOPMENT

Employee Termination Benefits

EMPLOYEE TERMINATION BENEFITS

Stock-Based Compensation

STOCK-BASED COMPENSATION

Pension Benefits

PENSION BENEFITS

Concentration Of Credit Risk

CONCENTRATION OF CREDIT RISK

Recent Accounting Pronouncements

RECENT ACCOUNTING PRONOUNCEMENTS

There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.

Revenue Recognition and Shipping and Handling Fees

REVENUE RECOGNITION

Total revenue, net, includes product sales, product royalties and other revenues, such as fees received from services.

Performance Obligations

Significant Judgments

Shipping and Handling Fees

Product Warranties

Taxes Collected from Customers

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Schedule of Inventories

Inventories consisted of the following:



	December 31,
	2019	2018
	(In thousands)
Finished goods	201,870	$	179,885
Work in process	48,333	47,715
Raw materials	65,851	52,747
Total inventories, net	316,054	$	280,347

Schedule of Property, Plant and Equipment Balances and Corresponding Lives

Property, plant and equipment balances and corresponding lives were as follows:



	December 31,
	2019			2018			Useful Lives
	(In thousands)
Land	$	1,476		$	1,837
Buildings and building improvements	16,262			20,472			5-40 years
Leasehold improvements	114,941			105,063			1-20 years
Machinery and production equipment	155,313			143,921			3-20 years
Surgical instrument kits	33,104			31,231			4-5 years
Information systems and hardware	138,398			129,962			1-7 years
Furniture, fixtures, and office equipment	22,145			17,731			1-15 years
Construction-in-progress	140,366			105,075
Total	622,005			555,292
Less: Accumulated depreciation	(284,601		)	(255,180		)
Property, plant and equipment, net	$	337,404		$	300,112

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

12 Months Ended

Dec. 31, 2019

Revenue from Contract with Customer [Abstract]

Schedule of Changes in Contract Assets and Contract Liabilities

The following table summarized the changes in the contract asset and liability balances for the year ended December 31, 2019:



		Total
	(amounts in thousands)
Contract Asset
Contract asset, January 1, 2019		$	4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset		(4,193		)
Contract asset, net of transferred to trade receivables on contracts during the period		8,680
Contract asset, December 31, 2019		$	8,680

Contract Liability
Contract liability, January 1, 2019		$	12,716
Recognition of revenue included in beginning of year contract liability		(5,613		)
Contract liability, net of revenue recognized on contracts during the period		4,872
Foreign currency translation		(29		)
Contract liability, December 31, 2019		$	11,946

Schedule of Disaggregation of Revenue

years-ended December 31, 2019, 2018 and 2017 (amounts in thousands):



	Year Ended December 31, 2019		Year Ended December 31, 2018		Year Ended December 31, 2017
	(amounts in thousands)
Neurosurgery	707,011		684,148		446,994
Precision Tools and Instruments	289,195		$	279,781	$	273,307
Total Codman Specialty Surgical	996,206		963,929		720,301

Wound Reconstruction	322,739		311,565		274,398
Extremity Orthopedics	90,082		90,588		93,546
Private Label	108,530		106,359		99,991
Total Orthopedics and Tissue Technologies	521,351		508,512		467,935
Total revenue	$	1,517,557	$	1,472,441	$	1,188,236

Schedule of Impact on Statement of Operations

The impact of adoption of Topic 606 to the Company's consolidated statement of operations for the year ended December 31, 2018 was as follows:



	Year Ended December 31, 2018
	As Reported			Excluding Impact of Topic 606
	(Amounts in thousands)
Statement of Operations
Total revenue, net	$	1,472,441		$	1,468,075
Cost of goods sold	571,496			570,028
Income tax benefit	(3,398		)	(4,119		)
Net income	60,801			58,624

ACQUISITIONS AND PRO FORMA RESULTS (Tables)

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Schedule of Assets Acquired and Liabilities Assumed



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Inventory	74,962
Assets held for sale	30,813
Other current assets	8,202
Property, plant and equipment	41,339
Intangible assets:
Codman corporate trade name	162,900		Indefinite
Completed technology	375,200		22 years
Goodwill	342,322
Total assets acquired	1,035,738
Accrued expenses	1,730
Pension liabilities	19,917
Net assets acquired	$	1,014,091



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Cash and cash equivalents	$	16,512
Short-term investments	19,238
Accounts receivable	8,949
Inventory	17,977
Prepaid expenses and other current assets	4,369
Property, plant and equipment	4,311
Intangible assets:
Customer relationship	78,300		14 years
Trademarks/brand names	13,500		15 years
Completed technology	11,600		14 years
Non-compete agreement	280		1 year
Goodwill	73,765
Deferred tax assets	14,524
Other assets	101
Total assets acquired	263,426
Accounts payable	4,560
Accrued expenses and other current liabilities	7,409
Contingent liability	37,174
Other liabilities	3,805
Net assets acquired	$	210,478

The following table summarizes the fair values of the assets acquired and liabilities assumed at the acquisition date:



	Preliminary Valuation as of December 31, 2019		Weighted Average Life
	(Dollars in thousands)
Cash	$	90
Other current assets	751
Property, plant and equipment	159
Deferred Tax Assets	1,535
Intangible assets:
CerebroFlo developed Technology	20,100		15 years
Enabling technology license	1,980		14 years
Goodwill	27,600
Total assets acquired	52,215

Accounts Payable, accrued expenses and other liabilities	2,926
Contingent consideration	13,100
Deferred tax liabilities	5,305
Net assets acquired	$	30,884

Pro Forma Financial Information, Summary of Results of Operations

As a result, these pro forma results do not necessarily represent results that would have occurred if the acquisitions had taken place on the basis assumed above, nor are they indicative of the results of future combined operations.



	Year Ended December 31, 2017
	(Pro forma)
	(In thousands except per share amounts)
Total revenue from continuing operations	$	1,428,491
Net income from continuing operations	$	81,730

Basic earnings per share from continuing operations	$	1.06

Schedule of Assets and Liabilities Divested

Assets and liabilities divested consisted of the following as of October 6, 2017 (amounts in thousands):



Inventories	$	8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets divested	$	43,180

Deferred revenue	$	1,082
Accrued compensation	209
Total liabilities divested	$	1,291

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

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+ Details

DEBT (Tables)

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of May 2018 Amendment through March 31, 2019		5.50 : 1.00
June 30, 2019 through March 31, 2020		5.00 : 1.00
June 30, 2020 through March 31, 2021		4.50 : 1.00
June 30, 2021 and thereafter		4.00 : 1.00

In connection with the February 2020 Amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants was modified to the following:



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

First fiscal quarter ending after the Closing Date through June 30, 2022		5.00 to 1.00
September 30, 2022 through June 30, 2023		4.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter		4.00 to 1.00

Schedule of Maturities of Long-term Debt

Contractual repayments of the Term Loan component of Senior Credit Facility are due as follows:



Year-ended December 31, 2019	Principal Repayment
	(In thousands)
2020	$	45,000
2021	56,250
2022	67,500
2023	708,750
	$	877,500

- Definition

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.

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+ Details

DERIVATIVE INSTRUMENTS (Tables)

12 Months Ended

Dec. 31, 2019

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following cross-currency rate swaps designated as net investment hedges as of December 31, 2019 and December 31, 2018, respectively (dollar amounts in thousands):



						December 31, 2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—	EUR	44,859	2,459
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	52,000	2,459

Pay EUR	October 3, 2018	September 30, 2023	—	EUR	51,760	3,087
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	3,087

Pay EUR	October 3, 2018	September 30, 2025	—	EUR	38,820	2,032
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,032

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(154		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	(154		)

Pay CHF	October 3, 2018	September 30, 2025	—	CHF	165,172	1,221
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	1,221

Total						$	8,645



						December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—	EUR	70,738	1,359
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	82,000	1,359

Pay EUR	October 3, 2018	September 30, 2023	—	EUR	51,760	(421		)
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	(421		)

Pay EUR	October 3, 2018	September 30, 2025	—	EUR	38,820	(150		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	(150		)

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	2,360
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	2,360

Pay CHF	October 3, 2018	September 30, 2025	—	CHF	165,172	(3,780		)
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(3,780		)

Total						$	(632	)

The Company held the following interest rate swaps as of December 31, 2019 (dollar amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Assets (Liabilities)
3-month USD LIBOR	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	(2	)
1-month USD LIBOR	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	12
1-month USD LIBOR	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(581	)
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(2,880	)
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(2,880	)
1-month USD LIBOR	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(3,517	)
1-month USD LIBOR	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(1,778	)
1-month USD LIBOR	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(6,595	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(5,750	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(5,747	)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(5,807	)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(4,930	)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(4,691	)
Total interest rate derivatives designated as cash flow hedge	$	1,325,000						(45,145	)

The Company held the following interest rate swaps as of December 31, 2018 (dollar amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Assets (Liabilities)
3-month USD LIBOR	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	$	410
3-month USD LIBOR	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	415
1-month USD LIBOR	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	418
3-month USD LIBOR	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	619
1-month USD LIBOR	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	1,287
1-month USD LIBOR	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	1,246
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1,491
1-month USD LIBOR	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1,460
1-month USD LIBOR	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	418
1-month USD LIBOR	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	162
1-month USD LIBOR	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	2,076
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(2,594		)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(2,551		)
1-month USD LIBOR	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(2,568		)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(797		)
1-month USD LIBOR	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(873		)
Total interest rate derivatives designated as cash flow hedges	$	1,475,000						$	619

The Company held the following cross-currency rate swaps as of December 31, 2018 (dollar amounts in thousands):



						2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(215	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(215	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(422		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(422		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(2,193		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(2,193		)

Total						$	(2,830	)

The Company held the following cross-currency rate swaps designated as cash flow hedges as of December 31, 2019 (dollar amounts in thousands):



						2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	32,355	$	(101	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	33,333	$	(101	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(119		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(119		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(289		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(289		)

Total						$	(509	)

Summary of Fair Value in Balance Sheet for Derivatives Designated as Hedging Instruments

The following table summarizes the fair value and presentation in the consolidated balance sheet for derivatives designated as hedging instruments:



	Fair Value as of December 31,
	2019		2018
Location on Balance Sheet ⁽¹⁾:	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap⁽²⁾	$	12	$	4,654
Cross-currency swap	5,032		7,615
Net Investment Hedges
Cross-currency swap	$	7,952	$	8,888
Other assets
Cash Flow Hedges
Interest rate swap⁽²⁾	—		5,350
Net Investment Hedges
Cross-currency swap	$	3,465	$	1,774
Total Derivatives designated as hedges — Assets	$	16,461	$	28,281

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	$	6,635	$	—
Cross-currency swap	101		—
Other liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	38,522		9,385
Cross-currency swap	5,440		10,445
Net Investment Hedges
Cross-currency swap	$	2,772	$	11,294
Total Derivative designated as hedges — Liabilities	$	53,470	$	31,124


⁽¹⁾	The Company classifies derivative assets and liabilities as current based on the cash flows expected to be incurred within the following 12 months.

⁽²⁾

At December 31, 2019 and 2018, the total notional amounts related to the Company’s interest rate swaps were $1.3 billion and $1.5 billion, respectively.

Effect of Derivative Instruments Designated as Cash Flow Hedges on Statements of Operations



	Balance in AOCL Beginning of Year			Amount of Gain (Loss) Recognized in AOCL			Amount of Gain (Loss) Reclassified from AOCL into Earnings		Balance in AOCL End of Year			Location in Statements of Operations
	(In thousands)
Year Ended December 31, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(43,493	)	$	2,271	$	(45,145	)	Interest expense
Cross-currency swap	(6,190		)	9,334			2,967		177			Other income, net
Net Investment Hedges
Cross-currency swap	(632		)	20,488			9,627		10,229			Interest income
	$	(6,203	)	$	(13,671	)	$	14,865	$	(34,739	)
Year Ended December 31, 2018
Cash Flow Hedges
Interest rate swap	$	592		$	924		$	897	$	619		Interest expense
Cross-currency swap	(5,104		)	9,062			10,148		(6,190		)	Other income, net
Net Investment Hedges
Cross-currency swap	—			1,723			2,355		(632		)	Interest income
	$	(4,512	)	$	11,709		$	13,400	$	(6,203	)

- Definition

Tabular disclosure of pertinent information about a derivative or group of derivatives on a disaggregated basis, such as for individual instruments, or small groups of similar instruments. May include a combination of the type of instrument, risks being hedged, notional amount, hedge designation, related hedged item, inception date, maturity date, or other relevant item.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
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+ Details

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill in 2019 and 2018 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at January 1, 2018	$	634,767		$	303,138		$	937,905
Codman acquisition measurement period adjustments	(3,964		)	—			(3,964		)
Foreign currency translation	(5,043		)	(2,423		)	(7,466		)
Goodwill at December 31, 2018	$	625,760		$	300,715		$	926,475
Arkis Acquisition	27,600			—			27,600
Foreign currency translation	140			65			205
Goodwill at December 31, 2019	$	653,500		$	300,780		$	954,280

Schedule of Indefinite-Lived Intangible Assets

The components of the Company's identifiable intangible assets were as follows:



	Weighted Average Life	December 31, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	880,623	$	(213,702	)	$	666,921
Customer relationships	12 years	222,575		(119,393		)	103,182
Trademarks/brand names	28 years	103,873		(28,514		)	75,359
Codman trade name	Indefinite	163,126		—			163,126
Supplier relationships	27 years	34,721		(17,947		)	16,774
All other⁽¹⁾	4 years	10,869		(4,640		)	6,229
		$	1,415,787	$	(384,196	)	$	1,031,591



	Weighted Average Life	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman trade name	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other⁽¹⁾	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496

(1)

At December 31, 2019 and 2018, all other included IPR&D of $1.0 million, which was indefinite-lived.

Schedule of Finite-Lived Intangible Assets

The components of the Company's identifiable intangible assets were as follows:



	Weighted Average Life	December 31, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	880,623	$	(213,702	)	$	666,921
Customer relationships	12 years	222,575		(119,393		)	103,182
Trademarks/brand names	28 years	103,873		(28,514		)	75,359
Codman trade name	Indefinite	163,126		—			163,126
Supplier relationships	27 years	34,721		(17,947		)	16,774
All other⁽¹⁾	4 years	10,869		(4,640		)	6,229
		$	1,415,787	$	(384,196	)	$	1,031,591



	Weighted Average Life	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in Thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman trade name	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other⁽¹⁾	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496

(1)

At December 31, 2019 and 2018, all other included IPR&D of $1.0 million, which was indefinite-lived.

STOCK-BASED COMPENSATION (Tables)

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

Summary Of Employee Stock-Based Compensation Expense

Stock-based compensation expense - all related to employees and members of the Board of Directors - recognized under the authoritative guidance was as follows:



	Years Ended December 31,
	2019		2018		2017
	(In thousands)
Selling, general and administrative	$	19,153	$	18,721	$	19,785
Research and development	1,785		1,609		1,273
Cost of goods sold	317		449		492
Total stock-based compensation expense	21,255		20,779		21,550
Total estimated tax benefit related to stock-based compensation expense	9,420		10,430		15,448
Net effect on net income	$	11,835	$	10,349	$	6,102

Summary Of Weighted-Average Assumptions

The following weighted-average assumptions were used in the calculation of fair value:



	Years Ended December 31,
	2019	2018	2017
Dividend yield	0%	0%	0%
Expected volatility	28%	28%	30%
Risk free interest rate	2.51%	2.79%	2.18%
Expected life of option from grant date	7 years	8 years	8 years

Summary Of Stock Option Activity

The following table summarizes the Company’s stock option activity.



			Weighted Average Exercise Price		Weighted Average Contractual Term in Years	Aggregate Intrinsic Value

	Shares
Stock Options	(In thousands)					(In thousands)
Outstanding at January 1, 2019	1,448		$	27.91	—	—
Granted	203		55.91
Exercised	(350	)	17.83
Forfeited or Expired	(17	)	46.52
Outstanding at December 31, 2019	1,284		$	34.83	4.03	$	30,128
Vested or expected to vest at December 31, 2019	1,284		$	34.83	4.03	$	30,128
Exercisable at December 31, 2019	961		$	28.49	3.15	$	28,639

Summary Of Restricted Stock, Performance Stock, and Contract Stock

The following table summarizes the Company’s awards of restricted stock, performance stock and contract stock for the year ended December 31, 2019.




	Restricted Stock Awards				Performance Stock and Contract Stock Awards
	Shares		Weighted Average Grant Date Fair Value Per Share		Shares		Weighted Average Grant Date Fair Value Per Share


	(In thousands)				(In thousands)
Unvested, January 1, 2019	417		$	48.97	85		45.56
Granted	303		55.41		157		55.86
Adjustments for performance achievement related to award target	—		—		19		50.36
Cancellations	(59	)	50.31		(27	)	—
Performance stock awards vested in 2018 and released in 2019	—				273		42.94
Released	(201	)	46.08		(175	)	56.03
Vested but not released	—		—		(140	)	50.36
Unvested, December 31, 2019	460		$	54.31	192		55.38

RETIREMENT BENEFIT PLANS (Tables)

12 Months Ended

Dec. 31, 2019

Retirement Benefits [Abstract]

Schedule of Net Periodic Benefit Costs

Net periodic benefit costs for the Company’s defined benefit pension plans for the years ended December 31, 2019 and 2018 included the following (amounts in thousands):



	Year ended December 31,
	2019			2018
Service cost	$	3,815		$	2,704
Interest cost	517			351
Expected return on plan assets	(1,047		)	(944		)
Amortization of prior service cost (credit)	(259		)	—
Recognized actuarial losses	65			8
Settlements	602			—
Net period benefit cost	$	3,693		$	2,119

Schedule of Weighted Average Assumptions Used



	As of December 31,
	2019		2018
Discount rate	0.40	%	1.00	%
Expected return on plan assets	3.33	%	3.40	%
Rate of compensation increase	2.25	%	1.70	%

Schedule of Benefit Obligations and Plan Assets



	Year ended December 31,
	2019			2018
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	52,542		$	47,661
Interest cost	517			351
Service cost	3,815			2,704
Actuarial loss	12,188			762
Plan amendments	(3,133		)	—
Plan settlements	(2,664		)	—
Employee contribution	899			641
Premiums paid	(395		)	—
Benefit payment	(635		)	(1,483		)
Plans transferred in	3,199			2,280
Effect of foreign currency exchange rates	639			(374		)
Projected benefit obligations, end of year	$	66,972		$	52,542

	Year ended December 31,
	2019			2018
Change In Plan Assets
Plan assets at fair value, beginning of year	$	31,103		$	26,943
Actual return on plan assets	(152		)	1,802
Employer contributions	2,189			1,720
Employee contributions	899			641
Plan settlements	(2,645		)	—
Benefits paid	(635		)	(1,463		)
Premiums paid	(395		)	—
Plans transferred in	—			1,589
Effect of foreign currency exchange rates	406			(129		)
Plan assets at fair value, end of year	$	30,770		$	31,103

Schedule of Funded Status



	Year ended December 31,
	2019		2018
Reconciliation Of Funded Status
Fair value of plan assets	$	30,770	$	31,103
Benefit obligations	66,972		52,542
Unfunded benefit obligations	$	36,202	$	21,439

Schedule of Expected Benefit Payments

The following table is the summary of expected future benefit payments (in thousands):



2020	$	1,702
2021	1,743
2022	1,499
2023	1,650
2024	2,115
Next five years	10,157

LEASES AND RELATED PARTY LEASES (Tables)

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases at December 31, 2019 were as follows:



	December 31, 2019
	(In thousands, except lease term and discount rate)
ROU assets	$	94,530

Current lease liabilities	12,253
Non-current lease liabilities	97,504
Total lease liabilities	$	109,757

Weighted average remaining lease term (in years):
Leased facilities	12.8 years
Leased vehicles	2.6 years

Weighted average discount rate:
Leased facilities	5.4		%
Leased vehicles	3.2		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases was as follows for the year ended December 31, 2019 (in thousands):



	December 31, 2019
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	11,469

ROU assets obtained in exchange for lease liabilities:
Operating leases	41,423

Future Minimum Lease Payment Obligations Under Operating Leases, After Adoption of 842

Future minimum lease payments under operating leases at December 31, 2019 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2020	296		12,100		12,396
2021	296		12,951		13,247
2022	296		13,753		14,049
2023	296		11,386		11,682
2024	296		11,060		11,356
Thereafter	1,428		91,235		92,663
Total minimum lease payments	$	2,908	$	152,485	$	155,393
Less: Imputed interest					$	45,636
Total lease liabilities					109,757
Less: Current lease liabilities					12,253
Long-term lease liabilities					97,504

Future Minimum Lease Payment Obligations Under Operating Leases, Before Adoption of 842

Future minimum lease payments under operating leases at December 31, 2018 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	296	$	16,472	$	16,768
2020	296		13,510		13,806
2021	296		12,197		12,493
2022	296		12,937		13,233
2023	296		10,707		11,003
Thereafter	1,724		100,675		102,399
Total minimum lease payments	$	3,204	$	166,498	$	169,702

INCOME TAXES (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Schedule Of Income (Loss) Before Income Taxes

Income (Loss) before income taxes consisted of the following:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
United States operations	$	(38,359	)	$	(21,218	)	$	(32,640	)
Foreign operations	98,463			78,621			44,025
Total	$	60,104		$	57,403		$	11,385

Schedule Of Effective Income Tax Rate Reconciliation

A reconciliation of the U.S. Federal statutory rate to the Company’s effective tax rate is as follows:



	Years Ended December 31,
	2019		2018		2017
Federal statutory rate	21.0	%	21.0	%	35.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	1.0	%	(0.4	)%	(17.0	)%
Foreign operations	(20.0	)%	(21.8	)%	(112.7	)%
Excess tax benefits from stock compensation	(5.6	)%	(7.8	)%	(57.9	)%
Charitable contributions	(0.6	)%	(1.2	)%	(10.6	)%
Nondeductible meals and entertainment	1.5	%	1.6	%	8.8	%
Intercompany profit in inventory	1.2	%	6.2	%	11.6	%
Nondeductible facilitative costs	0.8	%	—	%	22.5	%
Changes in valuation allowances	0.2	%	0.2	%	8.0	%
Uncertain tax positions	0.2	%	0.4	%	(4.6	)%
Research and development credit	(2.9	)%	(2.6	)%	(13.2	)%
Return to provision	1.7	%	(2.9	)%	(4.3	)%
Global intangible low-taxed income ("GILTI")	7.6	%	3.5	%	—	%
Nondeductible executive compensation	3.0	%	1.6	%	—	%
Carryback of Federal net operating loss ("NOL")	0.1	%	(3.7	)%	—	%
Other	0.4	%	—	%	0.8	%
Swiss tax holiday	(15.7	)%	—	%	—	%
In-process research and development	22.7	%	—	%	—	%
Reduction of book gain on sale of assets	—	%	—	%	(4.6	)%
Tax reform — Toll Tax	—	%	—	%	48.1	%
Tax reform — remeasurement of deferred tax assets and liabilities	—	%	—	%	(378.6	)%
Effective tax rate	16.5	%	(5.9	)%	(468.7	)%

Schedule Of Provision For Income Taxes

The provision for income taxes consisted of the following:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Current:
Federal	$	14,597		$	(3,880	)	$	6,644
State	3,447			1,609			1,233
Foreign	10,905			7,057			6,069
Total current	$	28,949		$	4,786		$	13,946
Deferred:
Federal	(10,889		)	(7,202		)	(66,466		)
State	(666		)	(3,048		)	(758		)
Foreign	(7,491		)	2,066			(80		)
Total deferred	$	(19,046	)	$	(8,184	)	$	(67,304	)
Provision for income taxes	$	9,903		$	(3,398	)	$	(53,358	)

Schedule Of Deferred Tax Assets And Liabilities

The income tax effects of significant temporary differences that give rise to deferred tax assets and liabilities, shown before jurisdictional netting, are presented below:



	December 31,
	2019			2018
	(In thousands)
Assets:
Doubtful accounts	$	2,426		$	1,507
Inventory related items	39,548			28,245
Tax credits	19,134			9,072
Accrued vacation	3,206			2,761
Accrued bonus	6,017			5,515
Stock compensation	8,347			10,093
Deferred revenue	1,805			2,173
Net operating loss carryforwards	37,418			33,350
Capitalization of research and development expenses	9,781			—
Unrealized foreign exchange loss	8,105			1,405
Charitable contributions carryforward	235			1,994
Others	5,900			8,835
Total deferred tax assets	141,922			104,950
Less valuation allowance	(9,865		)	(6,973		)
Deferred tax assets after valuation allowance	$	132,057		$	97,977
Liabilities:
Intangible and fixed assets	(150,879		)	(144,861		)
Others	(5,108		)	(4,089		)
Total deferred tax liabilities	$	(155,987	)	$	(148,950	)
Total net deferred tax liabilities	$	(23,930	)	$	(50,973	)

Schedule Of Uncertain Tax Benefits Reconciliation

A reconciliation of the beginning and ending amount of uncertain tax benefits is as follows:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Balance, beginning of year	$	676		$	424		$	754
Gross increases:
Current year tax positions	53			273			402
Prior years' tax positions	—			—			—
Gross decreases:
Prior years' tax positions	—			—			(777		)
Statute of limitations lapses	—			(21		)	(17		)
Other	(53		)	—			62
Balance, end of year	$	676		$	676		$	424

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

12 Months Ended

Dec. 31, 2019

Segment Reporting [Abstract]

Schedule of Segment Reporting Information, by Segment

Net sales and profit by reportable segment for the years ended December 31, 2019, 2018 and 2017 are as follows:



	Years Ended December 31,
	2019			2018			2017
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	996,206		$	963,929		$	720,301
Orthopedics and Tissue Technologies	521,351			508,512			467,935
Total revenues	$	1,517,557		$	1,472,441		$	1,188,236
Segment Profit
Codman Specialty Surgical	$	395,019		$	363,336		$	292,971
Orthopedics and Tissue Technologies	144,638			149,510			129,697
Segment profit	539,657			512,846			422,668
Amortization	(27,028)			(21,160)			(20,370)
Corporate and other	(418,869		)	(380,688		)	(357,494		)
Operating income	$	93,760		$	110,998		$	44,804

The Company attributes revenue to geographic areas based on the location of the customer. Total revenue, net and long-lived assets (tangible) by major geographic area are summarized below:



	United States*		Europe		Asia Pacific		Rest of the World		Consolidated
	(In thousands)
Total revenue, net:
2019	$	1,077,379	$	197,468	$	157,391	$	85,319	$	1,517,557
2018	1,045,887		201,354		144,253		80,947		1,472,441
2017	894,260		150,147		80,636		63,193		1,188,236
Total long-lived assets:
2019	$	383,652	$	47,325	$	8,598	$	7,143	$	446,718
2018	280,382		32,679		3,765		3,203		320,029

* Includes long-lived assets in Puerto Rico.

SUBSEQUENT EVENTS SUBSEQUENT EVENTS (Tables)

12 Months Ended

Dec. 31, 2019

Subsequent Events [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of May 2018 Amendment through March 31, 2019		5.50 : 1.00
June 30, 2019 through March 31, 2020		5.00 : 1.00
June 30, 2020 through March 31, 2021		4.50 : 1.00
June 30, 2021 and thereafter		4.00 : 1.00

In connection with the February 2020 Amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants was modified to the following:



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

First fiscal quarter ending after the Closing Date through June 30, 2022		5.00 to 1.00
September 30, 2022 through June 30, 2023		4.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter		4.00 to 1.00

- Definition

+ References

+ Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Narrative) (Details) shares in Millions	3 Months Ended	12 Months Ended
	Dec. 31, 2019 USD ($)	Dec. 31, 2019 USD ($) Customer reporting_unit Segment	Dec. 31, 2018 USD ($) Customer	Dec. 31, 2017 USD ($) Customer shares	Jan. 01, 2019 USD ($)	Jan. 01, 2018 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Provision for doubtful accounts		$ 2,100,000	$ 600,000	$ 2,000,000.0
Inventory, capitalized expenses		0	0
Depreciation expense		42,600,000	44,100,000	36,100,000
Interest expense capitalized to property, plant, and equipment		$ 3,100,000	2,300,000
Number of reportable segments \| Segment		2
Number of reporting units \| reporting_unit		3
Contributions to Integra Foundation		$ 300,000	800,000	500,000
Foreign currency transaction loss		300,000	1,700,000	2,900,000
Increase to opening retained earnings	$ 398,574,000	398,574,000	348,373,000
Increase to total assets	3,303,240,000	3,303,240,000	3,107,887,000
Increase to total liabilities	1,886,504,000	1,886,504,000	1,732,091,000
Lease liabilities	109,757,000	109,757,000
Right of use asset - operating leases	94,530,000	94,530,000
Interest paid		48,900,000	58,300,000	32,300,000
Interest paid, capitalized into construction in progress		3,100,000	2,300,000	1,100,000
Income taxes paid		16,200,000	10,400,000	14,600,000
In-process research and development		64,916,000	0	0
Property and equipment purchases included in liabilities		11,000,000.0	$ 5,400,000	$ 7,800,000
Rebound
Summary Of Significant Accounting Policies [Line Items]
Development milestone payment, to be paid	5,000,000.0	$ 5,000,000.0
In-process research and development	$ 5,000,000.0
Convertible Debt
Summary Of Significant Accounting Policies [Line Items]
Stock issued, exercise of warrants (in shares) \| shares				2.8
Warrants exercised (in shares) \| shares				8.7
Sales Revenue, Net
Summary Of Significant Accounting Policies [Line Items]
Concentration risk, number of customers over benchmark \| Customer		0	0	0
Concentration risk, percentage		10.00%	10.00%	10.00%
Accounting Standards Update 2014-09 \| Adjustment Resulting from Adoption of Topic 606
Summary Of Significant Accounting Policies [Line Items]
Increase to total assets						$ 7,100,000
Increase to total liabilities						5,200,000
Accounting Standards Update 2014-09 \| Private Label \| Adjustment Resulting from Adoption of Topic 606 \| Transferred over Time
Summary Of Significant Accounting Policies [Line Items]
Increase to opening retained earnings						$ 1,900,000
Accounting Standards Update 2016-02
Summary Of Significant Accounting Policies [Line Items]
Lease liabilities					$ 76,400,000
Right of use asset - operating leases					$ 67,300,000
Minimum
Summary Of Significant Accounting Policies [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance		1 month
Maximum
Summary Of Significant Accounting Policies [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance		3 months

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Inventories, Net) (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Finished goods	$ 201,870	$ 179,885
Work in process	48,333	47,715
Raw materials	65,851	52,747
Total inventories, net	$ 316,054	$ 280,347

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Property, Plant and Equipment Balances and Corresponding Lives) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 622,005	$ 555,292
Less: Accumulated depreciation	(284,601)	(255,180)
Property, plant and equipment, net	337,404	300,112
Land
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	1,476	1,837
Buildings and building improvements
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 16,262	20,472
Buildings and building improvements \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	5 years
Buildings and building improvements \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	40 years
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 114,941	105,063
Leasehold improvements \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	1 year
Leasehold improvements \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	20 years
Machinery and production equipment
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 155,313	143,921
Machinery and production equipment \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	3 years
Machinery and production equipment \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	20 years
Surgical instrument kits
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 33,104	31,231
Surgical instrument kits \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	4 years
Surgical instrument kits \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	5 years
Information systems and hardware
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 138,398	129,962
Information systems and hardware \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	1 year
Information systems and hardware \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	7 years
Furniture, fixtures, and office equipment
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 22,145	17,731
Furniture, fixtures, and office equipment \| Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	1 year
Furniture, fixtures, and office equipment \| Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	15 years
Construction-in-progress
Property, Plant and Equipment [Line Items]
Property, plant, and equipment, gross	$ 140,366	$ 105,075

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Jan. 01, 2018
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Number of days from shipment to issue a credit	90 days
Short-term portion of contract liability	$ 4,772	$ 3,764
Long-term portion of contract liability	$ 7,100
Product warranty period (up to)	2 years
Increase to opening retained earnings	$ 398,574	348,373
Increase to total assets	3,303,240	3,107,887
Increase to total liabilities	$ 1,886,504	$ 1,732,091
Accounting Standards Update 2014-09 \| Adjustment Resulting from Adoption of Topic 606
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Increase to total assets			$ 7,100
Increase to total liabilities			5,200
Accounting Standards Update 2014-09 \| Private Label \| Adjustment Resulting from Adoption of Topic 606 \| Transferred over Time
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Increase to opening retained earnings			$ 1,900

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative, Revenue Remaining Performance Obligation) (Details) $ in Millions	Dec. 31, 2019 USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 4.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 2.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 1.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 0.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 0.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 1.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Changes in Contract Assets and Liabilities) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(4,193)
Contract asset, net of transferred to trade receivables on contracts during the period	8,680
Contract asset, End of Period	8,680
Contract Liability
Contract liability, Beginning of Period	12,716
Recognition of revenue included in beginning of year contract liability	(5,613)
Contract liability, net of revenue recognized on contracts during the period	4,872
Foreign currency translation	(29)
Contract liability, End of Period	$ 11,946

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Revenues Disaggregated by Major Source) (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation of Revenue [Line Items]
Total revenue, net	$ 395,127,000	$ 379,095,000	$ 383,645,000	$ 359,690,000	$ 383,315,000	$ 365,854,000	$ 366,190,000	$ 357,082,000	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total revenue, net									996,206,000	963,929,000	720,301,000
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total revenue, net									707,011,000	684,148,000	446,994,000
Codman Specialty Surgical \| Precision Tools and Instruments
Disaggregation of Revenue [Line Items]
Total revenue, net									289,195,000	279,781,000	273,307,000
Orthopedics and Tissue Technologies
Disaggregation of Revenue [Line Items]
Total revenue, net									521,351,000	508,512,000	467,935,000
Orthopedics and Tissue Technologies \| Wound Reconstruction
Disaggregation of Revenue [Line Items]
Total revenue, net									322,739,000	311,565,000	274,398,000
Orthopedics and Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total revenue, net									90,082,000	90,588,000	93,546,000
Orthopedics and Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total revenue, net									$ 108,530,000	$ 106,359,000	$ 99,991,000

REVENUES FROM CONTRACTS WITH CUSTOMERS (Impact of Adoption on Statement of Operations) (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Statement of Operations
Total revenue, net	$ 395,127,000	$ 379,095,000	$ 383,645,000	$ 359,690,000	$ 383,315,000	$ 365,854,000	$ 366,190,000	$ 357,082,000	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Cost of goods sold									564,681,000	571,496,000	435,511,000
Income tax benefit									9,903,000	(3,398,000)	(53,358,000)
Net income	$ 15,319,000	$ (27,610,000)	$ 29,736,000	$ 32,756,000	$ 25,138,000	$ 13,295,000	$ 11,376,000	$ 10,992,000	$ 50,201,000	60,801,000	$ 64,743,000
Excluding Impact of Topic 606
Statement of Operations
Total revenue, net										1,468,075,000
Cost of goods sold										570,028,000
Income tax benefit										(4,119,000)
Net income										$ 58,624,000

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

ACQUISITIONS AND PRO FORMA RESULTS (Business Acquisition, Narrative) (Details)					3 Months Ended										6 Months Ended	9 Months Ended	12 Months Ended
	Jul. 29, 2019 USD ($)	Feb. 24, 2017 USD ($)	Feb. 23, 2017 USD ($)	Feb. 14, 2017 USD ($)	Dec. 31, 2019 USD ($) liability	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Sep. 30, 2018 USD ($)	Jun. 30, 2018 USD ($)	Mar. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Jun. 30, 2017 USD ($)	Jun. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Dec. 31, 2019 USD ($) liability	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Oct. 06, 2017 USD ($)
Business Acquisition [Line Items]
Payment for contingent consideration																	$ 0	$ 38,196,000	$ 4,661,000
Cost of goods sold related to fair value inventory purchase accounting adjustments																	564,681,000	571,496,000	435,511,000
Realized loss, included in other income, net														$ 2,300,000
Deferred tax assets, other					$ 5,900,000				$ 8,835,000								5,900,000	8,835,000
Net income					15,319,000	$ (27,610,000)	$ 29,736,000	$ 32,756,000	25,138,000	$ 13,295,000	$ 11,376,000	$ 10,992,000					$ 50,201,000	60,801,000	64,743,000
BioD Morselized Amniotic Membrane Based Products \| Product Concentration Risk
Business Acquisition [Line Items]
Revenue from product, percentage																	1.00%
Codman Specialty Surgical
Business Acquisition [Line Items]
Aggregate purchase price received																				$ 46,400,000
Assets provided upon termination of transitional supply agreement liability													$ 1,300,000						1,300,000
Codman Specialty Surgical \| Disposal Group, Held-for-sale, Not Discontinued Operations
Business Acquisition [Line Items]
Gain on sale of business, included in other income, net																			2,600,000
Interest Expense, Intangible Asset Amortization, and External Expenses Related to Acquisition
Business Acquisition [Line Items]
Net income																			24,900,000
Interest Expense, Intangible Asset Amortization, and External Expenses Related to Acquisition \| Derma Sciences
Business Acquisition [Line Items]
Net income			$ 2,900,000
Arkis
Business Acquisition [Line Items]
Purchase price of business combination	$ 30,900,000
Contingent consideration, liability	25,500,000
Contingent consideration, fair value	$ 13,100,000				14,200,000												$ 14,200,000
Acquired intangible assets, discount rate	14.50%
Deferred taxes	$ 1,535,000
Arkis \| Milestone Payment One
Business Acquisition [Line Items]
Contingent consideration, liability	10,000,000
Arkis \| Milestone Payment Two
Business Acquisition [Line Items]
Contingent consideration, liability	$ 15,500,000
Codman
Business Acquisition [Line Items]
Purchase price of business combination				$ 1,014,000,000.000
Amounts accrued for ancillary and service agreement					2,100,000				22,800,000								2,100,000	22,800,000
Cash received from working capital adjustment related to business acquisition																		26,700,000
Purchase price adjustment										(800,000)					$ 3,200,000			3,964,000
Purchase price, working capital adjustments															6,200,000
Purchase price, inventory adjustments															$ 3,000,000.0
Purchase price, property, plant and equipment adjustment										5,500,000
Payment for contingent consideration																$ 15,900,000
Write off of construction in progress													6,300,000
Codman \| Fair Value Adjustment to Inventory
Business Acquisition [Line Items]
Cost of goods sold related to fair value inventory purchase accounting adjustments																		17,300,000
Codman \| Completed technology
Business Acquisition [Line Items]
Purchase price, intangible asset adjustment										$ 4,700,000
Derma Sciences
Business Acquisition [Line Items]
Purchase price of business combination		$ 210,800,000
Contingent consideration, liability					200,000				$ 200,000								200,000	$ 200,000
Contingent consideration, fair value		37,174,000
Payment of closing expenses		4,800,000
Payment of stock plan settlement		4,300,000
Payments to acquire business		201,700,000
Deferred taxes		$ 14,524,000			14,500,000												14,500,000
Deferred tax assets, operating loss carryforwards					39,700,000												39,700,000
Deferred tax assets, goodwill and intangible assets					16,400,000												16,400,000
Deferred tax liabilities, intangible assets					41,100,000												41,100,000
Deferred tax assets, other					$ 500,000												$ 500,000
Adjustment, deferred tax assets													$ 3,300,000	$ 1,500,000					$ 3,300,000
Number of contingent liabilities remaining \| liability					1												1
Contingent consideration arrangements, maximum payout					$ 3,000,000.0												$ 3,000,000.0
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Business Acquisition [Line Items]
Payment for contingent consideration																	$ 33,300,000

ACQUISITIONS AND PRO FORMA RESULTS (Schedule of Assets Acquired and Liabilities Assumed) (Details) - USD ($) $ in Thousands	Jul. 29, 2019	Feb. 24, 2017	Feb. 14, 2017	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Intangible assets:
Goodwill				$ 954,280	$ 926,475	$ 937,905
Arkis
Business Acquisition [Line Items]
Cash and cash equivalents	$ 90
Other current assets	751
Property, plant and equipment	159
Intangible assets:
Goodwill	27,600
Total assets acquired	52,215
Accounts Payable, accrued expenses and other liabilities	2,926
Deferred tax assets	1,535
Contingent liability	13,100			14,200
Deferred tax liabilities	5,305
Net assets acquired	30,884
Arkis \| CerebroFlo developed Technology
Intangible assets:
Intangible assets	$ 20,100
Wtd. Avg. Life	15 years
Arkis \| Enabling technology license
Intangible assets:
Intangible assets	$ 1,980
Wtd. Avg. Life	14 years
Codman
Business Acquisition [Line Items]
Other current assets			$ 8,202
Property, plant and equipment			41,339
Inventory			74,962
Assets held for sale			30,813
Intangible assets:
Goodwill			342,322
Total assets acquired			1,035,738
Accrued expenses			1,730
Pension liabilities			19,917
Net assets acquired			1,014,091
Codman \| Completed technology
Intangible assets:
Intangible assets			$ 375,200
Wtd. Avg. Life			22 years
Codman \| Trade name
Intangible assets:
Codman corporate trade name			$ 162,900
Derma Sciences
Business Acquisition [Line Items]
Cash and cash equivalents		$ 16,512
Property, plant and equipment		4,311
Short-term investments		19,238
Accounts receivable		8,949
Inventory		17,977
Prepaid expenses and other current assets		4,369
Intangible assets:
Goodwill		73,765
Total assets acquired		263,426
Deferred tax assets		14,524		$ 14,500
Other assets		101
Accounts payable		4,560
Accrued expenses and other current liabilities		7,409
Contingent liability		37,174
Other liabilities		3,805
Net assets acquired		210,478
Derma Sciences \| Completed technology
Intangible assets:
Intangible assets		$ 11,600
Wtd. Avg. Life		14 years
Derma Sciences \| Customer relationship
Intangible assets:
Intangible assets		$ 78,300
Wtd. Avg. Life		14 years
Derma Sciences \| Trademarks/brand names
Intangible assets:
Intangible assets		$ 13,500
Wtd. Avg. Life		15 years
Derma Sciences \| Non-compete agreement
Intangible assets:
Intangible assets		$ 280
Wtd. Avg. Life		1 year

ACQUISITIONS AND PRO FORMA RESULTS (Asset Acquisition, Narrative) (Details)			3 Months Ended	12 Months Ended
	Sep. 09, 2019 USD ($) asset	Jan. 04, 2019 USD ($) asset	Dec. 31, 2019 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)
Schedule Of Asset Acquisition [Line Items]
In-process research and development expenses				$ 64,916,000	$ 0	$ 0
Rebound
Schedule Of Asset Acquisition [Line Items]
Upfront payment	$ 67,100,000
Contingent development milestone payments commitment (up to)	$ 35,000,000.0
Number of assets acquired \| asset	1
Remaining net assets acquired	$ 7,200,000
Development milestone payment, to be paid			$ 5,000,000.0	$ 5,000,000.0
In-process research and development expenses			$ 5,000,000.0
Rebound \| Cash and Cash Equivalents
Schedule Of Asset Acquisition [Line Items]
Remaining net assets acquired	2,100,000
Rebound \| Deferred Tax Asset
Schedule Of Asset Acquisition [Line Items]
Remaining net assets acquired	4,200,000
Rebound \| IPR&D
Schedule Of Asset Acquisition [Line Items]
Upfront payment	$ 59,900,000
ISC \| Enabling technology license
Schedule Of Asset Acquisition [Line Items]
Number of assets acquired \| asset		1
Upfront payment, intangible assets		$ 1,700,000
Option to acquire, period subsequent to first commercial sale		4 years
Maximum future purchase price, if circumstances met (not to exceed)		$ 80,000,000.0

ACQUISITIONS AND PRO FORMA RESULTS (Schedule of Assets and Liabilities Divested) (Details) - Disposal Group, Held-for-sale, Not Discontinued Operations - Codman Specialty Surgical $ in Thousands	Oct. 06, 2017 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Inventories	$ 8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets of discontinued operations	43,180
Deferred revenue	1,082
Accrued compensation	209
Current liabilities of discontinued operations	$ 1,291

DEBT (Narrative) (Details) - USD ($)	12 Months Ended
DEBT (Narrative) (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	May 03, 2018
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 2,200,000,000
Securitization program outstanding borrowings, maximum limit	$ 150,000,000.0
Securitization program, term	3 years
Outstanding borrowings from accounts receivable securitization revolving loan facility	$ 104,500,000	$ 121,200,000
Weighted average interest rate, accounts receivable securitization revolving loan facility	2.80%	3.40%
Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value	$ 105,800,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity			1,300,000,000
Line of credit facility outstanding	$ 375,000,000.0	$ 345,000,000.0
Weighted average interest rate on debt	3.20%	4.00%
Revolving Credit Facility \| Level 2
Debt Instrument [Line Items]
Outstanding borrowings, fair value	$ 381,100,000
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity			60,000,000.0
Swingline Loan
Debt Instrument [Line Items]
Maximum borrowing capacity			60,000,000.0
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 900,000,000.0
Line of credit facility outstanding	$ 877,500,000	$ 900,000,000.0
Weighted average interest rate on debt	3.20%	3.90%
Term Loan Facility \| Secured Debt \| Level 2
Debt Instrument [Line Items]
Outstanding borrowings, fair value	$ 889,900,000
Senior Credit Facility
Debt Instrument [Line Items]
Capitalized incremental financing costs		$ 4,200,000
Senior Credit Facility \| Minimum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage	0.15%
Senior Credit Facility \| Maximum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage	0.35%
Senior Credit Facility \| Eurodollar \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option	1.00%
Senior Credit Facility \| Eurodollar \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option	1.75%
Senior Credit Facility \| Federal Funds
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.50%
Senior Credit Facility \| Federal Funds \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.00%
Senior Credit Facility \| Federal Funds \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.75%
Senior Credit Facility \| Prime Rate \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.00%
Senior Credit Facility \| Prime Rate \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.75%
Senior Credit Facility \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available to the company at its option	1.00%
Senior Credit Facility \| One Month Eurodollar Rate \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.00%
Senior Credit Facility \| One Month Eurodollar Rate \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option	0.75%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding	$ 0
Letters of credit outstanding	$ 800,000	$ 600,000

DEBT (Schedule of Debt Maturity) (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Debt Disclosure [Abstract]
2020	$ 45,000
2021	56,250
2022	67,500
2023	708,750
Principal Repayment	$ 877,500

DERIVATIVE INSTRUMENTS (Schedule of Interest Rate Swap Derivatives) (Details) - Cash Flow Hedging - Designated as Hedging Instrument - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Derivative [Line Items]
Current Notional Amount	$ 1,325,000,000	$ 1,475,000,000
Estimated Fair Value	(45,145,000)	619,000
3-month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 50,000,000	$ 50,000,000
Fixed Interest Rate	1.834%	1.834%
Estimated Fair Value	$ (2,000)	$ 619,000
3-month USD LIBOR \| Interest Rate Swap Designated June 22, 2016 Tranche 1
Derivative [Line Items]
Current Notional Amount		$ 50,000,000
Fixed Interest Rate		1.062%
Estimated Fair Value		$ 410,000
3-month USD LIBOR \| Interest Rate Swap Designated June 22, 2016 Tranche 2
Derivative [Line Items]
Current Notional Amount		$ 50,000,000
Fixed Interest Rate		1.062%
Estimated Fair Value		$ 415,000
1-month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 100,000,000	$ 100,000,000
Fixed Interest Rate	1.652%	1.652%
Estimated Fair Value	$ 12,000	$ 1,287,000
1-month USD LIBOR \| Interest Rate Swap Designated March 27, 2017
Derivative [Line Items]
Current Notional Amount	$ 100,000,000	$ 100,000,000
Fixed Interest Rate	1.971%	1.971%
Estimated Fair Value	$ (581,000)	$ 1,246,000
1-month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 150,000,000	$ 150,000,000
Fixed Interest Rate	2.201%	2.201%
Estimated Fair Value	$ (2,880,000)	$ 1,491,000
1-month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 150,000,000	$ 150,000,000
Fixed Interest Rate	2.201%	2.201%
Estimated Fair Value	$ (2,880,000)	$ 1,460,000
1-month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Current Notional Amount	$ 100,000,000	$ 100,000,000
Fixed Interest Rate	2.423%	2.423%
Estimated Fair Value	$ (3,517,000)	$ 418,000
1-month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 4
Derivative [Line Items]
Current Notional Amount	$ 50,000,000	$ 50,000,000
Fixed Interest Rate	2.423%	2.423%
Estimated Fair Value	$ (1,778,000)	$ 162,000
1-month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 5
Derivative [Line Items]
Current Notional Amount	$ 200,000,000	$ 200,000,000
Fixed Interest Rate	2.313%	2.313%
Estimated Fair Value	$ (6,595,000)	$ 2,076,000
1-month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 75,000,000	$ 75,000,000
Fixed Interest Rate	3.22%	3.22%
Estimated Fair Value	$ (5,750,000)	$ (2,594,000)
1-month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 75,000,000	$ 75,000,000
Fixed Interest Rate	3.199%	3.199%
Estimated Fair Value	$ (5,747,000)	$ (2,551,000)
1-month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Current Notional Amount	$ 75,000,000	$ 75,000,000
Fixed Interest Rate	3.209%	3.209%
Estimated Fair Value	$ (5,807,000)	$ (2,568,000)
1-month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 100,000,000	$ 100,000,000
Fixed Interest Rate	2.885%	2.885%
Estimated Fair Value	$ (4,930,000)	$ (797,000)
1-month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 100,000,000	$ 100,000,000
Fixed Interest Rate	2.867%	2.867%
Estimated Fair Value	$ (4,691,000)	$ (873,000)
1-month USD LIBOR \| Interest Rate Swap Designated July 12, 2016
Derivative [Line Items]
Current Notional Amount		$ 50,000,000
Fixed Interest Rate		0.825%
Estimated Fair Value		$ 418,000

DERIVATIVE INSTRUMENTS (Narrative) (Details) SFr in Millions	12 Months Ended
	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Nov. 28, 2017 USD ($)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Derivative [Line Items]
Notional amount, matured	$ 150,000,000
Gain (loss) recorded in other income, net	14,865,000	$ 13,400,000	$ 2,958,000
Unrealized derivative (loss) gain arising during period	(13,671,000)	11,709,000	(3,425,000)
Designated as Hedging Instrument
Derivative [Line Items]
Unrealized derivative (loss) gain arising during period	(13,671,000)	11,709,000
Designated as Hedging Instrument \| Cash Flow Hedging
Derivative [Line Items]
Notional amount	1,325,000,000	1,475,000,000
Foreign Currency Forward Contract \| Not Designated as Hedging Instrument
Derivative [Line Items]
Notional amount				$ 8,900,000
Gain (loss) from change in fair value of the contract		(200,000)	$ 100,000
Cross Currency Interest Rate Swap \| Codman
Derivative [Line Items]
Gain (loss) recorded in other income, net	(4,000,000.0)	2,200,000
Unrealized derivative (loss) gain arising during period	9,300,000	9,100,000
Gain reclassified into income	7,000,000.0	7,900,000
Amount estimated to be reclassified to earnings during next twelve months	4,900,000
Cross Currency Interest Rate Swap \| Short \| Codman
Derivative [Line Items]
Notional amount					$ 300,000,000.0
Cross Currency Interest Rate Swap \| Long \| Codman
Derivative [Line Items]
Notional amount \| SFr						SFr 291.2
Cross Currency Interest Rate Swap \| Designated as Hedging Instrument \| Net Investment Hedging
Derivative [Line Items]
Notional amount	30,000,000.0
Gain (loss) recorded in other income, net	1,600,000
Gain reclassified into income	9,600,000	2,400,000
Amount estimated to be reclassified to earnings during next twelve months	8,000,000.0
Gain recorded in AOCI, change in fair value	20,500,000	$ 1,700,000
Cross Currency Interest Rate Swap \| Designated as Hedging Instrument \| Codman \| Cash Flow Hedging
Derivative [Line Items]
Notional amount	66,700,000
Gain (loss) recorded in other income, net	$ (400,000)

DERIVATIVE INSTRUMENTS (Schedule of Cross Currency Swap Derivatives) (Details)	Dec. 31, 2019 USD ($)	Dec. 31, 2019 CHF (SFr)	Dec. 31, 2018 USD ($)	Dec. 31, 2018 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Codman \| Cross Currency Interest Rate Swap \| Long
Derivative [Line Items]
Aggregate Notional Amount \| SFr						SFr 291,200,000
Codman \| Cross Currency Interest Rate Swap \| Short
Derivative [Line Items]
Aggregate Notional Amount					$ 300,000,000.0
Cash Flow Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	$ 1,325,000,000		$ 1,475,000,000
Fair Value Asset (Liability)	(45,145,000)		619,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount	66,700,000
Fair Value Asset (Liability)	(509,000)		(2,830,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (101,000)		$ (215,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap One \| Long
Derivative [Line Items]
Fixed Rate	1.75%	1.75%	1.75%	1.75%
Aggregate Notional Amount \| SFr		SFr 32,355,000		SFr 97,065,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap One \| Short
Derivative [Line Items]
Fixed Rate	4.38%	4.38%	4.38%	4.38%
Aggregate Notional Amount	$ 33,333,000		$ 100,000,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ (119,000)		$ (422,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Two \| Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%	1.85%	1.85%
Aggregate Notional Amount \| SFr		SFr 48,533,000		SFr 48,533,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Two \| Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%	4.46%	4.46%
Aggregate Notional Amount	$ 50,000,000		$ 50,000,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ (289,000)		$ (2,193,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Three \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%	1.95%	1.95%
Aggregate Notional Amount \| SFr		SFr 145,598,000		SFr 145,598,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap \| Swap Three \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%	4.52%	4.52%
Aggregate Notional Amount	$ 150,000,000		$ 150,000,000

DERIVATIVE INSTRUMENTS (Schedule of Net Investment Hedges Derivatives) (Details) - Net Investment Hedging - Designated as Hedging Instrument € in Thousands, £ in Thousands, SFr in Thousands	Dec. 31, 2019 USD ($)	Dec. 31, 2019 EUR (€)	Dec. 31, 2019 GBP (£)	Dec. 31, 2019 CHF (SFr)	Dec. 31, 2018 USD ($)	Dec. 31, 2018 EUR (€)	Dec. 31, 2018 GBP (£)	Dec. 31, 2018 CHF (SFr)
Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 2,459,000				$ 1,359,000
Cross Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €		€ 44,859				€ 70,738
Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Interest Rate	3.01%	3.01%	3.01%	3.01%	3.01%	3.01%	3.01%	3.01%
Aggregate Notional Amount	$ 52,000,000				$ 82,000,000
Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,087,000				$ (421,000)
Cross Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €		€ 51,760				€ 51,760
Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Interest Rate	2.57%	2.57%	2.57%	2.57%	2.57%	2.57%	2.57%	2.57%
Aggregate Notional Amount	$ 60,000,000				$ 60,000,000
Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 2,032,000				$ (150,000)
Cross Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €		€ 38,820				€ 38,820
Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Interest Rate	2.19%	2.19%	2.19%	2.19%	2.19%	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000,000				$ 45,000,000
Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ (154,000)				$ 2,360,000
Cross Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Interest Rate	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £			£ 128,284				£ 128,284
Cross Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Interest Rate	2.71%	2.71%	2.71%	2.71%	2.71%	2.71%	2.71%	2.71%
Aggregate Notional Amount	$ 167,500,000				$ 167,500,000
Cross Currency Interest Rate Swap Five
Derivative [Line Items]
Fair Value Asset (Liability)	$ 1,221,000				$ (3,780,000)
Cross Currency Interest Rate Swap Five \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr				SFr 165,172				SFr 165,172
Cross Currency Interest Rate Swap Five \| Short
Derivative [Line Items]
Fixed Interest Rate	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £			£ 128,284				£ 128,284
Cross Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount	$ 30,000,000.0
Fair Value Asset (Liability)	$ 8,645,000				$ (632,000)

DERIVATIVE INSTRUMENTS (Fair Value of Derivative Instruments By Balance Sheet Location) (Details) - Designated as Hedging Instrument - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	$ 16,461,000	$ 28,281,000
Total Derivative designated as hedges — Liabilities	53,470,000	31,124,000
Cash Flow Hedges
Derivatives, Fair Value [Line Items]
Notional amount	1,325,000,000	1,475,000,000
Interest rate swap
Derivatives, Fair Value [Line Items]
Notional amount	1,300,000,000	1,500,000,000
Interest rate swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	12,000	4,654,000
Interest rate swap \| Cash Flow Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	0	5,350,000
Interest rate swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total Derivative designated as hedges — Liabilities	6,635,000	0
Interest rate swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total Derivative designated as hedges — Liabilities	38,522,000	9,385,000
Cross-currency swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	5,032,000	7,615,000
Cross-currency swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total Derivative designated as hedges — Liabilities	101,000	0
Cross-currency swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total Derivative designated as hedges — Liabilities	5,440,000	10,445,000
Cross-currency swap \| Net Investment Hedges
Derivatives, Fair Value [Line Items]
Notional amount	30,000,000.0
Cross-currency swap \| Net Investment Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	7,952,000	8,888,000
Cross-currency swap \| Net Investment Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total Derivatives designated as hedges — Assets	3,465,000	1,774,000
Cross-currency swap \| Net Investment Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total Derivative designated as hedges — Liabilities	$ 2,772,000	$ 11,294,000

DERIVATIVE INSTRUMENTS (Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	$ 1,375,796	$ 962,306	$ 839,667
Amount of Gain (Loss) Recognized in AOCL	(13,671)	11,709	(3,425)
Balance in AOCL End of Year	1,416,736	1,375,796	962,306
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL	(13,671)	11,709
Amount of Gain (Loss) Reclassified from AOCL into Earnings	14,865	13,400
Designated as Hedging Instrument \| Interest rate swap \| Interest expense \| Cash Flow Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	619	592
Amount of Gain (Loss) Recognized in AOCL	(43,493)	924
Amount of Gain (Loss) Reclassified from AOCL into Earnings	2,271	897
Balance in AOCL End of Year	(45,145)	619	592
Designated as Hedging Instrument \| Cross-currency swap \| Other income, net \| Cash Flow Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(6,190)	(5,104)
Amount of Gain (Loss) Recognized in AOCL	9,334	9,062
Amount of Gain (Loss) Reclassified from AOCL into Earnings	2,967	10,148
Balance in AOCL End of Year	177	(6,190)	(5,104)
Designated as Hedging Instrument \| Cross-currency swap \| Interest income \| Net Investment Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(632)	0
Amount of Gain (Loss) Recognized in AOCL	20,488	1,723
Amount of Gain (Loss) Reclassified from AOCL into Earnings	9,627	2,355
Balance in AOCL End of Year	10,229	(632)	0
Accumulated Other Comprehensive Income (Loss)
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(45,443)	(23,807)	(57,154)
Balance in AOCL End of Year	(76,402)	(45,443)	(23,807)
Accumulated Other Comprehensive Income (Loss) \| Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(6,203)	(4,512)
Balance in AOCL End of Year	$ (34,739)	$ (6,203)	$ (4,512)

GOODWILL AND OTHER INTANGIBLE ASSETS (Narrative) (Details)	3 Months Ended				12 Months Ended
	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2017 USD ($)	Dec. 31, 2019 USD ($) reporting_unit	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)
Goodwill [Line Items]
Number of reporting units \| reporting_unit					3
Goodwill, impairment	$ 0
Impairment charge					$ 5,764,000	$ 4,941,000	$ 3,290,000
Amortization					72,800,000	71,600,000	52,800,000
Expected annual amortization expense, 2020					74,600,000
Expected annual amortization expense, 2021					64,100,000
Expected annual amortization expense, 2022					60,600,000
Expected annual amortization expense, 2023					59,700,000
Expected annual amortization expense, 2024					58,900,000
Expected annual amortization expense, thereafter					547,700,000
Amortization of product technology					$ 45,800,000	50,400,000	$ 35,700,000
Codman
Goodwill [Line Items]
Impairment assessment, royalty rate	5.00%
Intangible assets, indefinite life, discount rate percentage	12.50%
Codman \| Trade name
Goodwill [Line Items]
Impairment of intangible assets	$ 0
Metasurg \| Orthopedics and Tissue Technologies
Goodwill [Line Items]
Impairment charge			$ 4,900,000
Impairment charge, out of period adjustment included in original impairment						$ 2,500,000
Tarsus \| Orthopedics and Tissue Technologies
Goodwill [Line Items]
Impairment charge				$ 3,300,000
Contract Manufacturing Customer, Notified By FDA To Remove Product From Market \| Private Label \| Customer relationship
Goodwill [Line Items]
Impairment charge		$ 5,800,000
Minimum \| Codman
Goodwill [Line Items]
Impairment assessment, tax rate	17.40%
Maximum \| Codman
Goodwill [Line Items]
Impairment assessment, tax rate	20.70%

GOODWILL AND OTHER INTANGIBLE ASSETS (Schedule of Changes in Carrying Amount of Goodwill) (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended	12 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Roll Forward]
Beginning of period		$ 937,905	$ 926,475	$ 937,905
Foreign currency translation			205	(7,466)
End of period			954,280	926,475
Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments	$ 800	(3,200)		(3,964)
Arkis
Goodwill [Roll Forward]
Arkis Acquisition			27,600
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of period		634,767	625,760	634,767
Foreign currency translation			140	(5,043)
End of period			653,500	625,760
Codman Specialty Surgical \| Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments				(3,964)
Codman Specialty Surgical \| Arkis
Goodwill [Roll Forward]
Arkis Acquisition			27,600
Orthopedics and Tissue Technologies
Goodwill [Roll Forward]
Beginning of period		$ 303,138	300,715	303,138
Foreign currency translation			65	(2,423)
End of period			300,780	300,715
Orthopedics and Tissue Technologies \| Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments				$ 0
Orthopedics and Tissue Technologies \| Arkis
Goodwill [Roll Forward]
Arkis Acquisition			$ 0

GOODWILL AND OTHER INTANGIBLE ASSETS (Components of Company's Identifiable Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,415,787	$ 1,398,921
Accumulated Amortization	(384,196)	(319,425)
Net	1,031,591	1,079,496
Codman trade name
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	163,126	162,054
Net	163,126	162,054
IPR&D
Acquired Finite-Lived Intangible Assets [Line Items]
Other Indefinite-lived Intangible Assets	$ 1,000	$ 1,000
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	19 years	19 years
Cost	$ 880,623	$ 855,679
Accumulated Amortization	(213,702)	(167,384)
Net	$ 666,921	$ 688,295
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	13 years
Cost	$ 222,575	$ 231,448
Accumulated Amortization	(119,393)	(106,859)
Net	$ 103,182	$ 124,589
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 103,873	$ 104,061
Accumulated Amortization	(28,514)	(24,764)
Net	$ 75,359	$ 79,297
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	27 years
Cost	$ 34,721	$ 34,721
Accumulated Amortization	(17,947)	(16,519)
Net	$ 16,774	$ 18,202
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	4 years	4 years
Cost	$ 10,869	$ 10,958
Accumulated Amortization	(4,640)	(3,899)
Net	$ 6,229	$ 7,059

TREASURY STOCK (Narrative) (Details) - USD ($)	12 Months Ended
TREASURY STOCK (Narrative) (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 11, 2018	Dec. 31, 2016
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
Treasury stock outstanding (in shares)	2,900,000	2,900,000
Treasury stock, cost	$ 119,900,000	$ 120,600,000
Treasury stock, weighted average cost per share (in dollars per share)	$ 41.87
Stock repurchase program, authorized amount (up to)			$ 225,000,000	$ 150,000,000.0
Stock repurchased during period (in shares)	0	0

STOCK-BASED COMPENSATION (Summary of Employee Stock-Based Compensation Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 21,255	$ 20,779	$ 21,550
Total estimated tax benefit related to stock-based compensation expense	9,420	10,430	15,448
Net effect on net income	11,835	10,349	6,102
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	19,153	18,721	19,785
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	1,785	1,609	1,273
Cost of goods sold
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 317	$ 449	$ 492

STOCK-BASED COMPENSATION (Narrative) (Details) $ / shares in Units, $ in Thousands	1 Months Ended		12 Months Ended
	May 31, 2017 shares	May 31, 2010 shares	Dec. 31, 2019 USD ($) stock_based_compensation_plan $ / shares shares	Dec. 31, 2018 USD ($) $ / shares shares	Dec. 31, 2017 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for purchase (in shares) \| shares			2,500,000
Number of stock-based compensation plans \| stock_based_compensation_plan			3
Dividend yield			0.00%	0.00%	0.00%
Share-based compensation expense recognized			$ 21,255	$ 20,779	$ 21,550
Intrinsic value, options exercised			$ 14,600	$ 16,900	$ 16,200
Weighted average grant date fair value of options granted (in dollars per share) \| $ / shares			$ 18.74	$ 21.78	$ 16.95
Cash received from option exercises and employee stock purchase plan			$ 6,900	$ 9,400	$ 9,800
Tax benefit realized from stock options exercised			3,000	3,100	6,200
Capitalized share-based compensation cost			$ 300	$ 400	$ 500
2003 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares) \| shares			14,700,000
Increase in authorized shares (in shares) \| shares	1,700,000	3,500,000
2000 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares) \| shares			4,000,000.0
2001 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares) \| shares			4,000,000.0
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares) \| shares			3,000,000.0
Shares available for purchase (in shares) \| shares			2,000,000.0
Shares issued (in shares) \| shares			12,531	16,721	12,168
ESPP proceeds received			$ 700	$ 700	$ 600
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			4 years
Share-based compensation expense recognized			$ 3,000	2,600	3,000
Total unrecognized compensation costs related to unvested awards			$ 4,500
Weighted-average period for cost recognition, in years			2 years
Employee Stock Option \| Director
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Employee Stock Option \| Employee
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			8 years
Employee Stock Option \| Directors and Certain Executive Officers \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			6 years
Employee Stock Option \| Directors and Certain Executive Officers \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			10 years
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Vested but not issued (in shares) \| shares			500,000
Performance Shares Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vested but not issued (in shares) \| shares			100,000
Restricted Stock, Performance Stock and Contract Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense recognized			$ 18,100	18,100	18,500
Total unrecognized compensation costs related to unvested awards			$ 23,400
Weighted-average period for cost recognition, in years			2 years
Fair value of shares vested			$ 21,100	$ 24,800	$ 22,200
Requisite service periods of performance stock, restricted stock and contract stock awards, in years			3 years

STOCK-BASED COMPENSATION (Summary of Weighted-Average Assumptions) (Details)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Share-based Payment Arrangement [Abstract]
Dividend yield	0.00%	0.00%	0.00%
Expected volatility	28.00%	28.00%	30.00%
Risk free interest rate	2.51%	2.79%	2.18%
Expected life of option from grant date	7 years	8 years	8 years

STOCK-BASED COMPENSATION (Summary of Stock Option Activity) (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Outstanding at beginning of year (in shares) \| shares	1,448
Granted (in shares) \| shares	203
Exercised (in shares) \| shares	(350)
Forfeited or Expired (in shares) \| shares	(17)
Outstanding at end of year (in shares) \| shares	1,284
Vested or expected to vest at end of year (in shares) \| shares	1,284
Exercisable at end of year (in shares) \| shares	961
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Roll Forward]
Weighted Average Exercise Price, Outstanding at beginning of year (in dollars per share) \| $ / shares	$ 27.91
Weighted Average Exercise Price, Granted (in dollars per share) \| $ / shares	55.91
Weighted Average Exercise Price, Exercised (in dollars per share) \| $ / shares	17.83
Weighted Average Exercise Price, Forfeited or Expired (in dollars per share) \| $ / shares	46.52
Weighted Average Exercise Price, Outstanding at end of year (in dollars per share) \| $ / shares	34.83
Weighted Average Exercise Price, Vested or expected to vest at end of year (in dollars per share) \| $ / shares	34.83
Weighted Average Exercise Price, Exercisable at end of year (in dollars per share) \| $ / shares	$ 28.49
Weighted Average Contractual Term in Years, Outstanding at end of year	4 years 10 days
Weighted Average Contractual Term in Years, Vested or expected to vest at end of year	4 years 10 days
Weighted Average Contractual Term in Years, Exercisable at end of year	3 years 1 month 24 days
Aggregate Intrinsic Value, Outstanding at end of year \| $	$ 30,128
Aggregate Intrinsic Value, Vested or expected to vest at end of year \| $	30,128
Aggregate Intrinsic Value, Exercisable at end of year \| $	$ 28,639

STOCK-BASED COMPENSATION (Summary of Vested and Unvested Restricted Stock, Performance Stock, and Contract Stock) (Details) shares in Thousands	12 Months Ended
	Dec. 31, 2019 $ / shares shares
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested beginning balance (in shares) \| shares	417
Granted (in shares) \| shares	303
Cancellations (in shares) \| shares	(59)
Released (in shares) \| shares	(201)
Vested but not released (in shares) \| shares	0
Unvested ending balance (in shares) \| shares	460
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Roll Forward]
Weighted Average Grant Date Fair Value Per Share, Unvested beginning balance (in dollars per share) \| $ / shares	$ 48.97
Weighted Average Grant Date Fair Value Per Share, Granted (in dollars per share) \| $ / shares	55.41
Weighted Average Grant Date Fair Value Per Share, Cancellations (in dollars per share) \| $ / shares	50.31
Weighted Average Grant Date Fair Value Per Share, Released (in dollars per share) \| $ / shares	46.08
Weighted Average Grant Date Fair Value Per Share, Vested but not released (in dollars per share) \| $ / shares	0
Weighted Average Grant Date Fair Value Per Share, Unvested ending balance (in dollars per share) \| $ / shares	$ 54.31
Performance Stock and Contract Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Unvested beginning balance (in shares) \| shares	85
Granted (in shares) \| shares	157
Adjustments for performance achievement related to award target (in shares) \| shares	19
Cancellations (in shares) \| shares	(27)
Performance stock awards vested in 2018 and released in 2019 (in shares) \| shares	273
Released (in shares) \| shares	(175)
Vested but not released (in shares) \| shares	(140)
Unvested ending balance (in shares) \| shares	192
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Roll Forward]
Weighted Average Grant Date Fair Value Per Share, Unvested beginning balance (in dollars per share) \| $ / shares	$ 45.56
Weighted Average Grant Date Fair Value Per Share, Granted (in dollars per share) \| $ / shares	55.86
Weighted Average Grant Date Fair Value Per Share, Adjustments for performance achievement related to award target (in dollars per share) \| $ / shares	50.36
Weighted Average Grant Date Fair Value Per Share, Cancellations (in dollars per share) \| $ / shares	0
Weighted Average Grant Date Fair Value Per Share, Performance stock awards vested in 2018 and released in 2019 (in dollars per share) \| $ / shares	42.94
Weighted Average Grant Date Fair Value Per Share, Released (in dollars per share) \| $ / shares	56.03
Weighted Average Grant Date Fair Value Per Share, Vested but not released (in dollars per share) \| $ / shares	50.36
Weighted Average Grant Date Fair Value Per Share, Unvested ending balance (in dollars per share) \| $ / shares	$ 55.38

RETIREMENT BENEFIT PLANS (Schedule of Net Periodic Benefit Costs) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Retirement Benefits [Abstract]
Service cost	$ 3,815	$ 2,704
Interest cost	517	351
Expected return on plan assets	(1,047)	(944)
Amortization of prior service cost (credit)	(259)	0
Recognized actuarial losses	65	8
Settlements	602	0
Net period benefit cost	$ 3,693	$ 2,119

RETIREMENT BENEFIT PLANS (Schedule of Change in Benefit Obligations and Plan Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$ 52,542	$ 47,661
Interest cost	517	351
Service cost	3,815	2,704
Actuarial loss	12,188	762
Plan amendments	(3,133)	0
Plan settlements	(2,664)	0
Employee contribution	899	641
Premiums paid	(395)	0
Benefit payment	(635)	(1,483)
Plans transferred in	3,199	2,280
Effect of foreign currency exchange rates	639	(374)
Projected benefit obligations, end of year	66,972	52,542
Change In Plan Assets
Plan assets at fair value, beginning of year	31,103	26,943
Actual return on plan assets	(152)	1,802
Employer contributions	2,189	1,720
Employee contributions	899	641
Plan settlements	(2,645)	0
Benefits paid	(635)	(1,463)
Premiums paid	(395)	0
Plans transferred in	0	1,589
Effect of foreign currency exchange rates	406	(129)
Plan assets at fair value, end of year	$ 30,770	$ 31,103

RETIREMENT BENEFIT PLANS (Scheduled of Funded Status) (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Reconciliation Of Funded Status
Fair value of plan assets	$ 30,770	$ 31,103	$ 26,943
Benefit obligations	66,972	52,542	$ 47,661
Unfunded benefit obligations	$ 36,202	$ 21,439

RETIREMENT BENEFIT PLANS (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Defined Benefit Plan Disclosure [Line Items]
Losses recognized within accumulated other comprehensive loss	$ 9,000,000.0	$ 600,000
Accumulated benefit obligation	61,100,000	49,600,000
Fair value of plan assets	30,770,000	31,103,000	$ 26,943,000
Plan assets expected to be returned next twelve months	0
Contributions expected to be paid to plan	2,100,000
Total contributions made	8,600,000	$ 8,100,000	$ 7,200,000
Austria, France, and Germany
Defined Benefit Plan Disclosure [Line Items]
Fair value of plan assets	$ 0

RETIREMENT BENEFIT PLANS (Schedule of Expected Benefit Payments and Minimum Contribution on Unfunded Plans) (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Retirement Benefits [Abstract]
2020	$ 1,702
2021	1,743
2022	1,499
2023	1,650
2024	2,115
Next five years	$ 10,157

LEASES AND RELATED PARTY LEASES - Narrative (Details)	9 Months Ended	12 Months Ended
LEASES AND RELATED PARTY LEASES - Narrative (Details)	Sep. 30, 2019 renewal_option	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Jun. 30, 2019 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewal_option	1
Operating lease expense		$ 19,600,000
Future minimum lease payments, finance leases		0
Right of use asset - operating leases		94,530,000
Operating lease liability		109,757,000
Operating lease expense, Topic 840			$ 16,300,000
Future minimum lease payments, capital leases			$ 0
NEW JERSEY
Operating Leased Assets [Line Items]
Operating lease, term			18 years
Right of use asset - operating leases				$ 35,600,000
Operating lease liability				$ 35,600,000
Affiliated Entity
Operating Leased Assets [Line Items]
Operating lease expense		$ 300,000
Operating lease expense, Topic 840			$ 300,000
Percent of manufacturing facility owned by corporation whose shareholders are trusts whose beneficiaries include family members of company's former director		50.00%
Annual rate of lease agreement		$ 300,000
Affiliated Entity \| Five Year Option Lease From November 1, 2032 Through October 31, 2037
Operating Leased Assets [Line Items]
Option to extend lease, years		5 years
Period for extended lease		November 1, 2032 through October 31, 2037
Affiliated Entity \| Five Year Option Lease From November 1, 2037 Through October 31, 2042
Operating Leased Assets [Line Items]
Option to extend lease, years		5 years
Period for extended lease		November 1, 2037 through October 31, 2042

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Lessee, Lease, Description [Line Items]
Right of use asset - operating leases	$ 94,530
Current portion of lease liability - operating leases	12,253
Lease liability - operating leases	97,504
Total lease liabilities	$ 109,757
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	12 years 9 months 18 days
Weighted average discount rate	5.40%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 7 months 6 days
Weighted average discount rate	3.20%

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases, After Adoption of 842 (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Operating Leased Assets [Line Items]
2020	$ 12,396
2021	13,247
2022	14,049
2023	11,682
2024	11,356
Thereafter	92,663
Total minimum lease payments	155,393
Less: Imputed interest	45,636
Total lease liabilities	109,757
Less: Current lease liabilities	12,253
Long-term lease liabilities	97,504
Related Parties
Operating Leased Assets [Line Items]
2020	296
2021	296
2022	296
2023	296
2024	296
Thereafter	1,428
Total minimum lease payments	2,908
Third Parties
Operating Leased Assets [Line Items]
2020	12,100
2021	12,951
2022	13,753
2023	11,386
2024	11,060
Thereafter	91,235
Total minimum lease payments	$ 152,485

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases, Before Adoption of 842 (Details) $ in Thousands	Dec. 31, 2018 USD ($)
Operating Leased Assets [Line Items]
2019	$ 16,768
2020	13,806
2021	12,493
2022	13,233
2023	11,003
Thereafter	102,399
Total minimum lease payments	169,702
Related Parties
Operating Leased Assets [Line Items]
2019	296
2020	296
2021	296
2022	296
2023	296
Thereafter	1,724
Total minimum lease payments	3,204
Third Parties
Operating Leased Assets [Line Items]
2019	16,472
2020	13,510
2021	12,197
2022	12,937
2023	10,707
Thereafter	100,675
Total minimum lease payments	$ 166,498

INCOME TAXES (Narrative) (Details) - USD ($)	12 Months Ended
INCOME TAXES (Narrative) (Details) - USD ($)	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax [Line Items]
Final toll tax expense, Tax Cuts and Jobs Act of 2017		$ 4,500,000
Tax benefit, re-measurement of net deferred tax liabilities, Tax Cuts and Jobs Act of 2017			$ 43,400,000
Effective tax rate	16.50%	(5.90%)	(468.70%)
Effective income tax rate reconciliation, nondeductible in-process research and development, amount	$ 64,900,000
Effective income tax rate reconciliation, tax effect on U.S. federal rate, from Rebound acquisition	13,600,000
Effective income tax reconciliation, tax benefit, excess stock-based compensation deductions		$ 1,100,000
Tax benefit, net operating loss carryback, Tax Cuts and Jobs Act of 2017		2,100,000
Effective income tax rate reconciliation, foreign income tax rate differential, increase (decrease), amount	$ (5,700,000)	$ 3,100,000
Effective foreign income tax rate	3.50%	11.60%
Increase (decrease) in effective foreign income tax rate during period	(11.60%)	(2.00%)
Deferred tax assets, valuation allowance	$ 9,865,000	$ 6,973,000	$ 8,000,000.0
Deferred tax assets, gross	141,922,000	104,950,000	96,500,000
Valuation allowance, period increase (decrease)	2,900,000	(1,000,000.0)	4,400,000
Tax impact of repatriating foreign earnings	0
Unrecognized tax benefits that would impact effective tax rate	700,000
Amount of unrecorded benefit reasonably possible to be recognized (less than)	0
Penalties and interest expense	0	0	0
Penalties and interest accrued	0	$ 0	$ 0
Federal
Income Tax [Line Items]
Operating loss carryforwards	130,100,000
Operating loss carryforwards, not subject to expiration	18,900,000
Foreign Tax Authority
Income Tax [Line Items]
Operating loss carryforwards	37,500,000
Operating loss carryforwards, not subject to expiration	35,300,000
Foreign Tax Authority \| Expire Through 2024
Income Tax [Line Items]
Operating loss carryforwards, subject to expiration	1,300,000
Foreign Tax Authority \| Expire Through 2025
Income Tax [Line Items]
Operating loss carryforwards, subject to expiration	900,000
Foreign Tax Authority \| Switzerland
Income Tax [Line Items]
Effective income tax rate reconciliation, tax benefit, federal tax holiday	$ 9,400,000
Effective income tax rate reconciliation, tax benefit, federal tax holiday (in dollars per share)	$ 0.11
Federal tax credit	$ 12,100,000
Federal tax credit (in dollars per share)	$ 0.14
State and Local Jurisdiction
Income Tax [Line Items]
Operating loss carryforwards	$ 42,800,000

INCOME TAXES (Schedule of Effective Tax Rate Reconciliation) (Details)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	35.00%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	1.00%	(0.40%)	(17.00%)
Foreign operations	(20.00%)	(21.80%)	(112.70%)
Excess tax benefits from stock compensation	(5.60%)	(7.80%)	(57.90%)
Charitable contributions	(0.60%)	(1.20%)	(10.60%)
Nondeductible meals and entertainment	1.50%	1.60%	8.80%
Intercompany profit in inventory	1.20%	6.20%	11.60%
Nondeductible facilitative costs	0.80%	0.00%	22.50%
Changes in valuation allowances	0.20%	0.20%	8.00%
Uncertain tax positions	0.20%	0.40%	(4.60%)
Research and development credit	(2.90%)	(2.60%)	(13.20%)
Return to provision	1.70%	(2.90%)	(4.30%)
Global intangible low-taxed income (GILTI)	7.60%	3.50%	0.00%
Nondeductible executive compensation	3.00%	1.60%	0.00%
Carryback of Federal net operating loss (NOL)	0.10%	(3.70%)	0.00%
Other	0.40%	0.00%	0.80%
Swiss tax holiday	(15.70%)	0.00%	0.00%
In-process research and development	22.70%	0.00%	0.00%
Reduction of book gain on sale of assets	0.00%	0.00%	(4.60%)
Tax reform — Toll Tax	0	0	0.481
Tax reform — remeasurement of deferred tax assets and liabilities	0.00%	0.00%	(378.60%)
Effective tax rate	16.50%	(5.90%)	(468.70%)

INCOME TAXES (Schedule of Provision for Income Taxes) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Current:
Federal	$ 14,597,000	$ (3,880,000)	$ 6,644,000
State	3,447,000	1,609,000	1,233,000
Foreign	10,905,000	7,057,000	6,069,000
Total current	28,949,000	4,786,000	13,946,000
Deferred:
Federal	(10,889,000)	(7,202,000)	(66,466,000)
State	(666,000)	(3,048,000)	(758,000)
Foreign	(7,491,000)	2,066,000	(80,000)
Total deferred	(19,046,000)	(8,184,000)	(67,304,000)
Provision for income taxes	$ 9,903,000	$ (3,398,000)	$ (53,358,000)

INCOME TAXES (Schedule of Deferred Tax Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Assets:
Doubtful accounts	$ 2,426	$ 1,507
Inventory related items	39,548	28,245
Tax credits	19,134	9,072
Accrued vacation	3,206	2,761
Accrued bonus	6,017	5,515
Stock compensation	8,347	10,093
Deferred revenue	1,805	2,173
Net operating loss carryforwards	37,418	33,350
Capitalization of research and development expenses	9,781	0
Unrealized foreign exchange loss	8,105	1,405
Charitable contributions carryforward	235	1,994
Others	5,900	8,835
Total deferred tax assets	141,922	104,950	$ 96,500
Less valuation allowance	(9,865)	(6,973)	$ (8,000)
Deferred tax assets after valuation allowance	132,057	97,977
Liabilities:
Intangible and fixed assets	(150,879)	(144,861)
Others	(5,108)	(4,089)
Total deferred tax liabilities	(155,987)	(148,950)
Total net deferred tax liabilities	$ (23,930)	$ (50,973)

INCOME TAXES (Schedule of Uncertain Tax Benefits Reconciliation) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Reconciliation of Uncertain Tax Benefits [Roll Forward]
Balance, beginning of year	$ 676	$ 424	$ 754
Gross increases:
Current year tax positions	53	273	402
Prior years' tax positions	0	0	0
Gross decreases:
Prior years' tax positions	0	0	(777)
Statute of limitations lapses	0	(21)	(17)
Other	(53)	0	62
Balance, end of year	$ 676	$ 676	$ 424

NET INCOME PER SHARE (Basic and Diluted Net Income Per Share) (Details) - USD ($) $ / shares in Units, shares in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Basic net income per share:
Net income	$ 15,319,000	$ (27,610,000)	$ 29,736,000	$ 32,756,000	$ 25,138,000	$ 13,295,000	$ 11,376,000	$ 10,992,000	$ 50,201,000	$ 60,801,000	$ 64,743,000
Weighted average common shares outstanding - Basic (in shares)									85,637	82,857	76,897
Basic (in dollars per share)	$ 0.18	$ (0.32)	$ 0.35	$ 0.38	$ 0.29	$ 0.16	$ 0.14	$ 0.14	$ 0.59	$ 0.73	$ 0.84
Diluted net income per share:
Net income	$ 15,319,000	$ (27,610,000)	$ 29,736,000	$ 32,756,000	$ 25,138,000	$ 13,295,000	$ 11,376,000	$ 10,992,000	$ 50,201,000	$ 60,801,000	$ 64,743,000
Weighted average common shares outstanding - Basic (in shares)									85,637	82,857	76,897
Effect of dilutive securities:
Warrants (in shares)									0	0	971
Stock options and restricted stock (in shares)									857	1,142	1,253
Weighted average common shares for diluted earnings per share (in shares)									86,494	83,999	79,121
Diluted (in dollars per share)	$ 0.18	$ (0.32)	$ 0.34	$ 0.38	$ 0.29	$ 0.15	$ 0.14	$ 0.14	$ 0.58	$ 0.72	$ 0.82

ACCUMULATED OTHER COMPREHENSIVE LOSS (Schedule of Accumulated Other Comprehensive Income (Loss)) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	$ 1,375,796	$ 962,306	$ 839,667
Other comprehensive loss, net	(19,567)
Less: Amounts reclassified from accumulated other comprehensive income, net	11,392
Total other comprehensive income (loss), net of tax	(30,959)	(21,636)	33,347
Balance in AOCL End of Year	1,416,736	1,375,796	962,306
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(4,813)
Other comprehensive loss, net	(10,420)
Less: Amounts reclassified from accumulated other comprehensive income, net	11,392
Total other comprehensive income (loss), net of tax	(21,812)
Balance in AOCL End of Year	(26,625)	(4,813)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(736)
Other comprehensive loss, net	(8,973)
Less: Amounts reclassified from accumulated other comprehensive income, net	0
Total other comprehensive income (loss), net of tax	(8,973)
Balance in AOCL End of Year	(9,709)	(736)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(39,894)
Other comprehensive loss, net	(174)
Less: Amounts reclassified from accumulated other comprehensive income, net	0
Total other comprehensive income (loss), net of tax	(174)
Balance in AOCL End of Year	(40,068)	(39,894)
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance in AOCL Beginning of Year	(45,443)	(23,807)	(57,154)
Total other comprehensive income (loss), net of tax	(30,959)	(21,636)	33,347
Balance in AOCL End of Year	$ (76,402)	$ (45,443)	$ (23,807)

COMMITMENTS AND CONTINGENCIES (Fair Value Contingent Consideration) (Details) - Contingent Consideration Liability - Level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Other Noncurrent Liabilities \| Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 0
Additions from acquisition of Arkis	13,100
Payments	0
Balance, End of Period	14,210	$ 0
Other Noncurrent Liabilities \| Arkis \| Research and development
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities	1,110
Other Noncurrent Liabilities \| Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	1,387
Transfers from long-term to current portion		(1,387)
Payments	0	0
Balance, End of Period	230	230
Other Noncurrent Liabilities \| Derma Sciences \| Research and development
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities	0
Other Noncurrent Liabilities \| Derma Sciences \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities		230
Accrued expenses and other current liabilities \| Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0	315
Transfers from long-term to current portion		1,387
Payments		(2,000)
Balance, End of Period		0
Accrued expenses and other current liabilities \| Derma Sciences \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities		298
Accrued expenses and other current liabilities \| Confluent Surgical, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 0	22,478
Transfers from long-term to current portion		0
Payments		(24,000)
Balance, End of Period		0
Accrued expenses and other current liabilities \| Confluent Surgical, Inc. \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities		$ 1,522

COMMITMENTS AND CONTINGENCIES (Narrative) (Details) $ in Thousands	1 Months Ended	12 Months Ended
	Oct. 31, 2018 USD ($)	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Mar. 31, 2018 USD ($)	Jan. 15, 2014 USD ($)
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 0	$ 38,196	$ 4,661
Derma Sciences
Loss Contingencies [Line Items]
Contingent consideration arrangements, maximum payout		3,000
Contingent consideration, liability		$ 200	$ 200
Confluent Surgical, Inc.
Loss Contingencies [Line Items]
Contingent consideration arrangements, maximum payout						$ 30,000
Contingent consideration, liability					$ 19,000
Payment for contingent consideration	$ 5,000
Confluent Surgical, Inc. \| Measurement Input, Discount Rate \| Contingent Consideration Liability
Loss Contingencies [Line Items]
Discount rate						0.022
Confluent Surgical, Inc. \| Cash Consideration One
Loss Contingencies [Line Items]
Contingent consideration arrangements, maximum payout						$ 25,000
Confluent Surgical, Inc. \| Cash Consideration Two
Loss Contingencies [Line Items]
Contingent consideration arrangements, maximum payout						$ 5,000

SEGMENT AND GEOGRAPHIC INFORMATION (Net Sales and Profit by Reportable Segment) (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Net Sales
Total revenues	$ 395,127,000	$ 379,095,000	$ 383,645,000	$ 359,690,000	$ 383,315,000	$ 365,854,000	$ 366,190,000	$ 357,082,000	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Segment Profit
Operating income									93,760,000	110,998,000	44,804,000
Amortization									(27,028,000)	(21,160,000)	(20,370,000)
Codman Specialty Surgical
Segment Net Sales
Total revenues									996,206,000	963,929,000	720,301,000
Orthopedics and Tissue Technologies
Segment Net Sales
Total revenues									521,351,000	508,512,000	467,935,000
Operating Segments
Segment Profit
Operating income									539,657,000	512,846,000	422,668,000
Operating Segments \| Codman Specialty Surgical
Segment Profit
Operating income									395,019,000	363,336,000	292,971,000
Operating Segments \| Orthopedics and Tissue Technologies
Segment Profit
Operating income									144,638,000	149,510,000	129,697,000
Corporate and other
Segment Profit
Operating income									$ (418,869,000)	$ (380,688,000)	$ (357,494,000)

SEGMENT AND GEOGRAPHIC INFORMATION (Total Revenue by Major Geographic Area) (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Total revenue, net	$ 395,127,000	$ 379,095,000	$ 383,645,000	$ 359,690,000	$ 383,315,000	$ 365,854,000	$ 366,190,000	$ 357,082,000	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Total long-lived assets	446,718,000				320,029,000				446,718,000	320,029,000
United States (Includes long-lived assets in Puerto Rico)
Segment Reporting Information [Line Items]
Total revenue, net									1,077,379,000	1,045,887,000	894,260,000
Total long-lived assets	383,652,000				280,382,000				383,652,000	280,382,000
Europe
Segment Reporting Information [Line Items]
Total revenue, net									197,468,000	201,354,000	150,147,000
Total long-lived assets	47,325,000				32,679,000				47,325,000	32,679,000
Asia Pacific
Segment Reporting Information [Line Items]
Total revenue, net									157,391,000	144,253,000	80,636,000
Total long-lived assets	8,598,000				3,765,000				8,598,000	3,765,000
Rest of the World
Segment Reporting Information [Line Items]
Total revenue, net									85,319,000	80,947,000	$ 63,193,000
Total long-lived assets	$ 7,143,000				$ 3,203,000				$ 7,143,000	$ 3,203,000

SUBSEQUENT EVENTS (Narrative) (Details)		1 Months Ended	12 Months Ended
SUBSEQUENT EVENTS (Narrative) (Details)	Feb. 04, 2020 USD ($)	Feb. 21, 2020 shares	Dec. 31, 2019 shares	Dec. 31, 2018 shares	Feb. 10, 2020 USD ($)	Feb. 03, 2020 USD ($)	Feb. 02, 2020 USD ($)	May 03, 2018 USD ($)
Subsequent Event [Line Items]
Maximum borrowing capacity								$ 2,200,000,000
Stock repurchased during period (in shares) \| shares			0	0
Secured Debt \| Term Loan Facility
Subsequent Event [Line Items]
Maximum borrowing capacity								900,000,000.0
Revolving Credit Facility
Subsequent Event [Line Items]
Maximum borrowing capacity								1,300,000,000
Standby Letters of Credit
Subsequent Event [Line Items]
Maximum borrowing capacity								60,000,000.0
Swingline Loan
Subsequent Event [Line Items]
Maximum borrowing capacity								$ 60,000,000.0
Subsequent Event
Subsequent Event [Line Items]
Maximum borrowing capacity						$ 2,200,000,000
Stock repurchased during period (in shares) \| shares		1,438,615
Subsequent Event \| Convertible Debt
Subsequent Event [Line Items]
Debt, face amount	$ 575,000,000.0
Debt, interest rate	0.50%
Debt, initial conversion rate	13.5739
Proceeds intended to be used for payment of convertible note hedge transaction costs	$ 59,700,000
Proceeds intended to be used for stock repurchase	100,000,000.0
Proceeds intended to be used to repurchase shares through accelerated share repurchase transaction	92,400,000
Subsequent Event \| Convertible Debt \| Certain Purchasers
Subsequent Event [Line Items]
Proceeds intended to be used for stock repurchase	$ 7,600,000
Subsequent Event \| Secured Debt \| Term Loan Facility
Subsequent Event [Line Items]
Maximum borrowing capacity						877,500,000	$ 900,000,000
Subsequent Event \| Revolving Credit Facility
Subsequent Event [Line Items]
Maximum borrowing capacity						1,300,000,000
Debt, repaid principal amount					$ 315,000,000.0
Subsequent Event \| Standby Letters of Credit
Subsequent Event [Line Items]
Maximum borrowing capacity						60,000,000
Subsequent Event \| Swingline Loan
Subsequent Event [Line Items]
Maximum borrowing capacity						$ 60,000,000

SELECTED QUARTERLY INFORMATION - UNAUDITED (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Selected Quarterly Financial Information [Abstract]
Total revenue, net	$ 395,127,000	$ 379,095,000	$ 383,645,000	$ 359,690,000	$ 383,315,000	$ 365,854,000	$ 366,190,000	$ 357,082,000	$ 1,517,557,000	$ 1,472,441,000	$ 1,188,236,000
Gross margin	245,665,000	236,459,000	239,974,000	230,778,000	236,851,000	222,609,000	228,625,000	212,860,000	952,876,000	900,945,000
Net income (loss)	$ 15,319,000	$ (27,610,000)	$ 29,736,000	$ 32,756,000	$ 25,138,000	$ 13,295,000	$ 11,376,000	$ 10,992,000	$ 50,201,000	$ 60,801,000	$ 64,743,000
Per Share-Basic (in dollars per share)	$ 0.18	$ (0.32)	$ 0.35	$ 0.38	$ 0.29	$ 0.16	$ 0.14	$ 0.14	$ 0.59	$ 0.73	$ 0.84
Per Share-Diluted (in dollars per share)	$ 0.18	$ (0.32)	$ 0.34	$ 0.38	$ 0.29	$ 0.15	$ 0.14	$ 0.14	$ 0.58	$ 0.72	$ 0.82

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

+ References

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+ Details

- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

SCHEDULE II - VALUATION AND QUALIFYING ACCOUNTS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Allowance for doubtful accounts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 3,719	$ 8,882	$ 6,319
Charged to Costs and Expenses	2,126	557	4,920
Other	0	(4,649)	1,518
Deductions	(1,542)	(1,071)	(3,875)
Balance at End of Period	4,303	3,719	8,882
Deferred tax assets valuation allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	6,973	7,961	3,604
Charged to Costs and Expenses	3,848	(894)	740
Other	1,291	0	3,617
Deductions	(43)	(94)	0
Balance at End of Period	$ 12,069	$ 6,973	$ 7,961

BUSINESS	12 Months Ended
BUSINESS	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS	BUSINESS Integra LifeSciences Holdings Corporation (the “Company”) was incorporated in Delaware in 1989. The Company, a world leader in medical devices, is dedicated to limiting uncertainty for surgeons through the development, manufacturing, and marketing of cost-effective surgical implants and medical instruments. Its products are used primarily in neurosurgery, extremity reconstruction, orthopedics and general surgery. The Company sells its products directly through various sales forces and through a variety of other distribution channels.

TREASURY STOCK	12 Months Ended
TREASURY STOCK	Dec. 31, 2019
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
TREASURY STOCK	TREASURY STOCK There were 2.9 million shares of treasury stock outstanding as of December 31, 2019 and 2018, with a cost of $119.9 million and $120.6 million, respectively, at a weighted average cost of $41.87 per share. On December 11, 2018, the Board of Directors authorized the Company to repurchase up to $225 million of the Company’s common stock. The program allows the Company to repurchase its shares opportunistically from time to time. The repurchase authorization expires in December 2020. Purchases may be affected through one or more open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, or a combination of the foregoing. This stock repurchase authorization replaces the previous $150.0 million stock repurchase authorization, approved by the Board in 2016. There were no treasury stock repurchases during the years ended December 31, 2019 and 2018.

ACQUISITIONS AND PRO FORMA RESULTS (Pro Forma Financial Information Summarization Results of Operations) (Details) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($) $ / shares
Business Combinations [Abstract]
Total revenue from continuing operations	$ 1,428,491
Net income from continuing operations	$ 81,730
Basic earnings per share from continuing operations (in dollars per share) \| $ / shares	$ 1.06

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 11,469
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 41,423

NET INCOME PER SHARE (Narrative) (Details) - shares shares in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.4	0.4
Performance Shares and Restricted Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Additional EPS shares (in shares)	0.5

ACCUMULATED OTHER COMPREHENSIVE LOSS (Narrative) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gains reclassified from AOCL	$ 11,392
Accumulated Net Investment Gain (Loss) Attributable to Parent \| Other Income, net
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gains reclassified from AOCL	2,300
Accumulated Net Investment Gain (Loss) Attributable to Parent \| Interest income
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gains reclassified from AOCL	7,400
Accumulated Net Investment Gain (Loss) Attributable to Parent \| Interest Expense
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gains reclassified from AOCL	$ 1,700

SEGMENT AND GEOGRAPHIC INFORMATION (Narrative) (Details)	12 Months Ended
	Dec. 31, 2019 Segment product
Segment Reporting Information [Line Items]
Number of reportable segments \| Segment	2
Codman Specialty Surgical
Segment Reporting Information [Line Items]
Number of products offered (more than) \| product	40,000

Label	Element	Value
Accounting Standards Update 2014-09 [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 1,854,000
Accounting Standards Update 2014-09 [Member] \| Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	1,854,000
Accounting Standards Update 2018-02 [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	532,000
Accounting Standards Update 2018-02 [Member] \| Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 532,000