0000917520-20-000047 | 10-Q | XBRL Viewer | Integra Lifesciences Holdings Corp

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DOCUMENT AND ENTITY INFORMATION - shares	9 Months Ended
DOCUMENT AND ENTITY INFORMATION - shares	Sep. 30, 2020	Oct. 27, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2020
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	1100 Campus Road
Entity City	Princeton
Entity State	NJ
Entity Postal Zip Code	08540
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 Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Bankruptcy Proceedings, Reporting Current	false
Entity Common Stock, Shares Outstanding (in shares)		84,272,671
Amendment Flag	false
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME / (LOSS) (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Total revenue, net	$ 370,232	$ 379,095	$ 983,221	$ 1,122,430
Costs and expenses:
Cost of goods sold	134,811	142,636	373,765	415,219
Research and development	19,460	19,003	55,202	54,957
In-process research and development	0	59,889	0	59,889
Selling, general and administrative	150,076	173,098	432,136	513,345
Intangible asset amortization	8,343	5,056	23,393	21,340
Total costs and expenses	312,690	399,682	884,496	1,064,750
Operating income (loss)	57,542	(20,587)	98,725	57,680
Interest income	2,273	2,913	7,124	8,051
Interest expense	(20,796)	(13,962)	(54,230)	(40,495)
Other income, net	2,492	4,127	2,985	8,461
Income (loss) before income taxes	41,511	(27,509)	54,604	33,697
Provision (benefit) for income taxes	9,174	101	13,456	(1,185)
Net income (loss)	$ 32,337	$ (27,610)	$ 41,148	$ 34,882
Net income (loss) per share
Basic (in dollars per share)	$ 0.38	$ (0.32)	$ 0.49	$ 0.41
Diluted (in dollars per share)	$ 0.38	$ (0.32)	$ 0.48	$ 0.40
Weighted average common shares outstanding (See Note 14):
Basic (in shares)	84,325	85,688	84,745	85,536
Diluted (in shares)	84,752	85,688	85,303	86,581
Comprehensive income (loss) (See Note 15)	$ 43,548	$ (46,521)	$ 25,637	$ (7,288)

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 396,279	$ 198,911
Trade accounts receivable, net of allowances of $6,727 and $4,303	218,184	275,296
Inventories, net	307,839	316,054
Assets held for sale	159,977	0
Prepaid expenses and other current assets	69,817	67,907
Total current assets	1,152,096	858,168
Property, plant and equipment, net	294,439	337,404
Right of use asset - operating leases	84,916	94,530
Intangible assets, net	973,685	1,031,591
Goodwill	919,556	954,280
Deferred tax assets, net	8,150	12,623
Other assets	20,679	14,644
Total assets	3,453,521	3,303,240
Current liabilities:
Current portion of borrowings under senior credit facility	22,500	45,000
Current portion of lease liability - operating leases	12,518	12,253
Accounts payable, trade	50,254	113,090
Contract liabilities	4,875	4,772
Accrued compensation	71,712	79,385
Liabilities held for sale	12,349	0
Accrued expenses and other current liabilities	80,938	76,809
Total current liabilities	255,146	331,309
Long-term borrowings under senior credit facility	944,102	1,198,561
Long-term borrowings under securitization facility	92,300	104,500
Long-term convertible securities	469,898	0
Lease liability - operating leases	88,778	97,504
Deferred tax liabilities	27,780	36,553
Other liabilities	177,530	118,077
Total liabilities	2,055,534	1,886,504
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; 89,191 and 88,735 issued at September 30, 2020 and December 31, 2019, respectively	892	887
Additional paid-in capital	1,284,711	1,213,620
Treasury stock, at cost; 4,915 shares and 2,865 shares at September 30, 2020 and December 31, 2019, respectively	(235,224)	(119,943)
Accumulated other comprehensive loss	(91,913)	(76,402)
Retained earnings	439,521	398,574
Total stockholders’ equity	1,397,987	1,416,736
Total liabilities and stockholders’ equity	$ 3,453,521	$ 3,303,240

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 6,727	$ 4,303
Preferred stock, authorized shares (in shares)	15,000,000	15,000,000
Preferred stock, outstanding shares (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, authorized shares (in shares)	240,000,000	240,000,000
Common stock, issued shares (in shares)	89,191,000	88,735,000
Treasury stock, shares (in shares)	4,915,000	2,865,000

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
OPERATING ACTIVITIES:
Net income	$ 41,148	$ 34,882
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	89,853	81,584
Non-cash in-process research and development expense	0	59,889
Non-cash impairment charges	0	5,764
Income tax expense (benefit)	4,784	(10,536)
Share-based compensation	14,333	15,744
Amortization of debt issuance costs and expenses associated with debt refinancing	10,499	4,084
Non-cash lease expense	2,172	3,473
Accretion of bond issuance discount	11,075	0
Loss on disposal of property and equipment	559	844
Change in fair value of contingent consideration and others	(45)	10
Changes in assets and liabilities:
Accounts receivable	57,863	(17,519)
Inventories	(45,531)	(30,553)
Prepaid expenses and other current assets	(865)	(8,162)
Other non-current assets	10,868	6,650
Accounts payable, accrued expenses and other current liabilities	(67,178)	366
Contract liabilities	(548)	(1,395)
Other non-current liabilities	(5,417)	(2,876)
Net cash provided by operating activities	123,570	142,249
INVESTING ACTIVITIES:
Purchases of property and equipment	(30,463)	(47,343)
Acquired in-process research and development milestone	(5,000)	0
Proceeds from note receivable	0	752
Proceeds from sale of property and equipment	3,311	36
Cash (paid) provided for business acquisitions, net of cash acquired	0	(30,509)
Acquired in-process research and development	0	(64,995)
Net cash used in investing activities	(32,152)	(142,059)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	151,300	215,800
Payments on debt	(441,000)	(143,250)
Purchase of option hedge on convertible notes	(104,248)	0
Proceeds from convertible notes issuance	575,000	0
Proceeds from sale of stock purchase warrants	44,563	0
Payment of debt issuance costs	(24,347)	0
Purchases of treasury stock	(100,000)	0
Proceeds from exercised stock options	3,821	6,948
Cash taxes paid in net equity settlement	(4,686)	(6,272)
Net cash provided by financing activities	100,403	73,226
Effect of exchange rate changes on cash and cash equivalents	5,547	(4,273)
Net increase in cash and cash equivalents	197,368	69,143
Cash and cash equivalents at beginning of period	198,911	138,838
Cash and cash equivalents at end of period	$ 396,279	$ 207,981

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'S EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2018			88,044,000
Balance, Beginning of Period at Dec. 31, 2018	$ 1,375,796		$ 880	$ (120,615)	$ 1,192,601	$ (45,443)	$ 348,373
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2018				(2,881,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	32,756						32,756
Other comprehensive income (loss), net of tax	(11,236)					(11,236)
Issuance of common stock through employee stock purchase plan (in shares)			17,000
Issuance of common stock through employee stock purchase plan	716				716
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			243,000	12,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(5,121)		$ 2	$ 506	(5,629)
Share-based compensation	4,119				4,119
Balance End of Period, Shares (in shares) at Mar. 31, 2019			88,304,000
Balance, End of Period at Mar. 31, 2019	1,397,030		$ 882	$ (120,109)	1,191,807	(56,679)	381,129
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2019				(2,869,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2018			88,044,000
Balance, Beginning of Period at Dec. 31, 2018	1,375,796		$ 880	$ (120,615)	1,192,601	(45,443)	348,373
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2018				(2,881,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	34,882
Balance End of Period, Shares (in shares) at Sep. 30, 2019			88,689,000
Balance, End of Period at Sep. 30, 2019	1,384,974		$ 886	$ (120,101)	1,208,549	(87,615)	383,255
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2019				(2,869,000)
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2019			88,304,000
Balance, Beginning of Period at Mar. 31, 2019	1,397,030		$ 882	$ (120,109)	1,191,807	(56,679)	381,129
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2019				(2,869,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	29,736						29,736
Other comprehensive income (loss), net of tax	(12,021)					(12,021)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			47,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	408		$ 1	$ 2	405
Share-based compensation	5,798				5,798
Balance End of Period, Shares (in shares) at Jun. 30, 2019			88,351,000
Balance, End of Period at Jun. 30, 2019	1,420,951		$ 883	$ (120,107)	1,198,010	(68,700)	410,865
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2019				(2,869,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(27,610)						(27,610)
Other comprehensive income (loss), net of tax	(18,915)					(18,915)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			338,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	4,674		$ 3	$ 6	4,665
Share-based compensation	5,874				5,874
Balance End of Period, Shares (in shares) at Sep. 30, 2019			88,689,000
Balance, End of Period at Sep. 30, 2019	1,384,974		$ 886	$ (120,101)	1,208,549	(87,615)	383,255
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2019				(2,869,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	$ 1,416,736	$ (200)	$ 887	$ (119,943)	1,213,620	(76,402)	398,574	$ (200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019	(2,865,000)			(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	$ 9,180						9,180
Other comprehensive income (loss), net of tax	(28,187)					(28,187)
Issuance of common stock through employee stock purchase plan (in shares)			13,000
Issuance of common stock through employee stock purchase plan	694				694
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			357,000	10,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(2,739)		$ 2	$ 476	(3,217)
Share-based compensation	3,781				3,781
Share repurchase and equity component of the convertible note issuance, net (in shares)				(135,000)
Share repurchase and equity component of the convertible note issuance, net	34,906			$ (7,632)	42,538
Accelerated shares repurchased (in shares)				(1,304,000)
Accelerated shares repurchased	(92,368)			$ (75,407)	(16,961)
Balance End of Period, Shares (in shares) at Mar. 31, 2020			89,105,000
Balance, End of Period at Mar. 31, 2020	1,341,802		$ 889	$ (202,506)	1,240,455	(104,589)	407,553
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2020				(4,294,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	$ 1,416,736	$ (200)	$ 887	$ (119,943)	1,213,620	(76,402)	398,574	$ (200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019	(2,865,000)			(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	$ 41,148
Other comprehensive income (loss), net of tax	$ (15,511)
Accelerated shares repurchased (in shares)	(2,100,000)
Balance End of Period, Shares (in shares) at Sep. 30, 2020			89,191,000
Balance, End of Period at Sep. 30, 2020	$ 1,397,987		$ 892	$ (235,224)	1,284,711	(91,913)	439,521
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2020	(4,915,000)			(4,915,000)
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2020			89,105,000
Balance, Beginning of Period at Mar. 31, 2020	$ 1,341,802		$ 889	$ (202,506)	1,240,455	(104,589)	407,553
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2020				(4,294,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(369)						(369)
Other comprehensive income (loss), net of tax	1,464					1,464
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			84,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	1,250		$ 3	$ (35)	1,282
Share-based compensation	4,948				4,948
Accelerated shares repurchased (in shares)				(621,000)
Accelerated shares repurchased	0			$ (32,685)	32,685
Balance End of Period, Shares (in shares) at Jun. 30, 2020			89,189,000
Balance, End of Period at Jun. 30, 2020	1,349,095		$ 892	$ (235,226)	1,279,370	(103,125)	407,184
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2020				(4,915,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	32,337						32,337
Other comprehensive income (loss), net of tax	11,212					11,212
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			2,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(67)			$ 2	(69)
Share-based compensation	5,410				5,410
Balance End of Period, Shares (in shares) at Sep. 30, 2020			89,191,000
Balance, End of Period at Sep. 30, 2020	$ 1,397,987		$ 892	$ (235,224)	$ 1,284,711	$ (91,913)	$ 439,521
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2020	(4,915,000)			(4,915,000)

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'S EQUITY (UNAUDITED) (PARENTHETICAL)	12 Months Ended
	Dec. 31, 2019
Statement of Stockholders' Equity [Abstract]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member

- Definition

Indicates amendment to accounting standards.

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+ Details

BASIS OF PRESENTATION	9 Months Ended
BASIS OF PRESENTATION	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BASIS OF PRESENTATION	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the September 30, 2020 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, statement of changes in shareholder's equity, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 2019 included in the Company’s Annual Report on Form 10-K. The December 31, 2019 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three and nine month period ended September 30, 2020 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with generally accepted accounting principles in the United States ("GAAP") which requires management to make estimates and assumptions that affect the reported amount 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 including 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 and 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 derivative instruments, valuation of the equity component of convertible debt instruments, valuation of contingent liabilities, the fair value 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. The novel coronavirus (“COVID-19”) pandemic and the resulting adverse impacts to global economic conditions, as well as our operations, may impact future estimates including, but not limited to, inventory valuations, fair value measurements, goodwill and long-lived asset impairments, the effectiveness of the Company’s hedging instruments, deferred tax valuation allowances, and allowances for doubtful accounts receivable. Risks and Uncertainties The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic. The extent of the impact of the COVID-19 pandemic on the Company's business is highly uncertain and difficult to predict, as the responses to the pandemic and information is rapidly evolving. From late March, the Company's customers diverted resources to treat COVID-19 patients and deferred or canceled elective or non-emergent surgical procedures, all of which impacted hospitals' abilities to meet their obligations, including to the Company. Beginning in May 2020 and through the end of the third quarter of 2020, procedural volumes relevant to the Company’s products steadily increased and, in some geographic areas, began to approach normalized levels. However, on-going uncertainty persists about the continuing sustainability of those procedural volumes as virus outbreaks constrain healthcare networks. Furthermore, capital markets and economies worldwide have also been negatively impacted by the COVID-19 pandemic, and it is possible that it could cause a local and/or global economic recession. Such economic disruption has had an adverse effect on the Company's business as customers curtailed and reduced capital and overall spending. Policymakers around the globe have responded with fiscal policy actions to support the healthcare industry and the economy as a whole. The magnitude and overall effectiveness of these actions remains uncertain. The severity of the impact of the COVID-19 pandemic on the Company's business will depend on a number of factors, including, but not limited to, the duration and severity of the pandemic and the extent and severity of the impact on the Company's customers, all of which are uncertain and cannot be predicted with certainty. The Company's future results of operations and liquidity could be adversely impacted by delays in payments of outstanding receivable amounts beyond normal payment terms, supply chain disruptions and uncertain demand, and the impact of any initiatives or programs that the Company may undertake to address financial and operations challenges faced by its customers. The COVID-19 pandemic continues to cause a financial strain on healthcare systems which varies by location, and as a result we do not expect the same level of spending in the fourth quarter that we experienced last year. Even after the COVID-19 pandemic and government responses thereto have subsided, residual economic and other effects may have an impact on the demand for post-pandemic surgery levels that are difficult to predict. If the downturn is more severe and prolonged than currently expected, the Company may need to take further steps to reduce costs. Recently Issued Accounting Standards 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 ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020, is not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the current COVID-19 pandemic, or other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact as hospital's cash flows are impacted by their response to the COVID-19 pandemic. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans. The new guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and clarifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption is permitted. The adoption is not expected to have a material 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 ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a prospective transition method. The adoption of this guidance did 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 its financial condition and results of operations. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform, which provides optional guidance for a limited period of time to ease the potential burden in accounting for (or recognizing the effects of) reference rate reform on financial reporting. This amendment applies to all entities, subject to meeting certain criteria, that have contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued because of reference rate reform. This ASU is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into or evaluated on or before December 31, 2022. The Company is currently assessing the impact that this ASU will have on its consolidated financial statements and related disclosures. In August 2020, the FASB issued ASU No. 2020-06 Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting For Convertible Instruments and Contracts in an Entity's Own Equity . The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will be effective for annual and interim periods beginning after December 15, 2021, and early adoption is permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact of this standard on its consolidated financial statements and related disclosures. 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.

ASSETS AND LIABILITIES HELD FOR SALE

9 Months Ended

Sep. 30, 2020

Discontinued Operations and Disposal Groups [Abstract]

ASSETS AND LIABILITIES HELD FOR SALE

On September 29, 2020, the Company and certain of its subsidiaries entered into an agreement to sell its Extremity Orthopedics business to Smith & Nephew USD Limited for approximately $240 million in cash. The transaction includes the sale of the Company’s upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. In connection with the transaction, the Company will pay $41.5 million to the Consortium of Focused Orthopedists, LLC (“CFO”) pursuant to the terms of certain agreements between Integra and CFO relating to the development of shoulder arthroplasty products. The transaction is expected to close at or around the end of 2020, subject to the satisfaction of customary conditions, including regulatory approvals and consultation with employee representative bodies.

The Company considered the assets and liabilities associated with the Extremity Orthopedics business to be accounted as held-for-sale as the six criteria under ASC 260 were met during the third quarter of 2020. Upon designation of the assets and liabilities as held for sale, the Company recorded the assets at the lower of their carrying value or their estimated fair value, less estimated costs to sell. Goodwill was allocated to the assets and liabilities held for sale using the relative fair value method of the Extremity Orthopedics business to the Company's Orthopedics and Tissue Technologies reporting unit. The fair value of the business less costs to sell exceeded the related carrying value.

The Extremity Orthopedics business was treated as a single disposal group and presented separately in the condensed consolidated balance sheet as assets and liabilities held for sale as of September 30, 2020. These balances are presented as current assets and liabilities as they are expected to be sold within twelve months. The major classes of assets and liabilities classified as a held for sale consisted of the following as of September 30, 2020 (amounts in thousands):



Prepaid and other current assets	$	748
Other assets	4,448
Deferred tax assets	6,927
Intangible assets	13,332
Property, plant and equipment, net	36,714
Goodwill	47,117
Inventories	50,691
Total assets held for sale	$	159,977
Other liabilities	241
Current portion of lease liability - operating leases	1,060
Accrued compensation	1,584
Deferred tax liabilities	3,035
Lease liability - operating leases	6,429
Total liabilities held for sale	$	12,349

BUSINESS DEVELOPMENT

9 Months Ended

Sep. 30, 2020

Business Combinations [Abstract]

BUSINESS DEVELOPMENT

Arkis BioSciences Inc.

On July 29, 2019, the Company acquired Arkis BioSciences Inc. ("Arkis") for an acquisition purchase price of $30.6 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.

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



	Final Valuation as of September 30, 2019		Weighted Average Life
	(Dollars in thousands)
Cash	$	90
Other current assets	751
Property, plant and equipment	457
Deferred tax assets	1,697
Intangible assets:
CerebroFlo developed technology	20,100		15 years
Enabling technology license	1,980		14 years
Goodwill	27,153
Total assets acquired	52,228

Accounts payable, accrued expenses and other liabilities	2,926
Contingent consideration	13,100
Deferred tax liabilities	5,603
Net assets acquired	$	30,599

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 the Company's 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.

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 $10.0 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 fair value as of September 30, 2020 was $14.2 million. This amount is included in other liabilities at September 30, 2020 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 (IPR&D) 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 IPR&D expense in the consolidated statements of operations during the year ended December 31, 2019. 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. During the quarter ended March 31, 2019, 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.

In connection with the sale of the Company's Extremity Orthopedic business, the Company will pay $41.5 million to CFO pursuant to the terms of certain agreements between Integra and CFO relating to the sale of shares of ISC which includes the development of shoulder arthroplasty products effectively terminating our licensing agreement with ISC. See Note 2, Assets and Liabilities Held for Sale, for details of the transaction.

REVENUES FROM CONTRACTS WITH CUSTOMERS

9 Months Ended

Sep. 30, 2020

Revenue from Contract with Customer [Abstract]

REVENUES FROM CONTRACTS WITH CUSTOMERS

Summary of Accounting Policies on Revenue Recognition

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 for 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 product 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 thirty 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.

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 and 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 summarizes the changes in the contract asset and liability balances for the nine months ended September 30, 2020:



Contract Asset
Contract asset, January 1, 2020	$	8,680
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(8,680		)
Contract asset, net of transferred to trade receivables on contracts during the period	6,653
Contract asset, September 30, 2020	$	6,653

Contract Liability
Contract liability, January 1, 2020	$	11,946
Recognition of revenue included in beginning of year contract liability	(3,150		)
Contract liability, net of revenue recognized on contracts during the period	2,631
Foreign currency translation	(42		)
Contract liability, September 30, 2020	$	11,385

At September 30, 2020, the short-term portion of the contract liability of $4.9 million and the long-term portion of $6.5 million were included in accrued expenses and other current liabilities and other liabilities in the consolidated balance sheet.

As of September 30, 2020, the Company is expected to recognize approximately 43% of unsatisfied (or partially unsatisfied) performance obligations as revenue through 2020, with the remaining balance to be recognized in 2021 and 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 the three and nine months ended September 30, 2020 and 2019 (amounts in thousands):



	Three Months Ended September 30, 2020		Three Months Ended September 30, 2019		Nine Months Ended September 30, 2020		Nine Months Ended September 30, 2019

Neurosurgery	$	189,674	$	195,330	$	516,048	$	567,779
Instruments	49,649		57,654		124,493		169,031
Total Codman Specialty Surgical	239,323		252,984		640,541		736,810

Wound Reconstruction and Care	82,115		82,213		210,673		239,458
Extremity Orthopedics	21,922		20,852		54,556		65,299
Private Label	26,872		23,046		77,451		80,863
Total Orthopedics and Tissue Technologies	130,909		126,111		342,680		385,620
Total revenue	$	370,232	$	379,095	$	983,221	$	1,122,430

Prior period amounts were reclassified between categories within the Codman Specialty Surgical segment to conform to the current period presentation.

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

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

+ Details

INVENTORIES

9 Months Ended

Sep. 30, 2020

Inventory, Net [Abstract]

INVENTORIES

Inventories, net consisted of the following:



	September 30, 2020			December 31, 2019
	(In thousands)
Finished goods	$	223,726		$	201,870
Work in process	57,037			48,333
Raw materials	77,767			$	65,851
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	(50,691		)	—
Total inventories	$	307,839		$	316,054

GOODWILL AND OTHER INTANGIBLE ASSETS

9 Months Ended

Sep. 30, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the nine-month period ended September 30, 2020 were as follows:



	Codman Specialty Surgical		Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2019	$	653,500	$	300,780		$	954,280
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	—		(47,117		)	(47,117		)
Foreign currency translation	8,928		3,465			12,393
Goodwill at September 30, 2020	$	662,428	$	257,128		$	919,556

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



	September 30, 2020
	Weighted Average Life	Cost			Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	891,554		$	(250,609	)	$	640,945
Customer relationships	12 years	223,512			(138,989		)	84,523
Trademarks/brand names	28 years	104,404			(31,425		)	72,979
Codman tradename	Indefinite	167,013			—			167,013
Supplier relationships	27 years	34,721			(19,018		)	15,703
All other⁽¹⁾	4 years	11,101			(5,247		)	5,854
Transfer to assets held for sale (See Note 2. Assets Held for Sale)		(39,821		)	26,489			(13,332		)
		$	1,392,484		$	(418,799	)	$	973,685



	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 tradename	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


(1)	At September 30, 2020 and December 31, 2019, all other included IPR&D of $1.0 million, which was indefinite-lived. At September 30, 2020, this IPR&D asset was presented separately as "assets held for sale" in conjunction with the sale of the Extremity Orthopedics business which is expected to be sold within twelve months. See Note 2, Assets and Liabilities Held for Sale, for details.

Goodwill and Intangible Assets with Indefinite Lives

The Company tests goodwill and intangible assets with indefinite lives for impairment annually in the third quarter in accordance with ASC Topic 350. Additionally, the Company may perform interim tests if an event occurs or circumstances change that could potentially reduce the fair value of a reporting unit or indefinite lived intangible asset below its carrying amount. The carrying value of each reporting unit is determined by assigning the assets and liabilities, including the existing goodwill and intangible assets, to those reporting units.

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 this qualitative evaluation for some or all of its reporting units and perform a quantitative test. During the third quarter of 2020, the Company began with the qualitative evaluation, which was sufficient to find no impairment.

For intangible assets with indefinite lives, the Company elected to bypass the qualitative evaluation for its Codman tradename intangible asset and perform a quantitative test during the third quarter 2020. In performing this test, the Company utilized a discount rate of 11.5%. 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.

Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of product revenues) is expected to be approximately $15.7 million for the remainder of 2020, $62.1 million in 2021, $59.7 million in 2022, $58.9 million in 2023, $58.4 million in 2024, $58.4 million in 2025 and $494.9 million thereafter.

DEBT

9 Months Ended

Sep. 30, 2020

Debt Disclosure [Abstract]

DEBT

Amendment to the Sixth Amended and Restated Senior Credit Agreement

On February 3, 2020, the Company entered into the sixth amendment and restatement (the "February 2020 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 February 2020 Amendment extended the maturity date to February 3, 2025. The Company continues to have the aggregate principal amount of up to approximately $2.2 billion available to it through the following facilities: (i) a $877.5 million Term Loan facility, 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.

On July 14, 2020, the Company entered into an amendment (the "July 2020 Amendment") to the February 2020 Amendment of the Senior Credit Facility to increase financial flexibility in light of the unprecedented impact and uncertainty of the COVID-19 pandemic on the global economy. The July 2020 amendment does not increase the Company’s total indebtedness.

In connection with the July 14, 2020 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 July 2020 Amendment through June 30, 2021		5.50 to 1.00
September 30, 2021 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

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 2.25%), 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%


2.	the prime lending rate of Bank of America, N.A. or


3.	the one-month Eurodollar Rate plus 1.00%

The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness as of such date less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA as defined by the July 2020 amendment, for the period of four consecutive fiscal quarters ending on such date).

The Company will pay an annual commitment fee (ranging from 0.15% to 0.30%), based on the Company's consolidated total leverage ratio, on the amount available for borrowing under the revolving credit facility.

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 September 30, 2020, the Company was in compliance with all such covenants. In connection with the February 2020 Amendment, the Company capitalized $4.6 million of financing costs in connection with modification of the Senior Credit Facility and wrote off $1.2 million of previously capitalized financing costs during the first quarter of 2020. In connection with the July 2020 amendment, the Company expensed $3.3 million of incremental financing costs in connection with the modification of the Senior Credit Facility during the third quarter of 2020.

At September 30, 2020 and December 31, 2019, there was $97.5 million and $375.0 million outstanding, respectively, under the revolving credit component of the Senior Credit Facility at weighted average interest rates of 1.5% and 3.2%, respectively. At September 30, 2020 and December 31, 2019, there was $877.5 million outstanding, respectively, under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 1.5% and 3.2%, respectively. At September 30, 2020, $22.5

million of the Term Loan component of the Senior Credit Facility is classified as current on the consolidated balance sheet as the first mandatory repayment is due June 30, 2021.

The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at September 30, 2020 were $94.6 million and $853.7 million, respectively. 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 September 30, 2020 and December 31, 2019 totaled $1.6 million and $0.8 million. There were no amounts drawn as of September 30, 2020.

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



Quarter Ended September 30, 2020	Principal Repayment
	(In thousands)
Remainder of 2020	$	—
2021	33,750
2022	45,000
2023	61,875
2024	67,500
2025	669,375
	$	877,500

The outstanding balance of the revolving credit component of the Senior Credit Facility is due on February 3, 2025.

Convertible Senior Notes

On February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes will mature on August 15, 2025 and bear interest at a rate of 0.5% per annum payable semi-annually in arrears, unless earlier converted, repurchased or redeemed in accordance with the terms of the Notes. The portion of debt proceeds that was classified as equity at the time of the offering was $104.5 million, and that amount is being amortized to interest expense using the effective interest method through August 2025. The effective interest rate implicit in the liability component is 4.2%. In connection with this offering, the Company capitalized $13.2 million of financing fees. At September 30, 2020, the carrying amount of the liability component was $481.5 million, the remaining unamortized discount was $93.5 million, and the principal amount outstanding was $575.0 million. The fair value of the 2025 Notes at September 30, 2020 was $541.8 million.

The 2025 Notes are senior, unsecured obligations of the Company, and are convertible into cash and shares of its common stock based on initial conversion rate, subject to adjustment of 13.5739 shares per $1,000 principal amounts of the 2025 Notes (which represents an initial conversion price of $73.67 per share). The 2025 Notes convert only in the following circumstances: (1) if the closing price of the Company's common stock has been at least 130% of the conversion price during the period; (2) if the average trading price per $1000 principal amount of the 2025 Notes is less than or equal to 98% of the average conversion value of the 2025 Notes during a period as defined in the indenture; (3) at any time on or after February 20, 2023; or (4) if specified corporate transactions occur. As of September 30, 2020, none of these conditions existed with respect to the 2025 Notes and as a result the 2025 Notes are classified as long term.

Holders of the Notes will have the right to require the Company to repurchase for cash all or a portion of their Notes at 100% of their principal amount, plus any accrued and unpaid interest, upon the occurrence of a fundamental change (as defined in the indenture relating to the Notes). The Company will also be required to increase the conversion rate for holders who convert their Notes in connection with certain fundamental changes occurring prior to the maturity date or following delivery by the Company of a notice of redemption.

In connection with the issuance of the 2025 Notes, the Company entered into call transactions and warrant transactions, primarily with affiliates of the initial purchasers of the 2025 Notes (the “hedge participants”). The cost of the call transactions was $104.2 million for the 2025 Notes. The Company received $44.5 million of proceeds from the warrant transactions for the 2025 Notes. The call transactions involved purchasing call options from the hedge participants, and the warrant transactions involved selling call options to the hedge participants with a higher strike price than the purchased call options. The initial strike price of the call transactions was $73.67, subject to anti-dilution adjustments substantially similar to those in the 2025

Notes. The initial strike price of the warrant transactions was $113.34 for the 2025 Notes, subject to customary anti-dilution adjustments.

During the nine months ended September 30, 2020, the Company recognized cash interest related to the contractual interest coupon of $1.9 million and amortization of the discount on the liability component of $11.1 million for a total interest charge of $13.0 million on the 2025 Notes.

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 ("Securitization Agreement") is for an initial three-year term and may be extended. The Securitization 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 Agreement may give rise to the right of its counterparty to terminate this facility. As of September 30, 2020, the Company was in compliance with the covenants and none of the termination events had occurred. At September 30, 2020 and December 31, 2019, the Company had $92.3 million and $104.5 million, respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 1.4% and 2.8%, respectively.

The fair value of the outstanding borrowing of the Securitization Facility at September 30, 2020 was $92.8 million.

DERIVATIVE INSTRUMENTS

9 Months Ended

Sep. 30, 2020

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 the Company's expected LIBOR-indexed floating-rate borrowings.

The Company held the following interest rate swaps as of September 30, 2020 and December 31, 2019 (dollar amounts in thousands):



	September 30, 2020		December 31, 2019							September 30, 2020			December 31, 2019
Hedged Item	Notional Amount		Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
3-month USD LIBOR Loan	—		50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	$	—		$	(2	)
1-month USD LIBOR Loan	—		100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	—			12
1-month USD LIBOR Loan	100,000		100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(1,377		)	(581		)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(6,901		)	(2,880		)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(6,922		)	(2,880		)
1-month USD LIBOR Loan	100,000		100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(8,454		)	(3,517		)
1-month USD LIBOR Loan	50,000		50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(4,064		)	(1,778		)
1-month USD LIBOR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(18,188		)	(6,595		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(10,608		)	(5,750		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(10,871		)	(5,747		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(10,586		)	(5,807		)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(11,282		)	(4,930		)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(11,127		)	(4,691		)
Total interest rate derivatives designated as cash flow hedge	$	1,175,000	$	1,325,000						$	(100,380	)	$	(45,145	)

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.

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.

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 an acquisition. The objective of these cross-currency swaps is to reduce volatility of earnings and 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 as of September 30, 2020 and December 31, 2019 (dollar amounts in thousands):



						September 30, 2020			December 31, 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	$	(1,565	)	$	(101	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	33,333	$	(1,565	)	$	(101	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(2,003		)	(119		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(2,003		)	(119		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(4,167		)	(289		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(4,167		)	(289		)

Total						$	(7,735	)	$	(509	)

On October 2, 2020 in accordance with the termination date, the Company settled a cross-currency swap designated as a cash flow hedge of an intercompany loan with an aggregate notional amount of $33.3 million.

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 three and nine months ended September 30, 2020, the Company recorded losses of $6.9 million and $12.0 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gains recognized on the intercompany loans. For the three and nine months ended September 30, 2019, the Company recorded gains of $5.7 million and $3.9 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans.

For the three and nine months ended September 30, 2020, the Company recorded a loss of $6.3 million and a gain of $2.7 million in AOCL, respectively, related to change in fair value of the cross-currency swaps. For the three and nine months ended September 30, 2019, the Company recorded gains of $9.7 million and $15.4 million in AOCL, respectively, related to change in fair value of the cross-currency swaps.

For the three and nine months ended September 30, 2020, the Company recorded gains of $1.5 million and $4.5 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and nine months ended September 30, 2019, the Company recorded gains of $1.8 million and

$5.5 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 (expense), net from AOCL as of September 30, 2020 within the next twelve months is $3.0 million. As of September 30, 2020, 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 September 30, 2020 and December 31, 2019, respectively (dollar amounts in thousands):



						September 30, 2020			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	$	589		$	2,459
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	52,000	$	589		$	2,459

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	2,443			3,087
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	2,443			3,087

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	2,398			2,032
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,398			2,032

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	8,580			(154		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	8,580			(154		)

Pay CHF	October 3, 2018	September 30, 2025	—%	CHF	165,172	(6,828		)	1,221
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(6,828		)	1,221

Total						$	7,182		$	8,645

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 three and nine months ended September 30, 2020, the Company recorded loss of $11.3 million and a gain of $5.1 million in AOCL related to the change in fair value of the cross-currency swaps. For the three and nine months ended September 30, 2019, the Company recorded gains of $17.1 million and $26.6 million in AOCL related to the change in fair value of the cross-currency swaps.

For the three and nine months ended September 30, 2020, the Company recorded gains of $2.2 million and $6.6 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and nine months ended September 30, 2019, the Company recorded gains of $2.5 million and $7.2 million, respectively, in interest income included in the consolidation 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 September 30, 2020 within the next twelve months is $7.7 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 for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of September 30, 2020 and December 31, 2019:



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2020		December 31, 2019
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap	$	—	$	12
Cross-currency swap	4,608		5,032
Net Investment Hedges
Cross-currency swap	7,717		7,952
Other assets
Net Investment Hedges
Cross-currency swap	9,071		3,465
Total derivatives designated as hedges — Assets	$	21,396	$	16,461

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap	$	22,324	$	6,635
Cross-currency swap	1,565		101
Other liabilities
Cash Flow Hedges
Interest rate swap	78,056		38,522
Cross-currency swap	10,777		5,440
Net Investment Hedges
Cross-currency swap	9,605		2,772
Total derivatives designated as hedges — Liabilities	$	122,327	$	53,470


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

The following presents the effect of derivative instruments designated as cash flow hedges on the accompanying condensed consolidated statement of operations during the three and nine months ended September 30, 2020 and 2019:



	Balance in AOCL Beginning of Quarter			Amount of Gain (Loss) Recognized in AOCL			Amount of Gain (Loss) Reclassified from AOCL into Earnings			Balance in AOCL End of Quarter			Location in Statements of Operations
	(In thousands)
Three Months Ended September 30, 2020
Cash Flow Hedges
Interest rate swap	$	(102,128	)	$	(3,971	)	$	(5,718	)	$	(100,381	)	Interest expense
Cross-currency swap	5,843			(6,272		)	(5,353		)	4,924			Other income (expense),net
Net Investment Hedges
Cross-currency swap	22,223			(11,254		)	2,202			8,767			Interest income
	$	(74,062	)	$	(21,497	)	$	(8,869	)	$	(86,690	)
Three Months Ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	(43,161	)	$	(13,788	)	$	237		$	(57,186	)	Interest expense
Cross-currency swap	(2,284		)	9,661			7,520			(143		)	Other income (expense),net
Net Investment Hedges
Cross-currency swap	4,054			17,136			2,489			18,701			Interest income
	$	(41,391	)	$	13,009		$	10,246		$	(38,628	)

	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 Quarter			Location in Statements of Operations
	(In thousands)
Nine Months Ended September 30, 2020
Cash Flow Hedges
Interest rate swap	$	(45,146	)	$	(65,608	)	$	(10,373	)	$	(100,381	)	Interest expense
Cross-currency swap	177			(2,688		)	(7,435		)	4,924			Other income (expense),net
Net Investment Hedges
Cross-currency swap	10,229			5,102			6,564			8,767			Interest income
	$	(34,740	)	$	(63,194	)	$	(11,244	)	$	(86,690	)
Nine months ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(54,841	)	$	2,964		$	(57,186	)	Interest expense
Cross-currency swap	(6,190		)	15,418			9,371			(143		)	Other income (expense), net
Net Investment Hedges
Cross-currency swap	(632		)	26,558			7,225			18,701			Interest income
	$	(6,203	)	$	(12,865	)	$	19,560		$	(38,628	)

STOCK-BASED COMPENSATION	9 Months Ended
STOCK-BASED COMPENSATION	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of September 30, 2020, the Company had stock options, restricted stock awards, performance stock units, contract stock awards and restricted stock unit awards outstanding under two plans, the 2001 Equity Incentive Plan (the “2001 Plan”) and the 2003 Equity Incentive Plan (the “2003 Plan,” and collectively, the “Plans”). 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 date of grant for directors and generally expire eight years from the grant date for employees, and from six to ten years for directors and certain executive officers. The Company values stock option grants using the binomial distribution model. Restricted stock issued under the Plans vests over specified periods, generally three years after the date of grant. The vesting of performance stock issued under the Plans is subject to service and performance conditions. Stock Options As of September 30, 2020, there were approximately $6.0 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 three years. There were 348,587 stock options granted during the nine months ended September 30, 2020. For the nine months ended September 30, 2020, the weighted average grant date fair value for stock options was $13.03 per option. Awards of Restricted Stock and Performance Stock Performance stock and restricted stock awards generally have requisite service periods of three years. Performance stock units are subject to graded vesting conditions based on revenue goals of the Company. The Company expenses the fair value of restricted stock awards on a straight-line basis over the requisite service period. As of September 30, 2020, there was approximately $27.5 million of total unrecognized compensation costs related to these unvested awards. The Company expects to recognize these costs over a weighted-average period of approximately two years. The Company granted 322,485 restricted stock awards and 180,875 performance stock awards during the nine months ended September 30, 2020. For the nine months ended September 30, 2020, the weighted average grant date fair value for restricted stock awards and performance stock units was $44.08 and $43.39 per award, respectively. The Company also maintains an Employee Stock Purchase Plan (the “ESPP”), which provides eligible employees 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 based on its terms.

RETIREMENT PLANS	9 Months Ended
RETIREMENT PLANS	Sep. 30, 2020
Retirement Benefits [Abstract]
RETIREMENT PLANS	RETIREMENT PLANS The Company maintains defined benefit pension plans that cover certain employees in France, Japan, Germany and Switzerland. Net periodic benefit costs for the Company’s defined benefit pension plans for the three and nine months ended September 30, 2020 were $1.0 million and $3.0 million, respectively. The components of the net periodic benefit costs other than the service cost component of $1.0 million and $2.9 million for the three and nine months ended September 30, 2020, respectively, are included in other income (expense), net in the consolidated statements of operations. Net periodic benefit costs for the Company’s defined benefit pension plans for the three and nine months ended September 30, 2019 was $1.0 million and $2.1 million, respectively. The components of the net periodic benefit costs other than the service cost component of $0.7 million and $2.0 million for the three and nine months ended September 30, 2019, respectively, are included in other income (expense), net in the consolidated statements of operations. The estimated fair values of plan assets were $33.2 million and $30.8 million as of September 30, 2020 and December 31, 2019, respectively. The net plan assets of the pension plans are invested in common trusts as of September 30, 2020 and December 31, 2019. Common trusts are classified as Level 2 in the fair value hierarchy. The fair value of common trusts is valued at the 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 an appropriate risk profile. Deferred Compensation Plan In May 2019, the Company adopted the Integra LifeSciences Deferred Compensation Plan (the “Plan”). Under the Plan, certain employees of the Company may defer the payment and taxation of up to 75% of their base salary and up to 100% of bonus amounts and other eligible cash compensation. During the first quarter of 2020, employees participating in the Plan began to defer their compensation. This deferred compensation is invested in funds offered under the Plan and is valued based on Level 1 measurements in the fair value hierarchy. The purpose of the Plan is to retain key employees by providing them with an opportunity to defer a portion of their compensation as elected by the participant in accordance with the Plan. Any amounts set aside to defray the liabilities assumed by the Company will remain the general assets of the Company until such amounts are distributed to the participants. Assets of the Company's deferred compensation plan are included in Other current assets and recorded at fair value based on their quoted market prices. The fair value of these assets at September 30, 2020 was $1.7 million. Offsetting liabilities relating to the deferred compensation plan are included in Other liabilities.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

LEASES AND RELATED PARTY LEASES

9 Months Ended

Sep. 30, 2020

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 September 30, 2020. 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 Right of Use ("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 nine months ended September 30, 2020 and September 30, 2019, was $14.6 million and $14.2 million respectively, which includes $0.2 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases at September 30, 2020 were as follows:



	September 30, 2020
	(In thousands, except lease term and discount rate)
Weighted average remaining lease term (in years):

Leased facilities	11.8
Leased vehicles	1.4

Weighted average discount rate:
Leased facilities	4.6	%
Leased vehicles	2.2	%

Supplemental cash flow information related to leases for the nine months ended September 30, 2020 and September 30, 2019 were as follows:



	September 30, 2020		September 30, 2019
	(In thousands)		(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	10,976	$	10,680

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	6,007	$	41,860

Future minimum lease payments under operating leases at September 30, 2020 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2020	$	74	$	3,742	$	3,816
2021	296		13,209		13,505
2022	296		13,224		13,520
2023	296		10,782		11,078
2024	296		9,996		10,292
Thereafter	1,426		86,750		88,176
Total minimum lease payments	$	2,684	$	137,703	$	140,387
Less: Imputed interest					39,091
Total lease liabilities					101,296
Less: Current lease liabilities					12,518
Long-term lease liabilities					88,778

Related Party Leases

The Company 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 stockholder and former director. The term of the current lease agreement is through October 31, 2029 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, 2029 through October 31, 2034 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2034 through October 31, 2039 at the fair market rental rate of the premises.

TREASURY STOCK	9 Months Ended
TREASURY STOCK	Sep. 30, 2020
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
TREASURY STOCK	TREASURY STOCK As of September 30, 2020 and December 31, 2019, there were 4.9 million and 2.9 million shares of treasury stock outstanding with a cost of $235.2 million and $119.9 million, at a weighted average cost per share of $47.86 and $41.87, respectively. On December 11, 2018, the board of directors of the Company (the “Board”) authorized the Company to repurchase up to $225.0 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. During the nine months ended September 30, 2020, the Company repurchased 2.1 million shares of Integra’s common stock as part of the existing share repurchase authorization. The Company utilized $100.0 million of net proceeds from the offering of the Convertible Senior Notes to execute the share repurchase transactions. This included $7.6 million from certain purchasers of the convertible notes in conjunction with the closing of the offering. On February 5, 2020, the Company entered into a $92.4 million accelerated share repurchase ("ASR") to complete the remaining $100.0 million of share repurchase. The Company received 1.3 million shares at inception of the ASR, which represented approximately 80% of the expected total shares. Upon settlement of the ASR in June 2020, the Company received an additional 0.6 million shares determined using the volume-weighted average price of the Company's common stock during the term of the transaction. The Company has $125.0 million remaining under the share repurchase of its Common Stock. The price and timing of any future purchases under the share repurchase program will depend on factors such as levels of cash generation from operations, the volume of stock option exercises by employees, cash requirements for acquisitions, dividends, economic and market conditions and stock price.

INCOME TAXES

9 Months Ended

Sep. 30, 2020

Income Tax Disclosure [Abstract]

INCOME TAXES

The following table provides a summary of the Company's effective tax rate:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2020		2019		2020		2019
Reported tax rate	22.1	%	(0.4	)%	24.6	%	(3.5	)%

The Company’s effective income tax rates for the three months ended September 30, 2020 and 2019 were 22.1% and (0.4)%, respectively. For the three months ended September 30, 2020, the primary drivers of the higher tax rate are the jurisdictional mix of income along with a $4.2 million recognition of a deferred tax liability related to an outside tax basis from the sale of the Extremity Orthopedics business, offset by a $3.2 million benefit from the reversal of the French valuation allowance. For the three months ended September 30, 2019, the rate was primarily driven by the impact of the Rebound transaction, which resulted in a $59.9 million IPR&D expense. This amount was not deductible for tax purposes.

The Company's effective income tax rates for the nine months ended September 30, 2020 and September 30, 2019 were 24.6% and (3.5)%, respectively. For the nine months ended September 30, 2020, the primary drivers of the higher tax rate are the jurisdictional mix of income along with a $4.2 million recognition of a deferred tax liability related to an outside tax basis from the sale of the Extremity Orthopedics business. For the nine months ended September 30, 2019, the primary driver of the tax rate is the impact of the Rebound transaction, which resulted in a $59.9 million IPR&D expense. This amount is not deductible for tax purposes. This was offset by a tax benefit of $10.8 million related to a federal tax holiday in Switzerland, which was finalized during the quarter ended March 31, 2019. The Company received a federal tax credit in Switzerland of 12 million CHF, which may be used over a seven year period, ending in 2024.

As of September 30, 2020, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed 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 September 30, 2020. The Company does not anticipate the need to repatriate earnings from foreign subsidiaries as a result of the impact of the COVID-19 pandemic.

On March 27, 2020, the Coronavirus Aid Relief, and Economic Security Act (CARES Act) was signed into law. The CARES Act included certain income tax provisions for corporations and individuals, among other provisions. The Company does not expect the CARES Act provisions to have a significant impact on the Company's income taxes. The Company continues to monitor the issuance of new legislation, regulations, and case law that may impact federal, state, and international tax positions.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

NET INCOME (LOSS) PER SHARE

9 Months Ended

Sep. 30, 2020

Earnings Per Share [Abstract]

NET INCOME (LOSS) PER SHARE

Basic and diluted net income (loss) per share was as follows:



	Three Months Ended September 30,					Nine Months Ended September 30,
	2020		2019			2020		2019
	(In thousands, except per share amounts)					(In thousands, except per share amounts)
Basic net income (loss) per share:
Net income (loss)	$	32,337	$	(27,610	)	$	41,148	$	34,882
Weighted average common shares outstanding	84,325		85,688			84,745		85,536
Basic net income (loss) per common share	$	0.38	$	(0.32	)	$	0.49	$	0.41

Diluted net income (loss) per share:
Net income (loss)	$	32,337	$	(27,610	)	$	41,148	$	34,882

Weighted average common shares outstanding — Basic	84,325		85,688			84,745		85,536
Effect of dilutive securities:
Stock options and restricted stock	427		—			558		1,045
Weighted average common shares for diluted earnings per share	84,752		85,688			85,303		86,581

Diluted net income (loss) per common share	$	0.38	$	(0.32	)	$	0.48	$	0.40

Common stock of approximately 0.3 million and 0.6 million shares at September 30, 2020, and 2019, respectively that are issuable through exercise of dilutive securities were not included in the computation of diluted net income (loss) per share because their effect would have been anti-dilutive.

Performance Shares and Restricted Units that entitle the holders to approximately 0.5 million shares of common stock are included in the basic and diluted weighted average shares outstanding calculation from their date of issuance because no further consideration is due related to the issuance of the underlying common shares.

COMPREHENSIVE INCOME (LOSS)

9 Months Ended

Sep. 30, 2020

Equity [Abstract]

COMPREHENSIVE INCOME (LOSS)

Comprehensive income (loss) was as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2020			2019			2020			2019
	(In thousands)						(In thousands)
Net income (loss)	$	32,337		$	(27,610	)	$	41,148		$	34,882
Foreign currency translation adjustment	21,181			(18,651		)	24,801			(17,960		)
Change in unrealized loss on derivatives, net of tax	(9,679		)	(775		)	(39,814		)	(24,714		)
Pension liability adjustment, net of tax	(291		)	515			(498		)	504
Comprehensive income (loss), net	$	43,548		$	(46,521	)	$	25,637		$	(7,288	)

Changes in accumulated other comprehensive loss by component between December 31, 2019 and September 30, 2020 are presented in the table below, net of tax:



	Gains and Losses on Derivatives			Defined Benefit Pension Items			Foreign Currency Items			Total
	(In thousands)
Balance at January 1, 2020	$	(26,625	)	$	(9,709	)	$	(40,068	)	$	(76,402	)
Other comprehensive income (loss)	(48,429		)	(498		)	24,801			(24,126		)
Less: Amounts reclassified from accumulated other comprehensive loss	(8,615		)	—			—			(8,615		)
Net current-period other comprehensive income (loss)	(39,814		)	(498		)	24,801			(15,511		)
Balance at September 30, 2020	$	(66,439	)	$	(10,207	)	$	(15,267	)	$	(91,913	)

For the nine months ended September 30, 2020, the Company reclassified a loss of $5.7 million and $2.9 million from accumulated other comprehensive loss to other income (expense), net and interest income, respectively.

SEGMENT AND GEOGRAPHIC INFORMATION

9 Months Ended

Sep. 30, 2020

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 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 each reportable segment for the three and nine months ended September 30, 2020 and 2019 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2020			2019			2020			2019
	(In thousands)						(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	239,323		$	252,984		$	640,541		$	736,810
Orthopedics and Tissue Technologies	130,909			126,111			342,680			385,620
Total revenues	$	370,232		$	379,095		$	983,221		$	1,122,430
Segment Profit
Codman Specialty Surgical	$	97,061		$	101,129		$	249,552		$	291,750
Orthopedics and Tissue Technologies	50,132			30,383			110,091			112,664
Segment profit	147,193			131,512			359,643			$	404,414
Amortization	(8,343		)	(5,056)			$	(23,393	)	(21,340)
Corporate and other	(81,308		)	(147,043		)	(237,525		)	(325,394		)
Operating income	$	57,542		$	(20,587	)	$	98,725		$	57,680

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 revenues to geographic areas based on the location of the customer. Total revenue by major geographic area consisted of the following:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2020		2019		2020		2019
	(In thousands)				(In thousands)
United States	$	266,477	$	266,280	$	695,179	$	796,397
Europe	45,995		49,242		123,917		148,753
Asia Pacific	40,473		42,079		113,934		114,810
Rest of World	17,287		21,494		50,191		62,470
Total Revenues	$	370,232	$	379,095	$	983,221	$	1,122,430

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8924-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
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+ Details

COMMITMENTS AND CONTINGENCIES

9 Months Ended

Sep. 30, 2020

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 nine month period ended September 30, 2020 and September 30, 2019 to reflect the change in estimates, 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 nine months ended September 30, 2020 and September 30, 2019 is as follows (in thousands):



Nine Months Ended September 30, 2020	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 3)			Contingent Consideration Liability Related to Acquisition of Derma Sciences		Location in Financial Statements
	Long-term			Long-term
Balance as of January 1, 2020	$	14,210		$	230
Loss from change in fair value of contingent consideration liabilities	(45		)	—		Research and development
Balance as of September 30, 2020	$	14,165		$	230



Nine Months Ended September 30, 2019	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 3)		Contingent Consideration Liability Related to Acquisition of Derma Sciences		Location in Financial Statements
	Long-term		Long-term
Balance as of January 1, 2019	$	—	$	230
Additions from acquisition of Arkis	13,100		—
Balance as of September 30, 2019	$	13,100	$	230

Derma Sciences

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 already 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 September 30, 2020 and September 30, 2019 was $0.2 million.

BASIS OF PRESENTATION (Policies)	9 Months Ended
BASIS OF PRESENTATION (Policies)	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis Of Presentation	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the September 30, 2020 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, statement of changes in shareholder's equity, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 2019 included in the Company’s Annual Report on Form 10-K. The December 31, 2019 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three and nine month period ended September 30, 2020 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with generally accepted accounting principles in the United States ("GAAP") which requires management to make estimates and assumptions that affect the reported amount 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 including 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 and 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 derivative instruments, valuation of the equity component of convertible debt instruments, valuation of contingent liabilities, the fair value 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. The novel coronavirus (“COVID-19”) pandemic and the resulting adverse impacts to global economic conditions, as well as our operations, may impact future estimates including, but not limited to, inventory valuations, fair value measurements, goodwill and long-lived asset impairments, the effectiveness of the Company’s hedging instruments, deferred tax valuation allowances, and allowances for doubtful accounts receivable.
Recently Issued Accounting Standards	Recently Issued Accounting Standards 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 ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020, is not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the current COVID-19 pandemic, or other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact as hospital's cash flows are impacted by their response to the COVID-19 pandemic. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans. The new guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and clarifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption is permitted. The adoption is not expected to have a material 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 ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a prospective transition method. The adoption of this guidance did 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 its financial condition and results of operations. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform, which provides optional guidance for a limited period of time to ease the potential burden in accounting for (or recognizing the effects of) reference rate reform on financial reporting. This amendment applies to all entities, subject to meeting certain criteria, that have contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued because of reference rate reform. This ASU is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into or evaluated on or before December 31, 2022. The Company is currently assessing the impact that this ASU will have on its consolidated financial statements and related disclosures. In August 2020, the FASB issued ASU No. 2020-06 Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting For Convertible Instruments and Contracts in an Entity's Own Equity . The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will be effective for annual and interim periods beginning after December 15, 2021, and early adoption is permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years. The Company is currently assessing the impact of this standard on its consolidated financial statements and related disclosures. 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.
Summary of Accounting Policies on Revenue Recognition and Shipping and Handling Fees	Summary of Accounting Policies on Revenue Recognition 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 for 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 product 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 thirty 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. 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 and 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. 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	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	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.

- Definition

Disclosure of accounting policy for revenue from contract with customer.

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+ Details

ASSETS AND LIABILITIES HELD FOR SALE (Tables)

9 Months Ended

Sep. 30, 2020

Discontinued Operations and Disposal Groups [Abstract]

Schedule of Fair Values of Assets and Liabilities Held For Sale

The major classes of assets and liabilities classified as a held for sale consisted of the following as of September 30, 2020 (amounts in thousands):



Prepaid and other current assets	$	748
Other assets	4,448
Deferred tax assets	6,927
Intangible assets	13,332
Property, plant and equipment, net	36,714
Goodwill	47,117
Inventories	50,691
Total assets held for sale	$	159,977
Other liabilities	241
Current portion of lease liability - operating leases	1,060
Accrued compensation	1,584
Deferred tax liabilities	3,035
Lease liability - operating leases	6,429
Total liabilities held for sale	$	12,349

- 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

BUSINESS DEVELOPMENT (Tables)

9 Months Ended

Sep. 30, 2020

Business Combinations [Abstract]

Schedule of Assets Acquired and Liabilities Assumed

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



	Final Valuation as of September 30, 2019		Weighted Average Life
	(Dollars in thousands)
Cash	$	90
Other current assets	751
Property, plant and equipment	457
Deferred tax assets	1,697
Intangible assets:
CerebroFlo developed technology	20,100		15 years
Enabling technology license	1,980		14 years
Goodwill	27,153
Total assets acquired	52,228

Accounts payable, accrued expenses and other liabilities	2,926
Contingent consideration	13,100
Deferred tax liabilities	5,603
Net assets acquired	$	30,599

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

9 Months Ended

Sep. 30, 2020

Revenue from Contract with Customer [Abstract]

Schedule of Changes in Contract Assets and Contract Liabilities

The following table summarizes the changes in the contract asset and liability balances for the nine months ended September 30, 2020:



Contract Asset
Contract asset, January 1, 2020	$	8,680
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(8,680		)
Contract asset, net of transferred to trade receivables on contracts during the period	6,653
Contract asset, September 30, 2020	$	6,653

Contract Liability
Contract liability, January 1, 2020	$	11,946
Recognition of revenue included in beginning of year contract liability	(3,150		)
Contract liability, net of revenue recognized on contracts during the period	2,631
Foreign currency translation	(42		)
Contract liability, September 30, 2020	$	11,385

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three and nine months ended September 30, 2020 and 2019 (amounts in thousands):



	Three Months Ended September 30, 2020		Three Months Ended September 30, 2019		Nine Months Ended September 30, 2020		Nine Months Ended September 30, 2019

Neurosurgery	$	189,674	$	195,330	$	516,048	$	567,779
Instruments	49,649		57,654		124,493		169,031
Total Codman Specialty Surgical	239,323		252,984		640,541		736,810

Wound Reconstruction and Care	82,115		82,213		210,673		239,458
Extremity Orthopedics	21,922		20,852		54,556		65,299
Private Label	26,872		23,046		77,451		80,863
Total Orthopedics and Tissue Technologies	130,909		126,111		342,680		385,620
Total revenue	$	370,232	$	379,095	$	983,221	$	1,122,430

INVENTORIES (Tables)

9 Months Ended

Sep. 30, 2020

Inventory, Net [Abstract]

Schedule of Inventories, Net

Inventories, net consisted of the following:



	September 30, 2020			December 31, 2019
	(In thousands)
Finished goods	$	223,726		$	201,870
Work in process	57,037			48,333
Raw materials	77,767			$	65,851
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	(50,691		)	—
Total inventories	$	307,839		$	316,054

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

9 Months Ended

Sep. 30, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill for the nine-month period ended September 30, 2020 were as follows:



	Codman Specialty Surgical		Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2019	$	653,500	$	300,780		$	954,280
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	—		(47,117		)	(47,117		)
Foreign currency translation	8,928		3,465			12,393
Goodwill at September 30, 2020	$	662,428	$	257,128		$	919,556

Schedule of Finite-Lived Intangible Assets

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



	September 30, 2020
	Weighted Average Life	Cost			Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	891,554		$	(250,609	)	$	640,945
Customer relationships	12 years	223,512			(138,989		)	84,523
Trademarks/brand names	28 years	104,404			(31,425		)	72,979
Codman tradename	Indefinite	167,013			—			167,013
Supplier relationships	27 years	34,721			(19,018		)	15,703
All other⁽¹⁾	4 years	11,101			(5,247		)	5,854
Transfer to assets held for sale (See Note 2. Assets Held for Sale)		(39,821		)	26,489			(13,332		)
		$	1,392,484		$	(418,799	)	$	973,685



	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 tradename	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

(1)

At September 30, 2020 and December 31, 2019, all other included IPR&D of $1.0 million, which was indefinite-lived. At September 30, 2020, this IPR&D asset was presented separately as "assets held for sale" in conjunction with the sale of the Extremity Orthopedics business which is expected to be sold within twelve months. See Note 2, Assets and Liabilities Held for Sale, for details.

Schedule of Indefinite-Lived Intangible Assets

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



	September 30, 2020
	Weighted Average Life	Cost			Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	891,554		$	(250,609	)	$	640,945
Customer relationships	12 years	223,512			(138,989		)	84,523
Trademarks/brand names	28 years	104,404			(31,425		)	72,979
Codman tradename	Indefinite	167,013			—			167,013
Supplier relationships	27 years	34,721			(19,018		)	15,703
All other⁽¹⁾	4 years	11,101			(5,247		)	5,854
Transfer to assets held for sale (See Note 2. Assets Held for Sale)		(39,821		)	26,489			(13,332		)
		$	1,392,484		$	(418,799	)	$	973,685



	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 tradename	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

(1)

DEBT (Tables)

9 Months Ended

Sep. 30, 2020

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of July 2020 Amendment through June 30, 2021		5.50 to 1.00
September 30, 2021 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 Contractual Repayments of Long-Term Debt

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



Quarter Ended September 30, 2020	Principal Repayment
	(In thousands)
Remainder of 2020	$	—
2021	33,750
2022	45,000
2023	61,875
2024	67,500
2025	669,375
	$	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)

9 Months Ended

Sep. 30, 2020

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 September 30, 2020 and December 31, 2019, respectively (dollar amounts in thousands):



						September 30, 2020			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	$	589		$	2,459
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	52,000	$	589		$	2,459

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	2,443			3,087
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	2,443			3,087

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	2,398			2,032
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,398			2,032

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	8,580			(154		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	8,580			(154		)

Pay CHF	October 3, 2018	September 30, 2025	—%	CHF	165,172	(6,828		)	1,221
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(6,828		)	1,221

Total						$	7,182		$	8,645

The Company held the following cross-currency rate swaps as of September 30, 2020 and December 31, 2019 (dollar amounts in thousands):



						September 30, 2020			December 31, 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	$	(1,565	)	$	(101	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	33,333	$	(1,565	)	$	(101	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(2,003		)	(119		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(2,003		)	(119		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(4,167		)	(289		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(4,167		)	(289		)

Total						$	(7,735	)	$	(509	)

The Company held the following interest rate swaps as of September 30, 2020 and December 31, 2019 (dollar amounts in thousands):



	September 30, 2020		December 31, 2019							September 30, 2020			December 31, 2019
Hedged Item	Notional Amount		Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
3-month USD LIBOR Loan	—		50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	$	—		$	(2	)
1-month USD LIBOR Loan	—		100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	—			12
1-month USD LIBOR Loan	100,000		100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(1,377		)	(581		)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(6,901		)	(2,880		)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(6,922		)	(2,880		)
1-month USD LIBOR Loan	100,000		100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(8,454		)	(3,517		)
1-month USD LIBOR Loan	50,000		50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(4,064		)	(1,778		)
1-month USD LIBOR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(18,188		)	(6,595		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(10,608		)	(5,750		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(10,871		)	(5,747		)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(10,586		)	(5,807		)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(11,282		)	(4,930		)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(11,127		)	(4,691		)
Total interest rate derivatives designated as cash flow hedge	$	1,175,000	$	1,325,000						$	(100,380	)	$	(45,145	)

Schedule of Fair Value and Presentation of Derivatives

The following table summarizes the fair value for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of September 30, 2020 and December 31, 2019:



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2020		December 31, 2019
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap	$	—	$	12
Cross-currency swap	4,608		5,032
Net Investment Hedges
Cross-currency swap	7,717		7,952
Other assets
Net Investment Hedges
Cross-currency swap	9,071		3,465
Total derivatives designated as hedges — Assets	$	21,396	$	16,461

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap	$	22,324	$	6,635
Cross-currency swap	1,565		101
Other liabilities
Cash Flow Hedges
Interest rate swap	78,056		38,522
Cross-currency swap	10,777		5,440
Net Investment Hedges
Cross-currency swap	9,605		2,772
Total derivatives designated as hedges — Liabilities	$	122,327	$	53,470


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

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



	Balance in AOCL Beginning of Quarter			Amount of Gain (Loss) Recognized in AOCL			Amount of Gain (Loss) Reclassified from AOCL into Earnings			Balance in AOCL End of Quarter			Location in Statements of Operations
	(In thousands)
Three Months Ended September 30, 2020
Cash Flow Hedges
Interest rate swap	$	(102,128	)	$	(3,971	)	$	(5,718	)	$	(100,381	)	Interest expense
Cross-currency swap	5,843			(6,272		)	(5,353		)	4,924			Other income (expense),net
Net Investment Hedges
Cross-currency swap	22,223			(11,254		)	2,202			8,767			Interest income
	$	(74,062	)	$	(21,497	)	$	(8,869	)	$	(86,690	)
Three Months Ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	(43,161	)	$	(13,788	)	$	237		$	(57,186	)	Interest expense
Cross-currency swap	(2,284		)	9,661			7,520			(143		)	Other income (expense),net
Net Investment Hedges
Cross-currency swap	4,054			17,136			2,489			18,701			Interest income
	$	(41,391	)	$	13,009		$	10,246		$	(38,628	)

	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 Quarter			Location in Statements of Operations
	(In thousands)
Nine Months Ended September 30, 2020
Cash Flow Hedges
Interest rate swap	$	(45,146	)	$	(65,608	)	$	(10,373	)	$	(100,381	)	Interest expense
Cross-currency swap	177			(2,688		)	(7,435		)	4,924			Other income (expense),net
Net Investment Hedges
Cross-currency swap	10,229			5,102			6,564			8,767			Interest income
	$	(34,740	)	$	(63,194	)	$	(11,244	)	$	(86,690	)
Nine months ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(54,841	)	$	2,964		$	(57,186	)	Interest expense
Cross-currency swap	(6,190		)	15,418			9,371			(143		)	Other income (expense), net
Net Investment Hedges
Cross-currency swap	(632		)	26,558			7,225			18,701			Interest income
	$	(6,203	)	$	(12,865	)	$	19,560		$	(38,628	)

- 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.

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+ Details

LEASES AND RELATED PARTY LEASES (Tables)

9 Months Ended

Sep. 30, 2020

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases at September 30, 2020 were as follows:



	September 30, 2020
	(In thousands, except lease term and discount rate)
Weighted average remaining lease term (in years):

Leased facilities	11.8
Leased vehicles	1.4

Weighted average discount rate:
Leased facilities	4.6	%
Leased vehicles	2.2	%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases for the nine months ended September 30, 2020 and September 30, 2019 were as follows:



	September 30, 2020		September 30, 2019
	(In thousands)		(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	10,976	$	10,680

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	6,007	$	41,860

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at September 30, 2020 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2020	$	74	$	3,742	$	3,816
2021	296		13,209		13,505
2022	296		13,224		13,520
2023	296		10,782		11,078
2024	296		9,996		10,292
Thereafter	1,426		86,750		88,176
Total minimum lease payments	$	2,684	$	137,703	$	140,387
Less: Imputed interest					39,091
Total lease liabilities					101,296
Less: Current lease liabilities					12,518
Long-term lease liabilities					88,778

INCOME TAXES (Tables)

9 Months Ended

Sep. 30, 2020

Income Tax Disclosure [Abstract]

Schedule of Effective Income Tax Rate

The following table provides a summary of the Company's effective tax rate:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2020		2019		2020		2019
Reported tax rate	22.1	%	(0.4	)%	24.6	%	(3.5	)%

NET INCOME (LOSS) PER SHARE (Tables)

9 Months Ended

Sep. 30, 2020

Earnings Per Share [Abstract]

Basic and Diluted Net Income (Loss) Per Share

Basic and diluted net income (loss) per share was as follows:



	Three Months Ended September 30,					Nine Months Ended September 30,
	2020		2019			2020		2019
	(In thousands, except per share amounts)					(In thousands, except per share amounts)
Basic net income (loss) per share:
Net income (loss)	$	32,337	$	(27,610	)	$	41,148	$	34,882
Weighted average common shares outstanding	84,325		85,688			84,745		85,536
Basic net income (loss) per common share	$	0.38	$	(0.32	)	$	0.49	$	0.41

Diluted net income (loss) per share:
Net income (loss)	$	32,337	$	(27,610	)	$	41,148	$	34,882

Weighted average common shares outstanding — Basic	84,325		85,688			84,745		85,536
Effect of dilutive securities:
Stock options and restricted stock	427		—			558		1,045
Weighted average common shares for diluted earnings per share	84,752		85,688			85,303		86,581

Diluted net income (loss) per common share	$	0.38	$	(0.32	)	$	0.48	$	0.40

COMPREHENSIVE INCOME (LOSS) (Tables)

9 Months Ended

Sep. 30, 2020

Equity [Abstract]

Schedule of Comprehensive Income (Loss)

Comprehensive income (loss) was as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2020			2019			2020			2019
	(In thousands)						(In thousands)
Net income (loss)	$	32,337		$	(27,610	)	$	41,148		$	34,882
Foreign currency translation adjustment	21,181			(18,651		)	24,801			(17,960		)
Change in unrealized loss on derivatives, net of tax	(9,679		)	(775		)	(39,814		)	(24,714		)
Pension liability adjustment, net of tax	(291		)	515			(498		)	504
Comprehensive income (loss), net	$	43,548		$	(46,521	)	$	25,637		$	(7,288	)

Schedule of Changes in Accumulated Other Comprehensive Loss by Component

Changes in accumulated other comprehensive loss by component between December 31, 2019 and September 30, 2020 are presented in the table below, net of tax:



	Gains and Losses on Derivatives			Defined Benefit Pension Items			Foreign Currency Items			Total
	(In thousands)
Balance at January 1, 2020	$	(26,625	)	$	(9,709	)	$	(40,068	)	$	(76,402	)
Other comprehensive income (loss)	(48,429		)	(498		)	24,801			(24,126		)
Less: Amounts reclassified from accumulated other comprehensive loss	(8,615		)	—			—			(8,615		)
Net current-period other comprehensive income (loss)	(39,814		)	(498		)	24,801			(15,511		)
Balance at September 30, 2020	$	(66,439	)	$	(10,207	)	$	(15,267	)	$	(91,913	)

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

9 Months Ended

Sep. 30, 2020

Segment Reporting [Abstract]

Schedule of Net Sales and Profit by Segments

Net sales and profit by each reportable segment for the three and nine months ended September 30, 2020 and 2019 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2020			2019			2020			2019
	(In thousands)						(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	239,323		$	252,984		$	640,541		$	736,810
Orthopedics and Tissue Technologies	130,909			126,111			342,680			385,620
Total revenues	$	370,232		$	379,095		$	983,221		$	1,122,430
Segment Profit
Codman Specialty Surgical	$	97,061		$	101,129		$	249,552		$	291,750
Orthopedics and Tissue Technologies	50,132			30,383			110,091			112,664
Segment profit	147,193			131,512			359,643			$	404,414
Amortization	(8,343		)	(5,056)			$	(23,393	)	(21,340)
Corporate and other	(81,308		)	(147,043		)	(237,525		)	(325,394		)
Operating income	$	57,542		$	(20,587	)	$	98,725		$	57,680

Total revenue by major geographic area consisted of the following:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2020		2019		2020		2019
	(In thousands)				(In thousands)
United States	$	266,477	$	266,280	$	695,179	$	796,397
Europe	45,995		49,242		123,917		148,753
Asia Pacific	40,473		42,079		113,934		114,810
Rest of World	17,287		21,494		50,191		62,470
Total Revenues	$	370,232	$	379,095	$	983,221	$	1,122,430

Schedule of Geographic Revenue by Area

Net sales and profit by each reportable segment for the three and nine months ended September 30, 2020 and 2019 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2020			2019			2020			2019
	(In thousands)						(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	239,323		$	252,984		$	640,541		$	736,810
Orthopedics and Tissue Technologies	130,909			126,111			342,680			385,620
Total revenues	$	370,232		$	379,095		$	983,221		$	1,122,430
Segment Profit
Codman Specialty Surgical	$	97,061		$	101,129		$	249,552		$	291,750
Orthopedics and Tissue Technologies	50,132			30,383			110,091			112,664
Segment profit	147,193			131,512			359,643			$	404,414
Amortization	(8,343		)	(5,056)			$	(23,393	)	(21,340)
Corporate and other	(81,308		)	(147,043		)	(237,525		)	(325,394		)
Operating income	$	57,542		$	(20,587	)	$	98,725		$	57,680

Total revenue by major geographic area consisted of the following:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2020		2019		2020		2019
	(In thousands)				(In thousands)
United States	$	266,477	$	266,280	$	695,179	$	796,397
Europe	45,995		49,242		123,917		148,753
Asia Pacific	40,473		42,079		113,934		114,810
Rest of World	17,287		21,494		50,191		62,470
Total Revenues	$	370,232	$	379,095	$	983,221	$	1,122,430

COMMITMENTS AND CONTINGENCIES (Tables)

9 Months Ended

Sep. 30, 2020

Commitments and Contingencies Disclosure [Abstract]

Schedule of Contingent Consideration

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the nine months ended September 30, 2020 and September 30, 2019 is as follows (in thousands):



Nine Months Ended September 30, 2020	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 3)			Contingent Consideration Liability Related to Acquisition of Derma Sciences		Location in Financial Statements
	Long-term			Long-term
Balance as of January 1, 2020	$	14,210		$	230
Loss from change in fair value of contingent consideration liabilities	(45		)	—		Research and development
Balance as of September 30, 2020	$	14,165		$	230



Nine Months Ended September 30, 2019	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 3)		Contingent Consideration Liability Related to Acquisition of Derma Sciences		Location in Financial Statements
	Long-term		Long-term
Balance as of January 1, 2019	$	—	$	230
Additions from acquisition of Arkis	13,100		—
Balance as of September 30, 2019	$	13,100	$	230

ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details) - Smith & Nephew USD Limited - Disposal Group, Disposed of by Sale, Not Discontinued Operations - Subsequent Event - Forecast $ in Millions	Dec. 31, 2020 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of Extremity Orthopedics business, disposition price	$ 240.0
Consortium of Focused Orthopedists, LLC
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of Extremity Orthopedics business, product development payment	$ 41.5

ASSETS AND LIABILITIES HELD FOR SALE - Assets and Liabilities Held For Sale (Details) - Smith & Nephew USD Limited - Disposal Group, Disposed of by Sale, Not Discontinued Operations $ in Thousands	Sep. 30, 2020 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Prepaid and other current assets	$ 748
Other assets	4,448
Deferred tax assets	6,927
Intangible assets	13,332
Property, plant and equipment, net	36,714
Goodwill	47,117
Inventories	50,691
Total assets held for sale	159,977
Other liabilities	241
Current portion of lease liability - operating leases	1,060
Accrued compensation	1,584
Deferred tax liabilities	3,035
Lease liability - operating leases	6,429
Total liabilities held for sale	$ 12,349

BUSINESS DEVELOPMENT - Business Combination, Narrative (Details) - Arkis - USD ($)	Jul. 29, 2019	Sep. 30, 2020
Business Acquisition [Line Items]
Purchase price of business combination	$ 30,600,000
Contingent consideration, liability (up to)	25,500,000
Contingent consideration, fair value	$ 13,100,000	$ 14,200,000
Acquired intangible assets, discount rate	14.50%
Development Milestones
Business Acquisition [Line Items]
Contingent consideration, liability (up to)	$ 10,000,000.0
Commercial Sales Milestones
Business Acquisition [Line Items]
Contingent consideration, liability (up to)	$ 15,500,000

BUSINESS DEVELOPMENT - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	Jul. 29, 2019	Sep. 30, 2020	Dec. 31, 2019
Intangible assets:
Goodwill		$ 919,556	$ 954,280
Arkis
Business Acquisition [Line Items]
Cash	$ 90
Other current assets	751
Property, plant and equipment	457
Deferred tax assets	1,697
Intangible assets:
Goodwill	27,153
Total assets acquired	52,228
Accounts payable, accrued expenses and other liabilities	2,926
Contingent consideration	13,100	$ 14,200
Deferred tax liabilities	5,603
Net assets acquired	30,599
Arkis \| CerebroFlo developed technology
Intangible assets:
Intangible assets	$ 20,100
Weighted Average Life	15 years
Arkis \| Enabling technology license
Intangible assets:
Intangible assets	$ 1,980
Weighted Average Life	14 years

BUSINESS DEVELOPMENT - Asset Acquisition, Narrative (Details)				3 Months Ended			9 Months Ended		12 Months Ended
	Dec. 31, 2020 USD ($)	Sep. 09, 2019 USD ($) asset	Jan. 04, 2019 USD ($) asset	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Dec. 31, 2019 USD ($)
Schedule Of Asset Acquisition [Line Items]
In-process research and development				$ 0	$ 59,889,000		$ 0	$ 59,889,000
Consortium of Focused Orthopedists, LLC \| Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Subsequent Event \| Forecast \| Smith & Nephew USD Limited
Schedule Of Asset Acquisition [Line Items]
Sale of Extremity Orthopedics business, product development payment	$ 41,500,000
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									$ 5,000,000.0
In-process research and development									$ 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 \| In-Process Research and Development Expense
Schedule Of Asset Acquisition [Line Items]
Upfront payment		$ 59,900,000
ISC
Schedule Of Asset Acquisition [Line Items]
Number of assets acquired \| asset			1
Research and development						$ 1,700,000
ISC \| Enabling technology license
Schedule Of Asset Acquisition [Line Items]
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

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
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	$ 4,875	$ 4,772
Long-term portion of contract liability	$ 6,500
Product warranty period (up to)	2 years
Minimum
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance	1 month
Maximum
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance	3 months

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-10-01	Sep. 30, 2020
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation through 2020, percentage	43.00%
Performance obligations expected to be satisfied, expected timing	3 months

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 8,680
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(8,680)
Contract asset, net of transferred to trade receivables on contracts during the period	6,653
Contract asset, End of Period	6,653
Contract Liability
Contract liability, Beginning of Period	11,946
Recognition of revenue included in beginning of year contract liability	(3,150)
Contract liability, net of revenue recognized on contracts during the period	2,631
Foreign currency translation	(42)
Contract liability, End of Period	$ 11,385

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disaggregation of Revenue [Line Items]
Total Revenues	$ 370,232	$ 379,095	$ 983,221	$ 1,122,430
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	239,323	252,984	640,541	736,810
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	189,674	195,330	516,048	567,779
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	49,649	57,654	124,493	169,031
Orthopedics and Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	130,909	126,111	342,680	385,620
Orthopedics and Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	82,115	82,213	210,673	239,458
Orthopedics and Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total Revenues	21,922	20,852	54,556	65,299
Orthopedics and Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 26,872	$ 23,046	$ 77,451	$ 80,863

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Inventory, Net [Abstract]
Finished goods	$ 223,726	$ 201,870
Work in process	57,037	48,333
Raw materials	77,767	65,851
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	(50,691)	0
Inventories, net	$ 307,839	$ 316,054

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020 USD ($)
Goodwill [Roll Forward]
Beginning of Period	$ 954,280
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	(47,117)
Foreign currency translation	12,393
End of Period	919,556
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of Period	653,500
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	0
Foreign currency translation	8,928
End of Period	662,428
Orthopedics and Tissue Technologies
Goodwill [Roll Forward]
Beginning of Period	300,780
Transfer to assets held for sale (See Note 2. Assets Held for Sale)	(47,117)
Foreign currency translation	3,465
End of Period	$ 257,128

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,392,484	$ 1,415,787
Accumulated Amortization	(418,799)	(384,196)
Net	973,685	1,031,591
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	167,013	163,126
Net	167,013	163,126
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	$ 891,554	$ 880,623
Accumulated Amortization	(250,609)	(213,702)
Net	$ 640,945	$ 666,921
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 223,512	$ 222,575
Accumulated Amortization	(138,989)	(119,393)
Net	$ 84,523	$ 103,182
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 104,404	$ 103,873
Accumulated Amortization	(31,425)	(28,514)
Net	$ 72,979	$ 75,359
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	27 years
Cost	$ 34,721	$ 34,721
Accumulated Amortization	(19,018)	(17,947)
Net	$ 15,703	$ 16,774
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	4 years	4 years
Cost	$ 11,101	$ 10,869
Accumulated Amortization	(5,247)	(4,640)
Net	5,854	$ 6,229
Transfer to assets held for sale (See Note 2. Assets Held for Sale)
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	(39,821)
Accumulated Amortization	26,489
Net	$ (13,332)

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details)	3 Months Ended
	Sep. 30, 2020 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, impairment	$ 0
Intangible assets, indefinite lives, discount rate	11.50%
Intangible assets, indefinite lives, impairment	$ 0
Expected annual amortization expense, remainder of 2020	15,700,000
Expected annual amortization expense, in 2021	62,100,000
Expected annual amortization expense, in 2022	59,700,000
Expected annual amortization expense, in 2023	58,900,000
Expected annual amortization expense, in 2024	58,400,000
Expected annual amortization expense, in 2025	58,400,000
Expected annual amortization expense, thereafter	$ 494,900,000

DEBT - Narrative (Details)		3 Months Ended			9 Months Ended
DEBT - Narrative (Details)	Feb. 04, 2020 USD ($) $ / shares	Sep. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2018 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Feb. 03, 2020 USD ($)	Dec. 31, 2019 USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility		$ 22,500,000			$ 22,500,000			$ 45,000,000
Carrying amount, liability component		469,898,000			469,898,000			0
Cost of call transactions					104,248,000	$ 0
Proceeds from warrant transactions					44,563,000	$ 0
Securitization program outstanding borrowings, maximum limit				$ 150,000,000.0
Securitization program, term				3 years
Long-term borrowings under securitization facility		$ 92,300,000			$ 92,300,000			$ 104,500,000
Weighted average interest rate, accounts receivable securitization revolving loan facility		1.40%			1.40%			2.80%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value		$ 92,800,000			$ 92,800,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 1,300,000,000
Line of credit facility outstanding		$ 97,500,000			$ 97,500,000			$ 375,000,000.0
Weighted average interest rate on debt		1.50%			1.50%			3.20%
Revolving Credit Facility \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		$ 94,600,000			$ 94,600,000
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000
Swingline Loans
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000
Senior Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							2,200,000,000
Incremental financing costs capitalized							4,600,000
Previously capitalized financing costs, written-off			$ 1,200,000
Incremental financing cost expense		3,300,000
Senior Credit Facility \| Overnight Federal Funds
Debt Instrument [Line Items]
Interest rates available					0.50%
Senior Credit Facility \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available					1.00%
Senior Credit Facility \| Minimum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage					0.15%
Senior Credit Facility \| Minimum \| Eurodollar
Debt Instrument [Line Items]
Interest rates available					1.00%
Senior Credit Facility \| Maximum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage					0.30%
Senior Credit Facility \| Maximum \| Eurodollar
Debt Instrument [Line Items]
Interest rates available					2.25%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding		0			$ 0
Letters of credit outstanding		1,600,000			1,600,000			$ 800,000
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 877,500,000
Line of credit facility outstanding		$ 877,500,000			$ 877,500,000			$ 877,500,000
Weighted average interest rate on debt		1.50%			1.50%			3.20%
Term loan component of senior credit facility		$ 22,500,000			$ 22,500,000
Term Loan Facility \| Secured Debt \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		853,700,000			853,700,000
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Incremental financing costs capitalized	$ 13,200,000
Convertible notes, maximum borrowing capacity	$ 575,000,000.0	575,000,000.0			575,000,000.0
Convertible notes, interest rate	0.50%
Debt proceeds, classified as equity at time of offering	$ 104,500,000
Effective interest rate	4.20%
Carrying amount, liability component		481,500,000			481,500,000
Unamortized discount		93,500,000			93,500,000
Fair value		$ 541,800,000			541,800,000
Initial conversion rate	13.5739
Initial conversion price (in dollars per share) \| $ / shares	$ 73.67
Maximum selling price of the company's common stock of the conversion price	130.00%
Maximum average conversion value of notes	98.00%
Redemption price, percentage	100.00%
Warrant strike price (in dollars per share) \| $ / shares	$ 113.34
Cash interest					1,900,000
Amortization of discount					11,100,000
Interest expense					13,000,000.0
2025 Notes \| Convertible Debt \| Call Option
Debt Instrument [Line Items]
Cost of call transactions					104,200,000
Proceeds from warrant transactions					$ 44,500,000
Initial strike price (in dollars per share) \| $ / shares	$ 73.67

DEBT - Maximum Total Leverage Ratio Table (Details) - Senior Credit Facility	Jul. 14, 2020
Execution of July 2020 Amendment through June 30, 2021
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5.50
September 30, 2021 through June 30, 2022
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5.00
September 30, 2022 through June 30, 2023
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.50
September 30, 2023 and the last day of each fiscal quarter thereafter
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.00

DEBT - Contractual Maturity Table (Details) $ in Thousands	Sep. 30, 2020 USD ($)
Debt Disclosure [Abstract]
Remainder of 2020	$ 0
2021	33,750
2022	45,000
2023	61,875
2024	67,500
2025	669,375
Principal Repayment	$ 877,500

DERIVATIVE INSTRUMENTS - Schedule of Derivatives (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($)	Sep. 30, 2020	Dec. 31, 2019
Derivative [Line Items]
Notional Amount	$ 1,175,000,000	$ 1,325,000,000
Estimated Fair Value, Asset (Liability)	(100,380,000)	(45,145,000)
3-Month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 1
Derivative [Line Items]
Notional Amount	$ 0	50,000,000
Fixed Interest Rate	1.834%
Estimated Fair Value, Asset (Liability)	$ 0	(2,000)
1-Month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 0	100,000,000
Fixed Interest Rate	1.652%
Estimated Fair Value, Asset (Liability)	$ 0	12,000
1-Month USD LIBOR \| Interest Rate Swap Designated March 27, 2017
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	1.971%
Estimated Fair Value, Asset (Liability)	$ (1,377,000)	(581,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Notional Amount	$ 150,000,000	150,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Asset (Liability)	$ (6,901,000)	(2,880,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 150,000,000	150,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Asset (Liability)	$ (6,922,000)	(2,880,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Asset (Liability)	$ (8,454,000)	(3,517,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 4
Derivative [Line Items]
Notional Amount	$ 50,000,000	50,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Asset (Liability)	$ (4,064,000)	(1,778,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 5
Derivative [Line Items]
Notional Amount	$ 200,000,000	200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value, Asset (Liability)	$ (18,188,000)	(6,595,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.22%
Estimated Fair Value, Asset (Liability)	$ (10,608,000)	(5,750,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.199%
Estimated Fair Value, Asset (Liability)	$ (10,871,000)	(5,747,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.209%
Estimated Fair Value, Asset (Liability)	$ (10,586,000)	(5,807,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.885%
Estimated Fair Value, Asset (Liability)	$ (11,282,000)	(4,930,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.867%
Estimated Fair Value, Asset (Liability)	$ (11,127,000)	$ (4,691,000)

DERIVATIVE INSTRUMENTS - Narrative (Details)	3 Months Ended		9 Months Ended
DERIVATIVE INSTRUMENTS - Narrative (Details)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Oct. 02, 2020 USD ($)	Dec. 31, 2019 USD ($)	Oct. 02, 2017 CHF (SFr)	Oct. 02, 2017 USD ($)
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value	$ (21,497,000)	$ 13,009,000	$ (63,194,000)	$ (12,865,000)
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount	1,175,000,000		1,175,000,000			$ 1,325,000,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain reclassified into other income	2,200,000	2,500,000	6,600,000	7,200,000
Gain expected to be reclassified to earnings in the next twelve months	7,700,000		7,700,000
Gain (loss) recorded, net investment hedge, change in fair value	(11,300,000)	17,100,000	5,100,000	26,600,000
Cross-currency swap \| Codman \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in other income, net	(6,900,000)	5,700,000	(12,000,000.0)	3,900,000
Gain (loss) recorded in AOCL, change in fair value	(6,300,000)	9,700,000	2,700,000	15,400,000
Gain reclassified into other income	1,500,000	$ 1,800,000	4,500,000	$ 5,500,000
Gain expected to be reclassified to earnings in the next twelve months	$ 3,000,000.0		$ 3,000,000.0
Cross-currency swap \| Codman \| Cash Flow Hedges \| Subsequent Event \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount					$ 33,300,000
Cross-currency swap \| Short \| Codman
Derivative [Line Items]
Current notional amount								$ 300,000,000.0
Cross-currency swap \| Long \| Codman
Derivative [Line Items]
Current notional amount \| SFr							SFr 291,200,000

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details)	Sep. 30, 2020 CHF (SFr)	Sep. 30, 2020 USD ($)	Dec. 31, 2019 USD ($)	Oct. 02, 2017 CHF (SFr)	Oct. 02, 2017 USD ($)
Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Aggregate Notional Amount \| SFr				SFr 291,200,000
Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Aggregate Notional Amount					$ 300,000,000.0
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount		$ 1,175,000,000	$ 1,325,000,000
Fair Value Asset (Liability)		(100,380,000)	(45,145,000)
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		(7,735,000)	(509,000)
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ (1,565,000)	(101,000)
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.75%	1.75%
Aggregate Notional Amount \| SFr	SFr 32,355,000
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.38%	4.38%
Aggregate Notional Amount		$ 33,333,000
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ (2,003,000)	(119,000)
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%
Aggregate Notional Amount \| SFr	SFr 48,533,000
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%
Aggregate Notional Amount		$ 50,000,000
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ (4,167,000)	$ (289,000)
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount \| SFr	SFr 145,598,000
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount		$ 150,000,000

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) - Designated as Hedging Instrument - Net Investment Hedges € in Thousands, £ in Thousands, SFr in Thousands, $ in Thousands	Sep. 30, 2020 CHF (SFr)	Sep. 30, 2020 USD ($)	Sep. 30, 2020 GBP (£)	Sep. 30, 2020 EUR (€)	Dec. 31, 2019 USD ($)
Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)		$ 589			$ 2,459
Cross Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €				€ 44,859
Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	3.01%	3.01%	3.01%	3.01%
Aggregate Notional Amount		$ 52,000
Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)		$ 2,443			3,087
Cross Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €				€ 51,760
Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	2.57%	2.57%	2.57%	2.57%
Aggregate Notional Amount		$ 60,000
Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)		$ 2,398			2,032
Cross Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €				€ 38,820
Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Rate	2.19%	2.19%	2.19%	2.19%
Aggregate Notional Amount		$ 45,000
Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)		$ 8,580			(154)
Cross Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Rate	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £			£ 128,284
Cross Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Rate	2.71%	2.71%	2.71%	2.71%
Aggregate Notional Amount		$ 167,500
Cross Currency Interest Rate Swap Five
Derivative [Line Items]
Fair Value Asset (Liability)		$ (6,828)			1,221
Cross Currency Interest Rate Swap Five \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr	SFr 165,172
Cross Currency Interest Rate Swap Five \| Short
Derivative [Line Items]
Fixed Rate	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £			£ 128,284
Cross Currency Interest Rate Swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ 7,182			$ 8,645

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) - Designated as Hedging Instrument - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 21,396	$ 16,461
Total derivatives designated as hedges — Liabilities	122,327	53,470
Interest rate swap \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	0	12
Interest rate swap \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	22,324	6,635
Interest rate swap \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	78,056	38,522
Cross-currency swap \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	4,608	5,032
Cross-currency swap \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	1,565	101
Cross-currency swap \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	10,777	5,440
Cross-currency swap \| Net Investment Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	7,717	7,952
Cross-currency swap \| Net Investment Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	9,071	3,465
Cross-currency swap \| Net Investment Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 9,605	$ 2,772

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,349,095	$ 1,420,951	$ 1,416,736	$ 1,375,796
Balance, End of Period	1,397,987	1,384,974	1,397,987	1,384,974
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(103,125)	(68,700)	(76,402)	(45,443)
Balance, End of Period	(91,913)	(87,615)	(91,913)	(87,615)
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL	(21,497)	13,009	(63,194)	(12,865)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(8,869)	10,246	(11,244)	19,560
Designated as Hedging Instrument \| Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(74,062)	(41,391)	(34,740)	(6,203)
Balance, End of Period	(86,690)	(38,628)	(86,690)	(38,628)
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(102,128)	(43,161)	(45,146)	619
Amount of Gain (Loss) Recognized in AOCL	(3,971)	(13,788)	(65,608)	(54,841)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(5,718)	237	(10,373)	2,964
Balance, End of Period	(100,381)	(57,186)	(100,381)	(57,186)
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other income (expense),net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	5,843	(2,284)	177	(6,190)
Amount of Gain (Loss) Recognized in AOCL	(6,272)	9,661	(2,688)	15,418
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(5,353)	7,520	(7,435)	9,371
Balance, End of Period	4,924	(143)	4,924	(143)
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	22,223	4,054	10,229	(632)
Amount of Gain (Loss) Recognized in AOCL	(11,254)	17,136	5,102	26,558
Amount of Gain (Loss) Reclassified from AOCL into Earnings	2,202	2,489	6,564	7,225
Balance, End of Period	$ 8,767	$ 18,701	$ 8,767	$ 18,701

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2020 USD ($) plan $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share-based payment award, number of plans \| plan	2
Grants in period, net of forfeitures (in shares) \| shares	348,587
Options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 13.03
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs \| $	$ 6.0
Weighted-average period for cost recognition	3 years
Stock Options \| Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	1 year
Stock Options \| Employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	8 years
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	3 years
Total unrecognized compensation costs \| $	$ 27.5
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares) \| shares	322,485
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 44.08
Performance Stock and Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Requisite service periods of awards	3 years
Performance Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards granted during the period (in shares) \| shares	180,875
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 43.39
Minimum \| Stock Options \| Directors and Certain Executive Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	6 years
Maximum \| Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	4 years
Maximum \| Stock Options \| Directors and Certain Executive Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	10 years

RETIREMENT PLANS - Narrative (Details) - USD ($) $ in Millions	1 Months Ended	3 Months Ended		9 Months Ended
	May 31, 2019	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Retirement Benefits [Abstract]
Net periodic benefit costs		$ 1.0	$ 1.0	$ 3.0	$ 2.1
Service cost component		1.0	$ 0.7	2.9	$ 2.0
Estimated fair value of plan assets		33.2		33.2		$ 30.8
Defer payment and taxation, base salary, percentage (up to)	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%
Deferred compensation plan, fair value of assets		$ 1.7		$ 1.7

- Definition

Amount of asset segregated and restricted to provide benefit under defined benefit plan. Asset includes, but is not limited to, stock, bond, other investment, earning from investment, and contribution by employer and employee.

+ References + Details

LEASES AND RELATED PARTY LEASES - Narrative (Details) $ in Millions	9 Months Ended
	Sep. 30, 2020 USD ($) renewal_option	Sep. 30, 2019 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewal_option	1
Operating lease expense	$ 14.6	$ 14.2
Affiliated Entity
Operating Leased Assets [Line Items]
Operating lease expense	$ 0.2	$ 0.2
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	$ 0.3
Affiliated Entity \| Five Year Option Lease From November 1, 2029 Through October 31, 2034
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2029 through October 31, 2034
Affiliated Entity \| Five Year Option Lease From November 1, 2034 Through October 31, 2039
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2034 through October 31, 2039

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details)	Sep. 30, 2020
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	11 years 9 months 18 days
Weighted average discount rate	4.60%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	1 year 4 months 24 days
Weighted average discount rate	2.20%

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 10,976	$ 10,680
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 6,007	$ 41,860

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases, After Adoption of 842 (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Operating Leased Assets [Line Items]
2020	$ 3,816
2021	13,505
2022	13,520
2023	11,078
2024	10,292
Thereafter	88,176
Total minimum lease payments	140,387
Less: Imputed interest	39,091
Total lease liabilities	101,296
Less: Current lease liabilities	12,518	$ 12,253
Long-term lease liabilities	88,778	$ 97,504
Related Parties
Operating Leased Assets [Line Items]
2020	74
2021	296
2022	296
2023	296
2024	296
Thereafter	1,426
Total minimum lease payments	2,684
Third Parties
Operating Leased Assets [Line Items]
2020	3,742
2021	13,209
2022	13,224
2023	10,782
2024	9,996
Thereafter	86,750
Total minimum lease payments	$ 137,703

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, shares in Millions		1 Months Ended	3 Months Ended		9 Months Ended		12 Months Ended
	Feb. 05, 2020	Jun. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019	Dec. 11, 2018
Equity, Class of Treasury Stock [Line Items]
Treasury stock (in shares)					4.9		2.9
Treasury stock					$ 235,200,000		$ 119,900,000
Treasury stock, average cost per share (in dollars per share)					$ 47.86		$ 41.87
Stock repurchase program, authorized amount (up to)								$ 225,000,000.0
Stock repurchased during period (in shares)	1.3	0.6			2.1
Net proceeds from offering of convertible senior notes					$ 575,000,000	$ 0
Accelerated share repurchase program, payment	$ 92,400,000
Accelerated shares repurchased, amount	$ 100,000,000.0		$ 0	$ 92,368,000
Accelerated share repurchases, percentage of expected total repurchased	80.00%
Remaining amount under share repurchase					125,000,000.0
Convertible Debt
Equity, Class of Treasury Stock [Line Items]
Net proceeds from offering of convertible senior notes					100,000,000.0
Convertible Debt \| Certain Purchasers
Equity, Class of Treasury Stock [Line Items]
Net proceeds from offering of convertible senior notes					$ 7,600,000

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		9 Months Ended
INCOME TAXES - Summary of Effective Tax Rate (Details)	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Reported tax rate	22.10%	(0.40%)	24.60%	(3.50%)

INCOME TAXES - Narrative (Details) SFr in Millions, $ in Millions	3 Months Ended			9 Months Ended
	Sep. 30, 2020 USD ($)	Sep. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Sep. 30, 2020 USD ($)	Sep. 30, 2019 CHF (SFr)	Sep. 30, 2019 USD ($)
Income Tax Contingency [Line Items]
Effective income tax rate	22.10%	(0.40%)		24.60%	(3.50%)	(3.50%)
Effective income tax rate reconciliation, tax expense, sale of Extremity Orthopedic business	$ 4.2			$ 4.2
Rebound
Income Tax Contingency [Line Items]
Effective income tax rate reconciliation, in-process research and development (IPR&D) expense		$ 59.9				$ 59.9
Foreign Tax Authority \| Ministry of the Economy, Finance and Industry, France
Income Tax Contingency [Line Items]
Effective income tax rate reconciliation, tax benefit, reversal of valuation allowance	$ 3.2
Foreign Tax Authority \| Swiss Federal Tax Administration (FTA)
Income Tax Contingency [Line Items]
Federal tax credit			$ 10.8
Effective income tax rate reconciliation, tax benefit, federal tax holiday \| SFr					SFr 12

NET INCOME (LOSS) PER SHARE - Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019
Basic net income (loss) per share:
Net income (loss)	$ 32,337	$ (369)	$ 9,180	$ (27,610)	$ 29,736	$ 32,756	$ 41,148	$ 34,882
Weighted average common shares outstanding - Basic (in shares)	84,325			85,688			84,745	85,536
Basic net income (loss) per common share (in dollars per share)	$ 0.38			$ (0.32)			$ 0.49	$ 0.41
Diluted net income (loss) per share:
Net income (loss)	$ 32,337	$ (369)	$ 9,180	$ (27,610)	$ 29,736	$ 32,756	$ 41,148	$ 34,882
Weighted average common shares outstanding - Basic (in shares)	84,325			85,688			84,745	85,536
Effect of dilutive securities:
Stock options and restricted stock (in shares)	427			0			558	1,045
Weighted average common shares for diluted earnings per share (in shares)	84,752			85,688			85,303	86,581
Diluted net income (loss) per common share (in dollars per share)	$ 0.38			$ (0.32)			$ 0.48	$ 0.40

- Definition

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

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- 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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- Definition

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

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+ Details

NET INCOME (LOSS) PER SHARE - Narrative (Details) - shares shares in Millions	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.3	0.6
Performance Shares and Restricted Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares included in computation (in shares)	0.5

COMPREHENSIVE INCOME (LOSS) - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019
Equity [Abstract]
Net income (loss)	$ 32,337	$ (369)	$ 9,180	$ (27,610)	$ 29,736	$ 32,756	$ 41,148	$ 34,882
Foreign currency translation adjustment	21,181			(18,651)			24,801	(17,960)
Change in unrealized loss on derivatives, net of tax	(9,679)			(775)			(39,814)	(24,714)
Pension liability adjustment, net of tax	(291)			515			(498)	504
Comprehensive income (loss), net	$ 43,548			$ (46,521)			$ 25,637	$ (7,288)

- Definition

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

+ References

+ Details

COMPREHENSIVE INCOME (LOSS) - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2020
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,349,095	$ 1,341,802	$ 1,416,736	$ 1,420,951	$ 1,397,030	$ 1,375,796	$ 1,416,736
Other comprehensive income (loss)							(24,126)
Less: Amounts reclassified from accumulated other comprehensive loss							(8,615)
Net current-period other comprehensive income (loss)	11,212	1,464	(28,187)	(18,915)	(12,021)	(11,236)	(15,511)
Balance, End of Period	1,397,987	1,349,095	1,341,802	1,384,974	1,420,951	1,397,030	1,397,987
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(26,625)				(26,625)
Other comprehensive income (loss)							(48,429)
Less: Amounts reclassified from accumulated other comprehensive loss							(8,615)
Net current-period other comprehensive income (loss)							(39,814)
Balance, End of Period	(66,439)						(66,439)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(9,709)				(9,709)
Other comprehensive income (loss)							(498)
Less: Amounts reclassified from accumulated other comprehensive loss							0
Net current-period other comprehensive income (loss)							(498)
Balance, End of Period	(10,207)						(10,207)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(40,068)				(40,068)
Other comprehensive income (loss)							24,801
Less: Amounts reclassified from accumulated other comprehensive loss							0
Net current-period other comprehensive income (loss)							24,801
Balance, End of Period	(15,267)						(15,267)
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(103,125)	(104,589)	(76,402)	(68,700)	(56,679)	(45,443)	(76,402)
Net current-period other comprehensive income (loss)	11,212	1,464	(28,187)	(18,915)	(12,021)	(11,236)
Balance, End of Period	$ (91,913)	$ (103,125)	$ (104,589)	$ (87,615)	$ (68,700)	$ (56,679)	$ (91,913)

- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

+ References + Details

COMPREHENSIVE INCOME (LOSS) - Narrative (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	$ 8,615
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	8,615
Other income (expense) \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	5,700
Interest income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	$ 2,900

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	9 Months Ended
	Sep. 30, 2020 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

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Segment Net Sales
Total Revenues	$ 370,232	$ 379,095	$ 983,221	$ 1,122,430
Segment Profit
Operating income	57,542	(20,587)	98,725	57,680
Amortization	(8,343)	(5,056)	(23,393)	(21,340)
Operating Segments
Segment Profit
Operating income	147,193	131,512	359,643	404,414
Corporate and other
Segment Profit
Operating income	(81,308)	(147,043)	(237,525)	(325,394)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	239,323	252,984	640,541	736,810
Codman Specialty Surgical \| Operating Segments
Segment Profit
Operating income	97,061	101,129	249,552	291,750
Orthopedics and Tissue Technologies
Segment Net Sales
Total Revenues	130,909	126,111	342,680	385,620
Orthopedics and Tissue Technologies \| Operating Segments
Segment Profit
Operating income	$ 50,132	$ 30,383	$ 110,091	$ 112,664

- Definition

+ References

+ Details

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Segment Reporting Information [Line Items]
Total Revenues	$ 370,232	$ 379,095	$ 983,221	$ 1,122,430
United States
Segment Reporting Information [Line Items]
Total Revenues	266,477	266,280	695,179	796,397
Europe
Segment Reporting Information [Line Items]
Total Revenues	45,995	49,242	123,917	148,753
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	40,473	42,079	113,934	114,810
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 17,287	$ 21,494	$ 50,191	$ 62,470

- Definition

+ References

+ Details

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 14,210	$ 0
Loss from change in fair value of contingent consideration liabilities	(45)
Additions from acquisition of Arkis		13,100
Balance, End of Period	14,165	13,100
Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	230
Loss from change in fair value of contingent consideration liabilities	0
Additions from acquisition of Arkis		0
Balance, End of Period	$ 230	$ 230

COMMITMENTS AND CONTINGENCIES - Narrative (Details) - Derma Sciences	9 Months Ended
	Sep. 30, 2020 USD ($) liability
Loss Contingencies [Line Items]
Number of contingent liabilities remaining \| liability	1
Contingent consideration, maximum undiscounted payment amount	$ 3,000,000.0
Contingent consideration, estimated fair value	200,000
BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration	$ 33,300,000