0000917520-21-000027 | 10-Q | XBRL Viewer | Integra Lifesciences Holdings Corp

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DOCUMENT AND ENTITY INFORMATION - shares	3 Months Ended
DOCUMENT AND ENTITY INFORMATION - shares	Mar. 31, 2021	Apr. 27, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
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)		84,549,309
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
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
	Mar. 31, 2021	Mar. 31, 2020
Income Statement [Abstract]
Total revenue, net	$ 360,071	$ 354,324
Costs and expenses:
Cost of goods sold	145,823	133,476
Research and development	22,374	20,816
Selling, general and administrative	156,633	165,952
Intangible asset amortization	4,527	6,977
Total costs and expenses	329,357	327,221
Operating income	30,714	27,103
Interest income	1,748	2,570
Interest expense	(12,929)	(17,752)
Gain from the sale of business	42,876	0
Other income (expense), net	4,869	(479)
Income before income taxes	67,278	11,442
Provision for income taxes	21,884	2,262
Net income	$ 45,394	$ 9,180
Net income per share
Basic (in dollars per share)	$ 0.54	$ 0.11
Diluted (in dollars per share)	$ 0.53	$ 0.11
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	84,500	85,188
Diluted (in shares)	85,258	85,892
Comprehensive income (loss) (See Note 14)	$ 75,826	$ (19,007)

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 408,976	$ 470,166
Trade accounts receivable, net of allowances of $6,886 and $6,439	223,542	225,532
Inventories, net	328,049	310,117
Prepaid expenses and other current assets	78,508	69,282
Assets held for sale	0	162,105
Total current assets	1,039,075	1,237,202
Property, plant and equipment, net	296,193	287,529
Right of use asset - operating leases	91,174	83,635
Intangible assets, net	1,193,681	989,436
Goodwill	1,010,072	932,367
Deferred tax assets, net	74,626	73,690
Other assets	36,733	11,277
Total assets	3,741,554	3,615,136
Current liabilities:
Current portion of borrowings under senior credit facility	45,000	33,750
Current portion of borrowings under securitization facility	110,900	112,500
Current portion of lease liability - operating leases	13,900	12,818
Accounts payable, trade	61,500	54,608
Income taxes payable	13,700	0
Contract liabilities	5,400	5,275
Accrued compensation	65,442	76,117
Accrued expenses and other current liabilities	96,459	94,194
Liabilities held for sale	0	11,751
Total current liabilities	412,301	401,013
Long-term borrowings under senior credit facility	922,672	933,387
Long-term convertible securities	562,240	474,834
Lease liability - operating leases	95,549	88,118
Deferred tax liabilities	65,282	16,190
Other liabilities	154,179	186,727
Total liabilities	2,212,223	2,100,269
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; 89,406 and 89,251 issued at March 31, 2021 and December 31, 2020, respectively	894	893
Additional paid-in capital	1,231,637	1,290,909
Treasury stock, at cost; 4,899 shares and 4,914 shares at March 31, 2021 and December 31, 2020, respectively	(234,461)	(235,141)
Accumulated other comprehensive loss	(43,627)	(74,059)
Retained earnings	574,888	532,265
Total stockholders’ equity	1,529,331	1,514,867
Total liabilities and stockholders’ equity	$ 3,741,554	$ 3,615,136

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 6,886	$ 6,439
Preferred stock, par value (in dollars per share)	$ 0	$ 0
Preferred stock, authorized shares (in shares)	15,000	15,000
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)	89,406,000	89,251,000
Treasury stock, shares (in shares)	4,899,000	4,914,000

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
OPERATING ACTIVITIES:
Net income	$ 45,394	$ 9,180
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	29,214	29,151
Non-cash impairment charges	2,754	0
Deferred income tax (benefit) provision	(1,234)	5,068
Share-based compensation	6,334	3,750
Amortization of debt issuance costs and expenses associated with debt refinancing	1,721	4,246
Non-cash lease expense	1,522	178
Accretion of bond issuance discount	0	2,529
Loss on disposal of property and equipment	(2)	374
Gain from the sale of business	(42,876)	0
Change in fair value of contingent consideration and others	281	(1,051)
Changes in assets and liabilities:
Accounts receivable	16,756	28,301
Inventories	(2,332)	(26,236)
Prepaid expenses and other current assets	(3,574)	4,683
Other non-current assets	10,419	3,000
Accounts payable, accrued expenses and other current liabilities	14,449	(40,413)
Contract liabilities	(83)	338
Other non-current liabilities	(9,662)	(2,284)
Net cash provided by operating activities	69,081	20,814
INVESTING ACTIVITIES:
Purchases of property and equipment	(6,675)	(16,519)
Proceeds from sale of Extremity Orthopedics business	191,736	0
Proceeds from sale of property and equipment	0	34
Cash (paid) provided for business acquisitions, net of cash acquired	(302,627)	0
Acquired in-process research and development	0	(5,000)
Net cash used in investing activities	(117,566)	(21,485)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	600	113,200
Payments on debt	(2,200)	(344,200)
Purchase of option hedge on convertible notes	0	(104,248)
Proceeds from convertible notes issuance	0	575,000
Proceeds from sale of stock purchase warrants	0	44,562
Payment of debt issuance costs	0	(20,264)
Purchases of treasury stock	0	(100,000)
Proceeds from exercised stock options	2,222	2,303
Cash taxes paid in net equity settlement	(3,637)	(4,348)
Net cash (used) provided by financing activities	(3,015)	162,005
Effect of exchange rate changes on cash and cash equivalents	(9,690)	(2,533)
Net increase in cash and cash equivalents	(61,190)	158,801
Cash and cash equivalents at beginning of period	470,166	198,911	$ 198,911
Cash and cash equivalents at end of period	$ 408,976	$ 357,712	$ 470,166

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	Additional Paid-In Capital Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Loss	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment
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		$ (76,401)	$ 398,573	$ (200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	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	1,341,803		$ 889	$ (202,506)	1,240,455		(104,588)	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		(76,401)	398,573	(200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accelerated shares repurchased (in shares)	(2,100,000)
Balance End of Period, Shares (in shares) at Dec. 31, 2020			89,251,000
Balance, End of Period at Dec. 31, 2020	$ 1,514,867	$ (66,046)	$ 893	$ (235,141)	1,290,908	$ (63,274)	(74,059)	532,266	$ (2,772)
Balance, End of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2020	(4,914,000)			(4,914,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	iart:AccountingStandardsUpdate202006Member
Net income	$ 45,394							45,394
Other comprehensive income (loss), net of tax	30,432						30,432
Issuance of common stock through employee stock purchase plan (in shares)			18,000
Issuance of common stock through employee stock purchase plan	1,127				1,127
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			137,000	15,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(2,541)		$ 1	$ 680	(3,222)
Share-based compensation	6,098				6,098
Balance End of Period, Shares (in shares) at Mar. 31, 2021			89,406,000
Balance, End of Period at Mar. 31, 2021	$ 1,529,331		$ 894	$ (234,461)	$ 1,231,637		$ (43,627)	$ 574,888
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2021	(4,899,000)			(4,899,000)

BASIS OF PRESENTATION

3 Months Ended

Mar. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

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 March 31, 2021 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, 2020 included in the Company’s Annual Report on Form 10-K. The December 31, 2020 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 month period ended March 31, 2021 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 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.

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. During the beginning of 2020, 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. Towards the end of 2020 and during the first quarter of 2021, 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. During the first quarter of 2021, the Company's revenues were still impacted due to COVID-19 resurgences and lower surgical procedural volumes, though not to the levels seen in early 2020. As a result, the Company has continued to manage its operating costs in this environment. 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.

Recent Accounting Pronouncements

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 became 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 COVID-19 pandemic, and other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact due to customer and governmental responses 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. This 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 is effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption was permitted. The Company adopted this guidance during the year ended December 31, 2020. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures.

In August 2018, the FASB issued ASU No. 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under this 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 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 intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. This 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. The Company adopted ASU No. 2019-12 as of January 1, 2021. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The adoption of this guidance did not have a material impact on the Company's results or financial position.

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 London Inter-Bank Offered Rate ("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. In January 2021, the FASB also issued ASU 2021-01, Reference Rate Reform- Scope which clarified certain optional expedients and exceptions to entities that are affected because of the reference rate reform. The amendments in this ASU affect the guidance in ASU No. 2020-04 and are effective in the same timeframe as ASU No. 2020-04. 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 using either the modified retrospective or full retrospective method.

As detailed in Note 6 – Debt, 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 are subject to the guidance included in ASU 2020-06. The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts:


ADJUSTMENT	CONSOLIDATED BALANCE SHEET CLASSIFICATION	AMOUNT (in millions)
Deferred tax impact of cumulative-effect adjustment	Deferred tax liabilities	$	(20.6)
Debt discount reclassification	Long-term convertible securities	89.1
Equity issuance costs reclassification	Long-term convertible securities	(2.5)
Debt discount amortization and equity costs reclassification, net of tax	Retained Earnings	(2.8)
Net impact of cumulative-effect adjustment	Additional paid-in capital	(63.3)

Upon adoption of this ASU No. 2020-06, the Company’s Convertible Senior Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its convertible senior notes to be settled in cash and any excess in shares. Following the irrevocable notice, only the amounts settled in excess of the principal will be considered in diluted earnings per share under the “if-converted” method. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount, therefore the interest expense for the 2025 Notes, which is included in the interest expense on the consolidated statements of operations and comprehensive loss, is lower as compared to the fiscal year of 2020.

In October 2020, the FASB issued ASU 2020-10, Codification Improvements, which updates various codification topics by clarifying or improving disclosure requirements to align with the SEC’s regulations. The ASU will be effective for the Company for annual and interim periods beginning after beginning January 1, 2021. The Company adopted this standard on the January 1, 2021. The adoption of this guidance did not have a material impact on the Company's results, financial position or 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.

ACQUISITIONS AND DIVESTITURES

3 Months Ended

Mar. 31, 2021

Mergers, Acquisitions and Dispositions [Abstract]

ACQUISITIONS AND DIVESTITURES

Sale of Extremity Orthopedics Business

On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business to Smith & Nephew USD Limited ("Smith & Nephew"). The transaction included the sale of the Company's upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. The Company received an aggregate purchase price of $240.0 million from Smith and Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO") effectively terminating the licensing agreement between Integra and CFO relating to the development of shoulder arthroplasty products.

Assets and liabilities divested consisted of the following as of December 31, 2020 (amounts in thousands):


Prepaid expenses and other current assets	$	713
Right of use asset-operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	$	162,104
Other liabilities	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$	11,751

The Divestiture does not represent a strategic shift that will have a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method of the Extremity Orthopedics business to the Company's Tissue Technologies reporting unit. The Company recognized a gain of $42.9 million in connection with the sale that is presented in Gain from the sale of business in the consolidated statement of operations for the three months ended March 31, 2021. The net proceeds are subject to adjustments based on changes in the actual closing net working capital.The purchase price is preliminary pending finalization of potential working capital adjustments.

The Company also entered into a transition services agreement ("TSA") with Smith & Nephew which requires the Company to provide certain services on behalf of Smith & Nephew for the duration of the period subsequent to the sale of the business as defined in the agreement. The Company recognized a payable due to Smith & Nephew of $9.0 million, included in the consolidated balance sheet within accrued expenses and other current liabilities respectively.

ACell Inc. Acquisition

On January 20, 2021, the Company acquired ACell Inc. (the "ACell Acquisition") for an acquisition purchase price of $305.4 million plus contingent consideration of up to $100 million, that may be payable upon achieving certain revenue-based performance milestones in 2022, 2023 and 2025. The purchase price is subject to adjustments based on changes in the actual closing net working capital. The consideration is preliminary pending finalization of potential working capital adjustments. ACell was a privately-held company that offered a portfolio of regenerative products for complex wound management, including developing and commercializing products based on MatriStem Urinary Bladder Matrix ("UBM"), a technology platform derived from porcine urinary bladder extracellular matrix.

Assets Acquired and Liabilities Assumed at Fair Value

The ACell Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination are recognized at their fair values as of the acquisition date. As of March 31, 2021, certain amounts relating to the valuation of intangible assets and tax related matters have not been finalized. The finalization of these matters may result in changes to goodwill.

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


	Preliminary Valuation		Weighted Average Life
	(In thousands)
Current assets:
Cash	$	2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaids expenses and other current assets	1,498
Total current assets	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000		13-14 years
Goodwill	92,983
Right of use asset - operating leases	9,259
Deferred tax assets	9,768
Other assets	148
Total assets acquired	409,919

Current liabilities:
Accounts payable	$	718
Accrued expenses	6,227
Current portion of lease liability - operating leases	1,673
Total current liabilities	8,618
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	64,178
Contingent consideration	23,900
Total liabilities assumed	104,557

Net assets acquired	$	305,362

Intangible Assets

The estimated fair value of the developed technology acquired was determined using the multi-period excess earnings method of the income approach, which estimates value based on the present value of future economic benefits. 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 product including net revenues, cost of sales, R&D costs, selling and marketing costs, working capital, and 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 8.5% 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 ACell Acquisition to the Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

Contingent Consideration

As part of the acquisition, the Company is required to pay the former shareholders of ACell up to $100 million based on the achievement of certain revenue-based performance milestones in 2022, 2023, and 2025. The Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration that considered the possible outcomes of

scenarios related to each specific milestone. The Company estimated the fair value of the contingent consideration to be $23.9 million at the acquisition date.

The Company determines the acquisition date fair value of contingent consideration obligations using a Monte Carlo simulation, as well as significant unobservable inputs, reflecting the Company’s assessment of the assumptions market participants would use to value these liabilities. 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 most likely payouts are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligation will be revalued to estimated fair value and changes in fair value will be reflected as income or expense in our consolidated statement of operations. Changes in the fair value of the contingent considerations may result from changes in discount periods and rates and changes in the timing and amount of revenue estimates. Adverse changes in assumptions utilized in the contingent consideration fair value estimates could result in an increase in the contingent consideration obligation and a corresponding charge to operating results.

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.

Pro forma revenues for the three months ended March 31, 2021 and 2020 were $364.7 million and $377.3 million, respectively. Pro forma net income and earnings per share are not presented for this acquisition as they are not material.

REVENUES FROM CONTRACTS WITH CUSTOMERS

3 Months Ended

Mar. 31, 2021

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.

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 three months ended March 31, 2021:




Contract Asset
Contract asset, January 1, 2021	$	7,430
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(7,430)
Contract asset, net of transferred to trade receivables on contracts during the period	6,499
Contract asset, March 31, 2021	$	6,499

Contract Liability
Contract liability, January 1, 2021	$	11,961

Recognition of revenue included in beginning of year contract liability	(1,677)
Contract liability, net of revenue recognized on contracts during the period	1,604
Foreign currency translation	(22)
Contract liability, March 31, 2021	11,866

At March 31, 2021, the short-term portion of the contract liability of $5.4 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 March 31, 2021, the Company is expected to recognize approximately 46% of unsatisfied (or partially unsatisfied) performance obligations as revenue through 2021, with the remaining balance to be recognized in 2022 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 months ended March 31, 2021 and 2020 (amounts in thousands):


	Three Months Ended March 31, 2021		Three Months Ended March 31, 2020

Neurosurgery	$	189,254	$	184,943
Instruments	51,987		46,497
Total Codman Specialty Surgical	241,241		231,440

Wound Reconstruction and Care(2)	88,698		72,267
Extremity Orthopedics(1)	—		21,472
Private Label	30,132		29,145
Total Tissue Technologies	118,830		122,884
Total revenue	$	360,071	$	354,324

(1) On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business to Smith & Nephew USD Limited. In conjunction with the sale of this business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021. See Note 2. Acquisitions and Divestitures, for details.

(2) On January 20, 2021, the Company acquired ACell Inc. for an acquisition purchase price of $305.4 million plus contingent consideration of up to $100 million, that may be payable upon achieving certain revenue-based performance milestones in 2022, 2023 and 2025.See Note 2. Acquisitions and Divestitures, for details.

See Note 15, 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)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130556-203045

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
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-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

3 Months Ended

Mar. 31, 2021

Inventory Disclosure [Abstract]

INVENTORIES

Inventories, net consisted of the following:


	March 31, 2021		December 31, 2020
	(In thousands)
Finished goods	$	191,712	$	180,301
Work in process	57,173		53,336
Raw materials	79,164		$	76,480


Total inventories, net	$	328,049	$	310,117

At December 31, 2020, $52.8 million of inventories, net was presented separately as "Assets held for sale" in conjunction with the sale of the Extremity Orthopedics business. Further, the increase in inventory at March 31, 2021 as compared to the year ended December 31, 2020, was primarily driven from the inventory acquired in conjunction with the ACell Inc. acquisition. See Note 2, Acquisitions and Divestitures, for details.

GOODWILL AND OTHER INTANGIBLE ASSETS

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the three-month period ended March 31, 2021 were as follows:


	Codman Specialty Surgical		Tissue Technologies		Total
	(In thousands)


Goodwill at December 31, 2020	$	671,975	$	260,392	$	932,367



ACell Acquisition	—		92,983		92,983



Foreign currency translation	(10,013)		(5,265)		(15,278)
Goodwill at March 31, 2021	$	661,962	$	348,110	$	1,010,072

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


	March 31, 2021
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	18 years	1,120,918	(257,360)	863,558
Customer relationships	12 years	212,332	(134,794)	77,538
Trademarks/brand names	28 years	98,533	(28,862)	69,671
Codman tradename	Indefinite	165,091	—	165,091
Supplier relationships	30 years	30,211	(15,447)	14,764
All other	10 years	6,813	(3,754)	3,059


		1,633,898	(440,217)	1,193,681


	December 31, 2020
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	19 years	896,478	(248,088)	648,390
Customer relationships	12 years	213,270	(132,838)	80,432
Trademarks/brand names	28 years	104,209	(31,767)	72,442
Codman tradename	Indefinite	170,226	—	170,226
Supplier relationships	27 years	30,211	(15,203)	15,008
All other (1)	4 years	6,693	(3,755)	2,938
		1,421,087	(431,651)	989,436

(1)Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.

The increase in the Company's identifiable intangible assets at March 31, 2021 as compared to the year ended December 31, 2020, was primarily driven from intangible assets acquired in conjunction with the ACell Inc. acquisition. See Note 2, Acquisitions and Divestitures, for details.

Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of product revenues) is expected to be approximately $60.7 million for the remainder of 2021, $78.8 million in 2022, $78.0 million in 2023, $77.3 million in 2024, $77.3 million in 2025, $77.2 million in 2026 and $582.7 million thereafter.

DEBT

3 Months Ended

Mar. 31, 2021

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 March 31, 2021, 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 March 31, 2021 and December 31, 2020, there was $97.5 million outstanding under the revolving credit component of the Senior Credit Facility at weighted average interest rates of 1.5%. At March 31, 2021 and December 31, 2020, there was $877.5 million outstanding under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 1.5%. At March 31, 2021, $45.0 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 March 31, 2021 were $98.5 million and $884.9 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 March 31, 2021 and December 31, 2020 totaled $1.6 million. There were no amounts drawn as of March 31, 2021.

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


Quarter Ended March 31, 2021	Principal Repayment
	(In thousands)




Remainder of 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. The effective interest rate implicit in the liability component was 4.2%. In connection with this offering, the Company capitalized $13.2 million of financing fees.

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 March 31, 2021, none of these conditions existed with respect to the 2025 Notes and as a result the 2025 Notes are classified as long term.

On December 9, 2020, the Company entered into the First Supplemental Indenture to the original agreement dated as of February 4, 2020 between the Company and Citibank, N.A., as trustee, governing the Company’s outstanding 2025 Notes. The Company irrevocably elected (1) to eliminate the Company’s option to choose physical settlement on any conversion of the 2025 Notes that occurs on or after the date of the First Supplemental Indenture and (2) with respect to any Combination Settlement for a conversion of the 2025 Notes, the Specified Dollar Amount that will be settled in cash per $1,000 principal amount of the 2025 Notes shall be no lower than $1,000.

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.

At December 31, 2020, the carrying amount of the liability component was $485.9 million, the remaining unamortized discount was $89.1 million, and the principal amount outstanding was $575.0 million. On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. At March 31, 2021, in conjunction with the adoption of the ASU, the carrying amount of the liability was $575.0 million. The fair value of the 2025 Notes at March 31, 2021 was $642.1 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quote. The level of the 2025 Notes is considered as Level 1.

During the three months ended March 31, 2020, the Company recognized cash interest of $0.4 million and amortization of the discount on the liability component of $2.5 million for a total interest charge of $2.9 million on the 2020 Notes. On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. During the three months ended March 31, 2021, as a result of the adoption of the ASU, the Company recognized only cash interest related to the contractual interest coupon of $0.7 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 March 31, 2021, the Company was in compliance with the covenants and none of the termination events had occurred. At March 31, 2021 and December 31, 2020, the Company had $110.9 million and $112.5 million, respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 1.3%. At March 31, 2021, the total amount outstanding under the Securitization Facility is classified as current on the consolidated balance sheet as the total amount is due on December 21, 2021.

The fair value of the outstanding borrowing of the Securitization Facility at March 31, 2021 was $110.8 million. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly, and are other than active market observable inputs that reflect unadjusted quoted prices for identical assets or liabilities.

DERIVATIVE INSTRUMENTS

3 Months Ended

Mar. 31, 2021

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 March 31, 2021 and December 31, 2020 (dollar amounts in thousands):


								March 31, 2021		December 31, 2020
Hedged Item	Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Asset (Liability)
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(463)		(929)
1-month USD LIBOR Loan	300,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(10,526)		(12,557)

1-month USD LIBOR Loan	150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(9,413)		(11,502)

1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(12,293)		(16,243)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(7,842)		(9,836)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(7,805)		(9,826)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(7,849)		(9,783)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(6,037)		(10,407)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(5,826)		(10,431)
1-month USD LIBOR Loan	575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	11,810		(1,907)
1-month USD LIBOR Loan	125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	2,697		(348)



Total interest rate derivatives designated as cash flow hedge	$	1,875,000						$	(53,547)	$	(93,769)

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. Those amounts are subsequently reclassified to earnings from AOCL as impacted by the hedged item when the hedged item affects 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, net in the consolidated statements of operation, along with the offsetting foreign currency gain or loss on the underlying assets or liabilities.

During the fourth quarter of 2020, the Company entered into foreign currency forward contracts, with a notional amount of $9.7 million to mitigate the foreign exchange risk related to certain intercompany loans denominated in Canadian Dollar ("CAD") and intercompany receivables denominated in Japanese Yen ("JPY"). The contracts are not designated as hedging instruments. The Company recognized a $0.2 million loss from the change in fair value of the contracts, which was included in other income, net in the consolidated statement of operations as of March 31, 2021. The Company subsequently settled its foreign currency forward contracts associated with the intercompany receivables denominated in JPY during the first quarter of 2021. The fair value of the foreign currency forward contracts denominated in CAD was $0.2 million as of March 31, 2021.

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 Swiss Francs ("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.

On December 21, 2020, the Company entered into cross-currency swap agreements to convert a notional amount of $471.6 million equivalent to 420.1 million of a CHF denominated intercompany loan into U.S. dollars. The CHF denominated intercompany loan was the result of an intra-entity transfer of certain intellectual property rights to a subsidiary in Switzerland completed during the fourth quarter of 2020. The intercompany loan requires quarterly payments of CHF 5.8 million plus accrued interest. As a result, the aggregate notional amount of the related cross-currency swaps will decrease by a corresponding amount.

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 March 31, 2021 and December 31, 2020 (dollar amounts in thousands):


					March 31, 2021	December 31, 2020	March 31, 2021		December 31, 2020
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)










Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	48,533	(955)		(4,335)
Receive U.S.$			4.46%	$	50,000	50,000







Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	145,598	(868)		(11,262)
Receive U.S.$			4.52%	$	150,000	150,000

Pay CHF	December 21, 2020	December 20, 2025	3.00%	CHF	414,387	420,137	17,314		(7,843)
Receive U.S.$			3.98%	$	465,185	471,640

Total							$	15,491	$	(23,441)

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 months ended March 31, 2021 and 2020, the Company recorded a gain of $42.9 million and a loss of $1.7 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gains or losses recognized on the intercompany loans.

For the three months ended March 31, 2021 and 2020, the Company recorded gains of $40.2 million and $5.9 million in AOCL, respectively, related to change in fair value of the cross-currency swaps.

For the three months ended March 31, 2021 and 2020, the Company recorded gains of $1.3 million and $1.5 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 March 31, 2021 within the next twelve months is $9.1 million. As of March 31, 2021, 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 and December 16, 2020, 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 March 31, 2021 and December 31, 2020, respectively (dollar amounts in thousands):


						March 31, 2021		December 31, 2020
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—%	EUR	44,859	$	(9)	$	(1,884)
Receive U.S.$			3.01%	$	52,000

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	1,707		(450)
Receive U.S.$			2.57%	$	60,000

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	1,096		92
Receive U.S.$			2.19%	$	45,000







Pay CHF	December 16, 2020	December 16, 2027	—%	CHF	222,300	3,033		(3,794)
Receive U.S.$			1.10%	$	250,000

Total						$	5,827	$	(6,036)

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 months ended March 31, 2021 and 2020, the Company recorded gains of $11.9 million and $16.7 million in AOCL related to the change in fair value of the cross-currency swaps.

For the three months ended March 31, 2021 and 2020, the Company recorded gains of $1.7 million and $2.2 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated gain that is expected to be reclassified to interest income from AOCL as of March 31, 2021 within the next twelve months is $5.2 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 March 31, 2021 and December 31, 2020:


	Fair Value as of
Location on Balance Sheet (1):	March 31, 2021		December 31, 2020
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges

Cross-currency swap	10,083		7,623
Net Investment Hedges
Cross-currency swap	5,209		5,297
Other assets
Cash Flow Hedges
Interest rate swap(2)	14,507		—
Cross-currency swap	10,978
Net Investment Hedges
Cross-currency swap	656		—
Total derivatives designated as hedges — Assets	$	41,433	$	12,920

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	21,337		22,033
Cross-currency swap	955		4,335
Net Investment Hedges
Cross-currency swap	10		1,884
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	46,717		71,736
Cross-currency swap	4,615		26,728
Net Investment Hedges
Cross-currency swap	28		9,449
Total derivatives designated as hedges — Liabilities	$	73,652	$	136,165

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

(2) At March 31, 2021 and December 31, 2020, the total notional amounts related to the Company’s interest rate swaps both

were $1.9 billion.

The following presents the effect of derivative instruments designated as cash flow hedges on the accompanying condensed consolidated statement of operations during the three months ended March 31, 2021 and 2020:


	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 March 31, 2021
Cash Flow Hedges
Interest rate swap	$	(93,769)	$	34,518	$	(5,705)	$	(53,546)	Interest expense
Cross-currency swap	(1,073)		40,194		44,150		(5,029)		Other income (expense),net
Net Investment Hedges
Cross-currency swap	(12,291)		13,573		1,711		(429)		Interest income
	$	(107,133)	$	88,285	$	40,156	$	(59,004)
Three Months Ended March 31, 2020
Cash Flow Hedges
Interest rate swap	$	(45,145)	$	(51,651)	$	(1,043)	$	(95,753)	Interest expense
Cross-currency swap	177		5,907		(182)		6,266		Other income (expense),net
Net Investment Hedges
Cross-currency swap	10,229		18,897		2,180		26,946		Interest income
	$	(34,739)	$	(26,847)	$	955	$	(62,541)

STOCK-BASED COMPENSATION	3 Months Ended
STOCK-BASED COMPENSATION	Mar. 31, 2021
Share-based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of March 31, 2021, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under the 2003 Equity Incentive Plan (the “2003 Plan”). The 2000 and 2001 Equity Incentive Plans were terminated as of February 19, 2021, and no further awards may be issued under the plans. Stock options issued under the 2003 Plan 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 March 31, 2021, there were approximately $7.7 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 149,558 stock options granted during the three months ended March 31, 2021. For the three months ended March 31, 2021, the weighted average grant date fair value for stock options was $22.59 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 March 31, 2021, there was approximately $42.4 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 211,262 restricted stock awards and 176,147 performance stock awards during the three months ended March 31, 2021. For the three months ended March 31, 2021, the weighted average grant date fair value for restricted stock awards and performance stock units was $68.00 and $68.10 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	3 Months Ended
RETIREMENT PLANS	Mar. 31, 2021
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 months ended March 31, 2021 were $0.6 million. The components of the net periodic benefit costs other than the service cost component of $0.8 million for the three months ended March 31, 2021, 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 months ended March 31, 2020 was $1.0 million. The components of the net periodic benefit costs other than the service cost component of $0.9 million for the three months ended March 31, 2020, are included in other income (expense), net in the consolidated statements of operations. The estimated fair values of plan assets were $32.8 million and $37.8 million as of March 31, 2021 and December 31, 2020, respectively. The net plan assets of the pension plans are invested in common trusts as of March 31, 2021 and December 31, 2020. 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 The Company maintains a Deferred Compensation Plan in which 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 Company's deferred compensation plan began to defer their compensation. This deferred compensation is invested in funds offered under this plan and is valued based on Level 1 measurements in the fair value hierarchy. 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 March 31, 2021 was $2.9 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

3 Months Ended

Mar. 31, 2021

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 March 31, 2021. 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 three months ended March 31, 2021 and March 31, 2020 was $5.3 million and $4.8 million respectively, which includes $0.1 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases were as follows:


	March 31, 2021			December 31, 2020
	(In thousands, except lease term and discount rate)

ROU assets	91,174			83,635

Current lease liabilities	13,900			12,818
Non-current lease liabilities	95,549			88,118
Total lease liabilities	$	109,449		$	100,936

Weighted average remaining lease term (in years):

Leased facilities	11.8 years			11.6 years
Leased vehicles	2.0 years			2.3 years

Weighted average discount rate:
Leased facilities	5.1		%	4.6		%
Leased vehicles	2.7		%	2.3		%

Supplemental cash flow information related to leases for the three months ended March 31, 2021 and 2020 were as follows:


	March 31, 2021		March 31, 2020
	(In thousands)		(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	3,761	$	3,229

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	9,662	$	5,808

Future minimum lease payments under operating leases at March 31, 2021 were as follows:


	Third Parties		Related Parties		Total
	(In thousands)
2021	$	11,637	$	222	$	11,859
2022	16,331		296		16,627
2023	12,949		296		13,245
2024	11,410		296		11,706
2025	10,813		296		11,109
2026	9,672		296		9,968
Thereafter	72,854		837		73,691
Total minimum lease payments	$	145,666	$	2,539	$	148,205
Less: Imputed interest					38,756
Total lease liabilities					109,449
Less: Current lease liabilities					13,900
Long-term lease liabilities					95,549

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	3 Months Ended
TREASURY STOCK	Mar. 31, 2021
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of March 31, 2021 and December 31, 2020, there were 4.9 million shares of treasury stock outstanding with a cost of $234.5 million and $235.1 million, respectively, at a weighted average cost per share of $47.86. On December 7, 2020, the Board of Directors of the Company 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 2022. The Company has $225.0 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. During the twelve months ended December 31, 2020, the Company repurchased 2.1 million shares of Integra’s common stock as part of the previous 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.

INCOME TAXES

3 Months Ended

Mar. 31, 2021

Income Tax Disclosure [Abstract]

INCOME TAXES

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


	Three Months Ended March 31,
	2021		2020





Reported tax rate	32.5	%	19.8	%

The Company’s effective income tax rates for the three months ended March 31, 2021 and 2020 were 32.5% and 19.8%, respectively. For the three months ended March 31, 2021, the primary driver of the higher tax rate is the tax impact of the gain on the sale of the business which closed during the first quarter of 2021. For the three months ended March 31, 2020, the primary drivers of the rate were lower income impacted by the COVID-19 pandemic, coupled with a $3.3 million valuation allowance on certain foreign deferred tax assets.As of March 31, 2021, 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 March 31, 2021. The Company does not anticipate the need to repatriate earnings from foreign subsidiaries as a result of the impact of the COVID-19 pandemic.

- 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 PER SHARE

3 Months Ended

Mar. 31, 2021

Earnings Per Share [Abstract]

NET INCOME PER SHARE

Basic and diluted net income per share was as follows:


	Three Months Ended March 31,
	2021		2020
	(In thousands, except per share amounts)
Basic net income per share:


Net income	$	45,394	$	9,180

Weighted average common shares outstanding	84,500		85,188



Basic net income per common share	$	0.54	$	0.11

Diluted net income per share:


Net income	$	45,394	$	9,180

Weighted average common shares outstanding — Basic	84,500		85,188
Effect of dilutive securities:


Stock options and restricted stock	758		704
Weighted average common shares for diluted earnings per share	85,258		85,892



Diluted net income per common share	$	0.53	$	0.11

Common stock of approximately 0.5 million and 0.4 million shares at March 31, 2021, and 2020, respectively that are issuable through exercise of dilutive securities were not included in the computation of diluted net income 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.

Based on the adoption of ASU 2020-06, as the principal amount of the 2025 Notes will be paid in cash and only the conversion spread is settled in shares, the Company will be utilizing the if-converted method and only includes the net number of incremental shares that would be issued upon conversion.

ACCUMULATED OTHER COMPREHENSIVE LOSS

3 Months Ended

Mar. 31, 2021

Equity [Abstract]

ACCUMULATED OTHER COMPREHENSIVE LOSS

Comprehensive loss for three months ended March 31, 2021 and 2020 was as follows:


	Three Months Ended March 31,
	2021		2020
	(In thousands)
Net income	$	45,394	$	9,180
Foreign currency translation adjustment	(6,802)		(6,813)

Change in unrealized loss on derivatives, net of tax	36,915		(21,306)
Pension liability adjustment, net of tax	319		(68)
Comprehensive income (loss), net	$	75,826	$	(19,007)

Changes in accumulated other comprehensive loss by component between December 31, 2020 and March 31, 2021 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, 2021	$	(82,249)	$	(5,105)	$	13,295	$	(74,059)
Other comprehensive income (loss)	67,776		319		(6,802)		61,293
Less: Amounts reclassified from accumulated other comprehensive loss	30,861		—		—		30,861
Net current-period other comprehensive income (loss)	36,915		319		(6,802)		30,432
Balance at March 31, 2021	$	(45,334)	$	(4,786)	$	6,493	$	(43,627)

For the three months ended March 31, 2021, the Company reclassified a loss of $33.9 million and $3.1 million from accumulated other comprehensive loss to other income (expense), net and interest income.

SEGMENT AND GEOGRAPHIC INFORMATION

3 Months Ended

Mar. 31, 2021

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 Tissue Technologies segment includes such offerings as skin and wound repair, bone grafts, and nerve and tendon repair products. In conjunction with the sale of the Extremity Orthopedics business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021.

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 months ended March 31, 2021 and 2020 are as follows :


	Three Months Ended March 31,
	2021		2020
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	241,241	$	231,440
Tissue Technologies	118,830		122,884
Total revenues	$	360,071	$	354,324
Segment Profit
Codman Specialty Surgical	$	106,778	$	87,235
Tissue Technologies	50,011		31,271
Segment profit	156,789		118,506
Amortization	(4,527)		(6,977)
Corporate and other	(121,548)		(84,426)
Operating income	$	30,714	$	27,103

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 March 31,
	2021		2020
	(In thousands)
United States	$	247,793	$	246,852
Europe	45,819		45,896
Asia Pacific	47,295		39,960
Rest of World	19,164		21,616
Total Revenues	$	360,071	$	354,324

- 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.

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+ Details

COMMITMENTS AND CONTINGENCIES

3 Months Ended

Mar. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

In consideration for certain technology, manufacturing, distribution, 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 three month period ended March 31, 2021 and March 31, 2020 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 three months ended March 31, 2021 and March 31, 2020 is as follows (in thousands):


Three Months Ended March 31, 2021	Contingent Consideration Liability Related to Acquisition of:
	Arkis				Derma Sciences		ACell Inc. (See Note 2)		Location in Financial Statements
	Short-term		Long-term		Long-term		Long-term
Balance as of January 1, 2021	$	3,415	$	11,746	$	230	$	—
Additions from acquisition of ACell	—		—		—		23,900
Loss from change in fair value of contingent consideration liabilities	17		$	265	—		—		Research and development

Balance as of March 31, 2021	$	3,432	$	12,011	$	230	$	23,900


Three Months Ended March 31, 2020	Contingent Consideration Liability Related to Acquisition of:
	Arkis		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	(1,051)		—		Research and development
Balance as of March 31, 2020	$	13,159	$	230

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. 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.

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 March 31, 2021 and March 31, 2020 was $15.4 million and $13.2 million, respectively. The Company recorded $3.4 million in accrued expenses and other current liabilities at March 31, 2021 and $12 million and $13.2 million in other liabilities at March 31, 2021 and March 31, 2020, respectively, in the consolidated balance sheet of the Company.

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 March 31, 2021 and March 31, 2020 was $0.2 million.

BASIS OF PRESENTATION (Policies)

3 Months Ended

Mar. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis Of Presentation

BASIS OF PRESENTATION

General

Recently Issued Accounting Standards

Recent Accounting Pronouncements


ADJUSTMENT	CONSOLIDATED BALANCE SHEET CLASSIFICATION	AMOUNT (in millions)
Deferred tax impact of cumulative-effect adjustment	Deferred tax liabilities	$	(20.6)
Debt discount reclassification	Long-term convertible securities	89.1
Equity issuance costs reclassification	Long-term convertible securities	(2.5)
Debt discount amortization and equity costs reclassification, net of tax	Retained Earnings	(2.8)
Net impact of cumulative-effect adjustment	Additional paid-in capital	(63.3)

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

Performance Obligations

Significant Judgments

Contract Asset and Liability

Shipping and Handling FeesThe 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

Taxes Collected from Customers

Taxes Collected from CustomersThe 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.

+ References

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+ Details

BASIS OF PRESENTATION (Tables)

3 Months Ended

Mar. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Accounting Standards Update

The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts:


ADJUSTMENT	CONSOLIDATED BALANCE SHEET CLASSIFICATION	AMOUNT (in millions)
Deferred tax impact of cumulative-effect adjustment	Deferred tax liabilities	$	(20.6)
Debt discount reclassification	Long-term convertible securities	89.1
Equity issuance costs reclassification	Long-term convertible securities	(2.5)
Debt discount amortization and equity costs reclassification, net of tax	Retained Earnings	(2.8)
Net impact of cumulative-effect adjustment	Additional paid-in capital	(63.3)

ACQUISITIONS AND DIVESTITURES (Tables)

3 Months Ended

Mar. 31, 2021

Mergers, Acquisitions and Dispositions [Abstract]

Disposal Groups, Including Discontinued Operations

Assets and liabilities divested consisted of the following as of December 31, 2020 (amounts in thousands):


Prepaid expenses and other current assets	$	713
Right of use asset-operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	$	162,104
Other liabilities	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$	11,751

Schedule of Assets Acquired and Liabilities Assumed

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


	Preliminary Valuation		Weighted Average Life
	(In thousands)
Current assets:
Cash	$	2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaids expenses and other current assets	1,498
Total current assets	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000		13-14 years
Goodwill	92,983
Right of use asset - operating leases	9,259
Deferred tax assets	9,768
Other assets	148
Total assets acquired	409,919

Current liabilities:
Accounts payable	$	718
Accrued expenses	6,227
Current portion of lease liability - operating leases	1,673
Total current liabilities	8,618
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	64,178
Contingent consideration	23,900
Total liabilities assumed	104,557

Net assets acquired	$	305,362

- 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

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

3 Months Ended

Mar. 31, 2021

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 three months ended March 31, 2021:




Contract Asset
Contract asset, January 1, 2021	$	7,430
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(7,430)
Contract asset, net of transferred to trade receivables on contracts during the period	6,499
Contract asset, March 31, 2021	$	6,499

Contract Liability
Contract liability, January 1, 2021	$	11,961

Recognition of revenue included in beginning of year contract liability	(1,677)
Contract liability, net of revenue recognized on contracts during the period	1,604
Foreign currency translation	(22)
Contract liability, March 31, 2021	11,866

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three months ended March 31, 2021 and 2020 (amounts in thousands):


	Three Months Ended March 31, 2021		Three Months Ended March 31, 2020

Neurosurgery	$	189,254	$	184,943
Instruments	51,987		46,497
Total Codman Specialty Surgical	241,241		231,440

Wound Reconstruction and Care(2)	88,698		72,267
Extremity Orthopedics(1)	—		21,472
Private Label	30,132		29,145
Total Tissue Technologies	118,830		122,884
Total revenue	$	360,071	$	354,324

INVENTORIES (Tables)

3 Months Ended

Mar. 31, 2021

Inventory Disclosure [Abstract]

Schedule of Inventories, Net

Inventories, net consisted of the following:


	March 31, 2021		December 31, 2020
	(In thousands)
Finished goods	$	191,712	$	180,301
Work in process	57,173		53,336
Raw materials	79,164		$	76,480


Total inventories, net	$	328,049	$	310,117

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill for the three-month period ended March 31, 2021 were as follows:


	Codman Specialty Surgical		Tissue Technologies		Total
	(In thousands)


Goodwill at December 31, 2020	$	671,975	$	260,392	$	932,367



ACell Acquisition	—		92,983		92,983



Foreign currency translation	(10,013)		(5,265)		(15,278)
Goodwill at March 31, 2021	$	661,962	$	348,110	$	1,010,072

Schedule of Finite-Lived Intangible Assets

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


	March 31, 2021
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	18 years	1,120,918	(257,360)	863,558
Customer relationships	12 years	212,332	(134,794)	77,538
Trademarks/brand names	28 years	98,533	(28,862)	69,671
Codman tradename	Indefinite	165,091	—	165,091
Supplier relationships	30 years	30,211	(15,447)	14,764
All other	10 years	6,813	(3,754)	3,059


		1,633,898	(440,217)	1,193,681


	December 31, 2020
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	19 years	896,478	(248,088)	648,390
Customer relationships	12 years	213,270	(132,838)	80,432
Trademarks/brand names	28 years	104,209	(31,767)	72,442
Codman tradename	Indefinite	170,226	—	170,226
Supplier relationships	27 years	30,211	(15,203)	15,008
All other (1)	4 years	6,693	(3,755)	2,938
		1,421,087	(431,651)	989,436

(1)Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.

Schedule of Indefinite-Lived Intangible Assets

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


	March 31, 2021
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	18 years	1,120,918	(257,360)	863,558
Customer relationships	12 years	212,332	(134,794)	77,538
Trademarks/brand names	28 years	98,533	(28,862)	69,671
Codman tradename	Indefinite	165,091	—	165,091
Supplier relationships	30 years	30,211	(15,447)	14,764
All other	10 years	6,813	(3,754)	3,059


		1,633,898	(440,217)	1,193,681


	December 31, 2020
	Weighted Average Life	Cost	Accumulated Amortization	Net
	(Dollars in thousands)
Completed technology	19 years	896,478	(248,088)	648,390
Customer relationships	12 years	213,270	(132,838)	80,432
Trademarks/brand names	28 years	104,209	(31,767)	72,442
Codman tradename	Indefinite	170,226	—	170,226
Supplier relationships	27 years	30,211	(15,203)	15,008
All other (1)	4 years	6,693	(3,755)	2,938
		1,421,087	(431,651)	989,436

(1)Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.

DEBT (Tables)

3 Months Ended

Mar. 31, 2021

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 March 31, 2021	Principal Repayment
	(In thousands)




Remainder of 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.

+ References

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+ Details

DERIVATIVE INSTRUMENTS (Tables)

3 Months Ended

Mar. 31, 2021

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following interest rate swaps as of March 31, 2021 and December 31, 2020 (dollar amounts in thousands):


								March 31, 2021		December 31, 2020
Hedged Item	Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
								Asset (Liability)
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(463)		(929)
1-month USD LIBOR Loan	300,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(10,526)		(12,557)

1-month USD LIBOR Loan	150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(9,413)		(11,502)

1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(12,293)		(16,243)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(7,842)		(9,836)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(7,805)		(9,826)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(7,849)		(9,783)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(6,037)		(10,407)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(5,826)		(10,431)
1-month USD LIBOR Loan	575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	11,810		(1,907)
1-month USD LIBOR Loan	125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	2,697		(348)



Total interest rate derivatives designated as cash flow hedge	$	1,875,000						$	(53,547)	$	(93,769)

The Company held the following cross-currency rate swaps as of March 31, 2021 and December 31, 2020 (dollar amounts in thousands):


					March 31, 2021	December 31, 2020	March 31, 2021		December 31, 2020
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)










Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	48,533	(955)		(4,335)
Receive U.S.$			4.46%	$	50,000	50,000







Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	145,598	(868)		(11,262)
Receive U.S.$			4.52%	$	150,000	150,000

Pay CHF	December 21, 2020	December 20, 2025	3.00%	CHF	414,387	420,137	17,314		(7,843)
Receive U.S.$			3.98%	$	465,185	471,640

Total							$	15,491	$	(23,441)

The Company held the following cross-currency rate swaps designated as net investment hedges as of March 31, 2021 and December 31, 2020, respectively (dollar amounts in thousands):


						March 31, 2021		December 31, 2020
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—%	EUR	44,859	$	(9)	$	(1,884)
Receive U.S.$			3.01%	$	52,000

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	1,707		(450)
Receive U.S.$			2.57%	$	60,000

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	1,096		92
Receive U.S.$			2.19%	$	45,000







Pay CHF	December 16, 2020	December 16, 2027	—%	CHF	222,300	3,033		(3,794)
Receive U.S.$			1.10%	$	250,000

Total						$	5,827	$	(6,036)

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 March 31, 2021 and December 31, 2020:


	Fair Value as of
Location on Balance Sheet (1):	March 31, 2021		December 31, 2020
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges

Cross-currency swap	10,083		7,623
Net Investment Hedges
Cross-currency swap	5,209		5,297
Other assets
Cash Flow Hedges
Interest rate swap(2)	14,507		—
Cross-currency swap	10,978
Net Investment Hedges
Cross-currency swap	656		—
Total derivatives designated as hedges — Assets	$	41,433	$	12,920

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	21,337		22,033
Cross-currency swap	955		4,335
Net Investment Hedges
Cross-currency swap	10		1,884
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	46,717		71,736
Cross-currency swap	4,615		26,728
Net Investment Hedges
Cross-currency swap	28		9,449
Total derivatives designated as hedges — Liabilities	$	73,652	$	136,165

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

(2) At March 31, 2021 and December 31, 2020, the total notional amounts related to the Company’s interest rate swaps both

were $1.9 billion.

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 March 31, 2021
Cash Flow Hedges
Interest rate swap	$	(93,769)	$	34,518	$	(5,705)	$	(53,546)	Interest expense
Cross-currency swap	(1,073)		40,194		44,150		(5,029)		Other income (expense),net
Net Investment Hedges
Cross-currency swap	(12,291)		13,573		1,711		(429)		Interest income
	$	(107,133)	$	88,285	$	40,156	$	(59,004)
Three Months Ended March 31, 2020
Cash Flow Hedges
Interest rate swap	$	(45,145)	$	(51,651)	$	(1,043)	$	(95,753)	Interest expense
Cross-currency swap	177		5,907		(182)		6,266		Other income (expense),net
Net Investment Hedges
Cross-currency swap	10,229		18,897		2,180		26,946		Interest income
	$	(34,739)	$	(26,847)	$	955	$	(62,541)

- 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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-Name Accounting Standards Codification
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+ Details

LEASES AND RELATED PARTY LEASES (Tables)

3 Months Ended

Mar. 31, 2021

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases were as follows:


	March 31, 2021			December 31, 2020
	(In thousands, except lease term and discount rate)

ROU assets	91,174			83,635

Current lease liabilities	13,900			12,818
Non-current lease liabilities	95,549			88,118
Total lease liabilities	$	109,449		$	100,936

Weighted average remaining lease term (in years):

Leased facilities	11.8 years			11.6 years
Leased vehicles	2.0 years			2.3 years

Weighted average discount rate:
Leased facilities	5.1		%	4.6		%
Leased vehicles	2.7		%	2.3		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases for the three months ended March 31, 2021 and 2020 were as follows:


	March 31, 2021		March 31, 2020
	(In thousands)		(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	3,761	$	3,229

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	9,662	$	5,808

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at March 31, 2021 were as follows:


	Third Parties		Related Parties		Total
	(In thousands)
2021	$	11,637	$	222	$	11,859
2022	16,331		296		16,627
2023	12,949		296		13,245
2024	11,410		296		11,706
2025	10,813		296		11,109
2026	9,672		296		9,968
Thereafter	72,854		837		73,691
Total minimum lease payments	$	145,666	$	2,539	$	148,205
Less: Imputed interest					38,756
Total lease liabilities					109,449
Less: Current lease liabilities					13,900
Long-term lease liabilities					95,549

INCOME TAXES (Tables)

3 Months Ended

Mar. 31, 2021

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 March 31,
	2021		2020





Reported tax rate	32.5	%	19.8	%

NET INCOME PER SHARE (Tables)

3 Months Ended

Mar. 31, 2021

Earnings Per Share [Abstract]

Basic and Diluted Net Income (Loss) Per Share

Basic and diluted net income per share was as follows:


	Three Months Ended March 31,
	2021		2020
	(In thousands, except per share amounts)
Basic net income per share:


Net income	$	45,394	$	9,180

Weighted average common shares outstanding	84,500		85,188



Basic net income per common share	$	0.54	$	0.11

Diluted net income per share:


Net income	$	45,394	$	9,180

Weighted average common shares outstanding — Basic	84,500		85,188
Effect of dilutive securities:


Stock options and restricted stock	758		704
Weighted average common shares for diluted earnings per share	85,258		85,892



Diluted net income per common share	$	0.53	$	0.11

ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)

3 Months Ended

Mar. 31, 2021

Equity [Abstract]

Schedule of Comprehensive Income (Loss)

Comprehensive loss for three months ended March 31, 2021 and 2020 was as follows:


	Three Months Ended March 31,
	2021		2020
	(In thousands)
Net income	$	45,394	$	9,180
Foreign currency translation adjustment	(6,802)		(6,813)

Change in unrealized loss on derivatives, net of tax	36,915		(21,306)
Pension liability adjustment, net of tax	319		(68)
Comprehensive income (loss), net	$	75,826	$	(19,007)

Schedule of Changes in Accumulated Other Comprehensive Loss by Component

Changes in accumulated other comprehensive loss by component between December 31, 2020 and March 31, 2021 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, 2021	$	(82,249)	$	(5,105)	$	13,295	$	(74,059)
Other comprehensive income (loss)	67,776		319		(6,802)		61,293
Less: Amounts reclassified from accumulated other comprehensive loss	30,861		—		—		30,861
Net current-period other comprehensive income (loss)	36,915		319		(6,802)		30,432
Balance at March 31, 2021	$	(45,334)	$	(4,786)	$	6,493	$	(43,627)

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

3 Months Ended

Mar. 31, 2021

Segment Reporting [Abstract]

Schedule of Net Sales and Profit by Segments

Net sales and profit by each reportable segment for the three months ended March 31, 2021 and 2020 are as follows :


	Three Months Ended March 31,
	2021		2020
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	241,241	$	231,440
Tissue Technologies	118,830		122,884
Total revenues	$	360,071	$	354,324
Segment Profit
Codman Specialty Surgical	$	106,778	$	87,235
Tissue Technologies	50,011		31,271
Segment profit	156,789		118,506
Amortization	(4,527)		(6,977)
Corporate and other	(121,548)		(84,426)
Operating income	$	30,714	$	27,103

Total revenue by major geographic area consisted of the following:


	Three Months Ended March 31,
	2021		2020
	(In thousands)
United States	$	247,793	$	246,852
Europe	45,819		45,896
Asia Pacific	47,295		39,960
Rest of World	19,164		21,616
Total Revenues	$	360,071	$	354,324

Schedule of Geographic Revenue by Area

Net sales and profit by each reportable segment for the three months ended March 31, 2021 and 2020 are as follows :


	Three Months Ended March 31,
	2021		2020
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	241,241	$	231,440
Tissue Technologies	118,830		122,884
Total revenues	$	360,071	$	354,324
Segment Profit
Codman Specialty Surgical	$	106,778	$	87,235
Tissue Technologies	50,011		31,271
Segment profit	156,789		118,506
Amortization	(4,527)		(6,977)
Corporate and other	(121,548)		(84,426)
Operating income	$	30,714	$	27,103

Total revenue by major geographic area consisted of the following:


	Three Months Ended March 31,
	2021		2020
	(In thousands)
United States	$	247,793	$	246,852
Europe	45,819		45,896
Asia Pacific	47,295		39,960
Rest of World	19,164		21,616
Total Revenues	$	360,071	$	354,324

COMMITMENTS AND CONTINGENCIES (Tables)

3 Months Ended

Mar. 31, 2021

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 three months ended March 31, 2021 and March 31, 2020 is as follows (in thousands):


Three Months Ended March 31, 2021	Contingent Consideration Liability Related to Acquisition of:
	Arkis				Derma Sciences		ACell Inc. (See Note 2)		Location in Financial Statements
	Short-term		Long-term		Long-term		Long-term
Balance as of January 1, 2021	$	3,415	$	11,746	$	230	$	—
Additions from acquisition of ACell	—		—		—		23,900
Loss from change in fair value of contingent consideration liabilities	17		$	265	—		—		Research and development

Balance as of March 31, 2021	$	3,432	$	12,011	$	230	$	23,900


Three Months Ended March 31, 2020	Contingent Consideration Liability Related to Acquisition of:
	Arkis		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	(1,051)		—		Research and development
Balance as of March 31, 2020	$	13,159	$	230

BASIS OF PRESENTATION - Narrative (Details) - 2025 Notes $ in Thousands	Feb. 04, 2020 USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Convertible debt	$ 575,000
Convertible Debt
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Convertible notes, interest rate	0.50%

BASIS OF PRESENTATION - Adoption of 2020-06 (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
New Accounting Pronouncement, Early Adoption [Line Items]
Deferred tax liabilities	$ 65,282	$ 16,190
Long-term convertible securities	562,240	474,834
Retained earnings	$ 574,888	532,265
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncement, Early Adoption [Line Items]
Deferred tax liabilities		(20,600)
Retained earnings		(2,800)
Additional paid-in capital		(63,300)
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Reclassification
New Accounting Pronouncement, Early Adoption [Line Items]
Long-term convertible securities		89,100
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Amortization and Equity Costs Reclassification
New Accounting Pronouncement, Early Adoption [Line Items]
Long-term convertible securities		$ (2,500)

ACQUISITIONS AND DIVESTITURES - Divestitures, Narrative (Details) - USD ($) $ in Thousands		3 Months Ended
	Jan. 04, 2021	Mar. 31, 2021	Mar. 31, 2020
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain from the sale of business		$ 42,876	$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Extremity Orthopedics
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of Extremity Orthopedics business, disposition price	$ 240,000
Gain from the sale of business		$ 42,900
Transitional supply agreement, payable	9,000
Consortium of Focused Orthopedists, LLC \| Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Extremity Orthopedics
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payment related to contract termination	$ 41,500

ACQUISITIONS AND DIVESTITURES - Assets and Liabilities Divested (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - Extremity Orthopedics $ in Thousands	Dec. 31, 2020 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Prepaid expenses and other current assets	$ 713
Right of use asset-operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	162,104
Other liabilities	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$ 11,751

ACQUISITIONS AND DIVESTITURES- Business Combination, Narrative (Details) - ACell, Inc. - USD ($)		3 Months Ended
	Jan. 20, 2021	Mar. 31, 2021	Mar. 31, 2020
Business Acquisition [Line Items]
Payments to acquire businesses, gross	$ 305,400,000
Contingent consideration, maximum undiscounted payment amount	$ 100,000,000	$ 100,000,000
Intangible asset acquired, discount rate (percent)	8.50%
Contingent consideration, estimated fair value	$ 23,900,000
Business acquisition, pro forma revenue		$ 364,700,000	$ 377,300,000

ACQUISITIONS AND DIVESTITURES - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Jan. 20, 2021	Dec. 31, 2020
Current assets:
Goodwill	$ 1,010,072		$ 932,367
ACell, Inc.
Current assets:
Cash		$ 2,726
Trade accounts receivable, net		16,469
Inventories, net		18,299
Prepaids expenses and other current assets		1,498
Total current assets		38,992
Property, plant and equipment, net		13,769
Intangible assets		245,000
Goodwill		92,983
Right of use asset - operating leases		9,259
Deferred tax assets		9,768
Other assets		148
Total assets acquired		409,919
Current liabilities:
Accounts payable		718
Accrued expenses		6,227
Current portion of lease liability - operating leases		1,673
Total current liabilities		8,618
Other long-term liability		276
Lease liability - operating leases		7,585
Deferred tax liability		64,178
Total liabilities assumed		104,557
Net assets acquired		$ 305,362
ACell, Inc. \| Minimum
Current liabilities:
Weighted Average Life	13 years
ACell, Inc. \| Maximum
Current liabilities:
Weighted Average Life	14 years

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($)		3 Months Ended
	Jan. 20, 2021	Mar. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Number of days from shipment to issue a credit		90 days
Short-term portion of contract liability		$ 5,400,000	$ 5,275,000
Long-term portion of contract liability		$ 6,500,000
Product warranty period (up to)		2 years
ACell, Inc.
Business Acquisition [Line Items]
Payments to acquire businesses, gross	$ 305,400,000
Contingent consideration, maximum undiscounted payment amount	$ 100,000,000	$ 100,000,000

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-04-01	Mar. 31, 2021
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation through 2021, percentage	46.00%
Performance obligations expected to be satisfied, expected timing	9 months

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 7,430
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(7,430)
Contract asset, net of transferred to trade receivables on contracts during the period	6,499
Contract asset, End of Period	6,499
Contract Liability
Contract liability, Beginning of Period	11,961
Recognition of revenue included in beginning of year contract liability	(1,677)
Contract liability, net of revenue recognized on contracts during the period	1,604
Foreign currency translation	(22)
Contract liability, End of Period	$ 11,866

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disaggregation of Revenue [Line Items]
Total Revenues	$ 360,071	$ 354,324
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	241,241	231,440
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	189,254	184,943
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	51,987	46,497
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	118,830	122,884
Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	88,698	72,267
Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total Revenues	0	21,472
Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 30,132	$ 29,145

- 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	Mar. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Finished goods	$ 191,712	$ 180,301
Work in process	57,173	53,336
Raw materials	79,164	76,480
Inventories, net	$ 328,049	$ 310,117

INVENTORIES - Narrative (Details) $ in Thousands	Dec. 31, 2020 USD ($)
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Extremity Orthopedics
Inventory [Line Items]
Inventories	$ 52,845

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Goodwill [Roll Forward]
Beginning of Period	$ 932,367
ACell Acquisition	92,983
Foreign currency translation	(15,278)
End of Period	1,010,072
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of Period	671,975
ACell Acquisition	0
Foreign currency translation	(10,013)
End of Period	661,962
Tissue Technologies
Goodwill [Roll Forward]
Beginning of Period	260,392
ACell Acquisition	92,983
Foreign currency translation	(5,265)
End of Period	$ 348,110

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,633,898	$ 1,421,087
Accumulated Amortization	(440,217)	(431,651)
Net	1,193,681	989,436
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	165,091	170,226
Net	$ 165,091	$ 170,226
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	18 years	19 years
Cost	$ 1,120,918	$ 896,478
Accumulated Amortization	(257,360)	(248,088)
Net	$ 863,558	$ 648,390
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 212,332	$ 213,270
Accumulated Amortization	(134,794)	(132,838)
Net	$ 77,538	$ 80,432
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 98,533	$ 104,209
Accumulated Amortization	(28,862)	(31,767)
Net	$ 69,671	$ 72,442
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	27 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(15,447)	(15,203)
Net	$ 14,764	$ 15,008
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	10 years	4 years
Cost	$ 6,813	$ 6,693
Accumulated Amortization	(3,754)	(3,755)
Net	$ 3,059	$ 2,938

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) $ in Millions	Mar. 31, 2021 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Expected annual amortization expense, remainder of 2021	$ 60.7
Expected annual amortization expense, in 2022	78.8
Expected annual amortization expense, in 2023	78.0
Expected annual amortization expense, in 2024	77.3
Expected annual amortization expense, in 2025	77.3
Expected annual amortization expense, in 2026	77.2
Expected annual amortization expense, thereafter	$ 582.7

DEBT - Narrative (Details)		3 Months Ended
DEBT - Narrative (Details)	Feb. 04, 2020 USD ($) $ / shares	Mar. 31, 2021 USD ($)	Sep. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2020 USD ($)	Feb. 03, 2020 USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility		$ 45,000,000			$ 33,750,000
Cost of call transactions		0		$ 104,248,000
Proceeds from warrant transactions		0		44,562,000
Carrying amount, liability component		562,240,000			474,834,000
Securitization program outstanding borrowings, maximum limit		$ 150,000,000.0
Securitization program, term		3 years
Secured long-term debt, securitization program, noncurrent		$ 110,900,000			$ 112,500,000
Weighted average interest rate, accounts receivable securitization revolving loan facility		1.30%			1.30%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value		$ 110,800,000
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
Weighted average interest rate on debt		1.50%			1.50%
Revolving Credit Facility \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		$ 98,500,000
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
Letters of credit outstanding					$ 1,600,000
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
Weighted average interest rate on debt		1.50%
Term loan component of senior credit facility		$ 45,000,000.0
Term Loan Facility \| Secured Debt \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		884,900,000
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
Convertible notes, interest rate	0.50%
Debt proceeds, classified as equity at time of offering	$ 104,500,000
Effective interest rate	4.20%
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
Carrying amount, liability component					485,900,000
Unamortized discount					$ 89,100,000
Fair value		642,100,000
Cash interest		$ 700,000
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
2020 Notes
Debt Instrument [Line Items]
Incremental financing cost expense				2,500,000
Cash interest				400,000
Interest expense				$ 2,900,000

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	Mar. 31, 2021 USD ($)
Debt Disclosure [Abstract]
Remainder of 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 ($)	Mar. 31, 2021	Dec. 31, 2020
Derivative [Line Items]
Notional amount		$ 1,875,000,000
Estimated Fair Value, Asset (Liability)	$ (53,547,000)	(93,769,000)
1-Month USD LIBOR \| Interest Rate Swap Designated March 27, 2017
Derivative [Line Items]
Notional amount		100,000,000
Fixed Interest Rate	1.971%
Estimated Fair Value, Asset (Liability)	$ (463,000)	(929,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Notional amount		300,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Asset (Liability)	$ (10,526,000)	(12,557,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional amount		150,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Asset (Liability)	$ (9,413,000)	(11,502,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 5
Derivative [Line Items]
Notional amount		200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value, Asset (Liability)	$ (12,293,000)	(16,243,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional amount		75,000,000
Fixed Interest Rate	3.22%
Estimated Fair Value, Asset (Liability)	$ (7,842,000)	(9,836,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional amount		75,000,000
Fixed Interest Rate	3.199%
Estimated Fair Value, Asset (Liability)	$ (7,805,000)	(9,826,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional amount		75,000,000
Fixed Interest Rate	3.209%
Estimated Fair Value, Asset (Liability)	$ (7,849,000)	(9,783,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional amount		100,000,000
Fixed Interest Rate	2.885%
Estimated Fair Value, Asset (Liability)	$ (6,037,000)	(10,407,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional amount		100,000,000
Fixed Interest Rate	2.867%
Estimated Fair Value, Asset (Liability)	$ (5,826,000)	(10,431,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 15, 2020 Tranche 1
Derivative [Line Items]
Notional amount		575,000,000
Fixed Interest Rate	1.415%
Estimated Fair Value, Asset (Liability)	$ 11,810,000	(1,907,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 15, 2020 Tranche 2
Derivative [Line Items]
Notional amount		125,000,000
Fixed Interest Rate	1.404%
Estimated Fair Value, Asset (Liability)	$ 2,697,000	$ (348,000)

DERIVATIVE INSTRUMENTS - Narrative (Details)	3 Months Ended
DERIVATIVE INSTRUMENTS - Narrative (Details)	Mar. 31, 2021 USD ($)	Mar. 31, 2021 CHF (SFr)	Mar. 31, 2020 USD ($)	Dec. 31, 2020 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Designated as Hedging Instrument
Derivative [Line Items]
Total derivatives designated as hedges — Assets	$ 41,433,000			$ 12,920,000
Gain (loss) recorded in AOCL, change in fair value	88,285,000		$ (26,847,000)
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount				1,875,000,000
Foreign Exchange Forward \| Not Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount				$ 9,700,000
Loss on foreign currency derivatives	200,000
Total derivatives designated as hedges — Assets	200,000
Cross-currency swap
Derivative [Line Items]
Current notional amount					$ 471,600,000	SFr 420,100,000
Intercompany loan quarterly payments \| SFr		SFr 5,800,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	1,700,000		2,200,000
Gain expected to be reclassified to earnings in the next twelve months	5,200,000
Gain (loss) recorded, net investment hedge, change in fair value	11,900,000		16,700,000
Cross-currency swap \| Codman \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	1,300,000		1,500,000
Gain (loss) recorded in other income, net	42,900,000		(1,700,000)
Gain (loss) recorded in AOCL, change in fair value	40,200,000		$ 5,900,000
Gain expected to be reclassified to earnings in the next twelve months	$ 9,100,000
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)	Mar. 31, 2021 USD ($)	Mar. 31, 2021 CHF (SFr)	Dec. 31, 2020 USD ($)	Dec. 31, 2020 CHF (SFr)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount					$ 471,600,000	SFr 420,100,000
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			$ 1,875,000,000
Fair Value Asset (Liability)	$ (53,547,000)		(93,769,000)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 17,314,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Rate	3.00%	3.00%
Aggregate Notional Amount \| SFr		SFr 414,387,000		SFr 420,137,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 465,185,000		471,640,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (955,000)		(4,335,000)
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%
Aggregate Notional Amount \| SFr		SFr 48,533,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%
Aggregate Notional Amount	$ 50,000,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ (868,000)		(11,262,000)
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount \| SFr		SFr 145,598,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount	$ 150,000,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)			(7,843,000)
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ 15,491,000		$ (23,441,000)

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) € in Thousands, SFr in Thousands	Mar. 31, 2021 USD ($)	Mar. 31, 2021 CHF (SFr)	Mar. 31, 2021 EUR (€)	Dec. 31, 2020 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount					$ 471,600,000	SFr 420,100
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (9,000)			$ (1,884,000)
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 44,859
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	3.01%	3.01%	3.01%
Aggregate Notional Amount	$ 52,000,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 1,707,000			(450,000)
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 51,760
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	2.57%	2.57%	2.57%
Aggregate Notional Amount	$ 60,000,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 1,096,000			92,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 38,820
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Rate	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,033,000			(3,794,000)
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr		SFr 222,300
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Rate	1.10%	1.10%	1.10%
Aggregate Notional Amount	$ 250,000,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ 5,827,000			$ (6,036,000)

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) SFr in Millions	Mar. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 41,433,000	$ 12,920,000
Total derivatives designated as hedges — Liabilities	73,652,000	136,165,000
Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount		1,875,000,000
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,900,000,000	1,900,000,000
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	14,507,000	0
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	21,337,000	22,033,000
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	46,717,000	71,736,000
Cross-currency swap
Derivatives, Fair Value [Line Items]
Current notional amount			$ 471,600,000	SFr 420.1
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	10,083,000	7,623,000
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	955,000	4,335,000
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	4,615,000	26,728,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	5,209,000	5,297,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	656,000	0
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	10,000	1,884,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 28,000	$ 9,449,000

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,514,867	$ 1,416,736
Balance, End of Period	1,529,331	1,341,803
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(74,059)	(76,401)
Balance, End of Period	(43,627)	(104,588)
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL	88,285	(26,847)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	40,156	955
Designated as Hedging Instrument \| Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(107,133)	(34,739)
Balance, End of Period	(59,004)	(62,541)
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(93,769)	(45,145)
Amount of Gain (Loss) Recognized in AOCL	34,518	(51,651)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(5,705)	(1,043)
Balance, End of Period	(53,546)	(95,753)
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other income (expense),net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(1,073)	177
Amount of Gain (Loss) Recognized in AOCL	40,194	5,907
Amount of Gain (Loss) Reclassified from AOCL into Earnings	44,150	(182)
Balance, End of Period	(5,029)	6,266
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(12,291)	10,229
Amount of Gain (Loss) Recognized in AOCL	13,573	18,897
Amount of Gain (Loss) Reclassified from AOCL into Earnings	1,711	2,180
Balance, End of Period	$ (429)	$ 26,946

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	3 Months Ended
	Mar. 31, 2021 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grants in period, net of forfeitures (in shares) \| shares	149,558
Options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 22.59
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs \| $	$ 7.7
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 \| $	$ 42.4
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares) \| shares	211,262
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 68.00
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	176,147
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 68.10
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
	May 31, 2019	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Retirement Benefits [Abstract]
Net periodic benefit costs		$ 0.6	$ 1.0
Service cost component		0.8	$ 0.9
Estimated fair value of plan assets		32.8		$ 37.8
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		$ 2.9

- 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	3 Months Ended
	Mar. 31, 2021 USD ($) renewal_option	Mar. 31, 2020 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewal_option	1
Operating lease expense	$ 5.3	$ 4.8
Affiliated Entity
Operating Leased Assets [Line Items]
Operating lease expense	$ 0.1	$ 0.1
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) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Lessee, Lease, Description [Line Items]
ROU assets	$ 91,174	$ 83,635
Current lease liabilities	13,900	12,818
Non-current lease liabilities	95,549	88,118
Total lease liabilities	109,449	$ 100,936
Leased facilities
Lessee, Lease, Description [Line Items]
Total lease liabilities	$ 109,449
Weighted average remaining lease term (in years)	11 years 9 months 18 days	11 years 7 months 6 days
Weighted average discount rate	5.10%	4.60%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years	2 years 3 months 18 days
Weighted average discount rate	2.70%	2.30%

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 3,761	$ 3,229
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 9,662	$ 5,808

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Operating Leased Assets [Line Items]
2021	$ 11,859
2022	16,627
2023	13,245
2024	11,706
2025	11,109
2026	9,968
Thereafter	73,691
Total minimum lease payments	148,205
Less: Imputed interest	38,756
Total lease liabilities	109,449	$ 100,936
Less: Current lease liabilities	13,900	12,818
Long-term lease liabilities	95,549	$ 88,118
Third Parties
Operating Leased Assets [Line Items]
2021	11,637
2022	16,331
2023	12,949
2024	11,410
2025	10,813
2026	9,672
Thereafter	72,854
Total minimum lease payments	145,666
Related Parties
Operating Leased Assets [Line Items]
2021	222
2022	296
2023	296
2024	296
2025	296
2026	296
Thereafter	837
Total minimum lease payments	$ 2,539

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, shares in Millions		1 Months Ended	3 Months Ended		12 Months Ended
	Feb. 05, 2020	Jun. 30, 2020	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 07, 2020
Equity, Class of Treasury Stock [Line Items]
Treasury stock (in shares)			4.9
Treasury stock			$ 234,500,000		$ 235,100,000
Treasury stock, average cost per share (in dollars per share)			$ 47.86		$ 47.86
Stock repurchase program, authorized amount (up to)						$ 225,000,000.0
Remaining amount under share repurchase			$ 225,000,000.0
Stock repurchased during period (in shares)	1.3	0.6			2.1
Net proceeds from offering of convertible senior notes			$ 0	$ 575,000,000
Accelerated share repurchase program, payment	$ 92,400,000
Accelerated shares repurchased, amount	$ 100,000,000.0			$ 92,368,000
Accelerated share repurchases, percentage of expected total repurchased	80.00%
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
INCOME TAXES - Summary of Effective Tax Rate (Details)	Mar. 31, 2021	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Reported tax rate	32.50%	19.80%

INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2021	Mar. 31, 2020
Income Tax Contingency [Line Items]
Effective income tax rate	32.50%	19.80%
Foreign Tax Authority
Income Tax Contingency [Line Items]
Deferred tax assets, valuation allowance	$ 3.3

NET INCOME PER SHARE - Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Basic net income per share:
Net income	$ 45,394	$ 9,180
Weighted average common shares outstanding - Basic (in shares)	84,500	85,188
Basic net income (loss) per common share (in dollars per share)	$ 0.54	$ 0.11
Diluted net income per share:
Net income	$ 45,394	$ 9,180
Weighted average common shares outstanding - Basic (in shares)	84,500	85,188
Effect of dilutive securities:
Stock options and restricted stock (in shares)	758	704
Weighted average common shares for diluted earnings per share (in shares)	85,258	85,892
Diluted net income (loss) per common share (in dollars per share)	$ 0.53	$ 0.11

- 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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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 PER SHARE - Narrative (Details) - shares shares in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.5	0.4
Performance Shares and Restricted Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares included in computation (in shares)	0.5

ACCUMULATED OTHER COMPREHENSIVE LOSS - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Equity [Abstract]
Net income	$ 45,394	$ 9,180
Foreign currency translation adjustment	(6,802)	(6,813)
Change in unrealized loss on derivatives, net of tax	36,915	(21,306)
Pension liability adjustment, net of tax	319	(68)
Comprehensive income (loss), net	$ 75,826	$ (19,007)

- Definition

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

+ References

+ Details

ACCUMULATED OTHER COMPREHENSIVE LOSS - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,514,867	$ 1,416,736
Other comprehensive income (loss)	61,293
Less: Amounts reclassified from accumulated other comprehensive loss	30,861
Net current-period other comprehensive income (loss)	30,432	(28,187)
Balance, End of Period	1,529,331	1,341,803
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(74,059)	(76,401)
Net current-period other comprehensive income (loss)	30,432	(28,187)
Balance, End of Period	(43,627)	$ (104,588)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(82,249)
Other comprehensive income (loss)	67,776
Less: Amounts reclassified from accumulated other comprehensive loss	30,861
Net current-period other comprehensive income (loss)	36,915
Balance, End of Period	(45,334)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(5,105)
Other comprehensive income (loss)	319
Less: Amounts reclassified from accumulated other comprehensive loss	0
Net current-period other comprehensive income (loss)	319
Balance, End of Period	(4,786)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	13,295
Other comprehensive income (loss)	(6,802)
Less: Amounts reclassified from accumulated other comprehensive loss	0
Net current-period other comprehensive income (loss)	(6,802)
Balance, End of Period	$ 6,493

- 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

ACCUMULATED OTHER COMPREHENSIVE LOSS - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	$ (30,861)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	(30,861)
Other income (expense) \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	33,900
Interest income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Loss reclassified from accumulated other comprehensive loss	$ 3,100

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details) product in Thousands	3 Months Ended
	Mar. 31, 2021 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

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Net Sales
Total Revenues	$ 360,071	$ 354,324
Segment Profit
Operating income	30,714	27,103
Amortization	(4,527)	(6,977)
Operating Segments
Segment Profit
Operating income	156,789	118,506
Corporate and other
Segment Profit
Operating income	(121,548)	(84,426)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	241,241	231,440
Codman Specialty Surgical \| Operating Segments
Segment Profit
Operating income	106,778	87,235
Tissue Technologies
Segment Net Sales
Total Revenues	118,830	122,884
Tissue Technologies \| Operating Segments
Segment Profit
Operating income	$ 50,011	$ 31,271

- Definition

+ References

+ Details

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting Information [Line Items]
Total Revenues	$ 360,071	$ 354,324
United States
Segment Reporting Information [Line Items]
Total Revenues	247,793	246,852
Europe
Segment Reporting Information [Line Items]
Total Revenues	45,819	45,896
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	47,295	39,960
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 19,164	$ 21,616

- Definition

+ References

+ Details

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Arkis \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 3,415
Loss from change in fair value of contingent consideration liabilities	17
Balance, End of Period	3,432
Arkis \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	11,746	$ 14,210
Loss from change in fair value of contingent consideration liabilities	265	(1,051)
Balance, End of Period	12,011	13,159
Derma Sciences \| Other Long-term Liabilities
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	0
Balance, End of Period	230	$ 230
ACell \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Additions from acquisition of ACell	23,900
Loss from change in fair value of contingent consideration liabilities	0
Balance, End of Period	$ 23,900

COMMITMENTS AND CONTINGENCIES - Narrative (Details)		3 Months Ended
COMMITMENTS AND CONTINGENCIES - Narrative (Details)	Jul. 29, 2019 USD ($)	Mar. 31, 2021 USD ($) liability	Dec. 31, 2020 USD ($)	Mar. 31, 2020 USD ($)
Accrued Liabilities
Loss Contingencies [Line Items]
Contingent consideration		$ 3,400,000
Other liabilities
Loss Contingencies [Line Items]
Contingent consideration		12,000,000	$ 13,200,000
Arkis
Loss Contingencies [Line Items]
Purchase price of business combination	$ 30,600,000
Contingent consideration, estimated fair value	25,500,000
Contingent consideration	13,100,000	$ 15,400,000		$ 13,200,000
Arkis \| Development Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	10,000,000.0
Arkis \| Commercial Sales Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	$ 15,500,000
Derma Sciences
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value				$ 200,000
Number of contingent liabilities remaining \| liability		1
Contingent consideration, maximum undiscounted payment amount		$ 3,000,000.0
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 33,300,000

Label	Element	Value
Accounting Standards Update [Extensible List]	us-gaap_AccountingStandardsUpdateExtensibleList	us-gaap:AccountingStandardsUpdate201613Member

- Definition

Indicates amendment to accounting standards.

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+ Details