0000917520-24-000061 | 10-Q | XBRL Viewer | Integra Lifesciences Holdings Corp

DERIVATIVE INSTRUMENTS (Tables)

3 Months Ended

Mar. 31, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

The Company held the following interest rate swaps as of March 31, 2024 and December 31, 2023 (dollar amounts in thousands):


	March 31, 2024		December 31, 2023							March 31, 2024			December 31, 2023
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month Term SOFR Loan	150,000		150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1,125			2,105
1-month Term SOFR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	4,341			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,556			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,548			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,548			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,512			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,519			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	29,267			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	6,770			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(2,127)		0	(1,829)
	$	1,475,000	$	1,475,000						$	53,059		$	43,556
(1) The notional of the basis swap amortizes to match the total notional of the interest rate swap portfolio over time

The Company held the following cross-currency rate swaps as of March 31, 2024 and December 31, 2023 (dollar amounts in thousands):


					March 31, 2024	December 31, 2023	March 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	333,887	351,137	(9,902)		(38,324)
Receive U.S.$			3.98%	$	374,817	394,183




Pay CHF	September 22, 2023	September 29, 2024	2.40%	CHF	28,500	28,500	(2,578)		(2,348)
Receive U.S.$			6.27%	$	31,457	31,457

Total							$	(12,480)	$	(40,672)

The Company held the following cross-currency rate swaps designated as net investment hedges as of March 31, 2024 and December 31, 2023, respectively (dollar amounts in thousands):


					March 31, 2024	December 31, 2023	March 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	3,459		2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	288,210	(29,614)		(48,047)
Receive U.S.$			1.94%	$	300,000	300,000

Pay CHF	November 21, 2023	December 17, 2029	—%	CHF	66,525	66,525	(736)		(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Total							$	(26,891)	$	(49,609)

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, 2024 and December 31, 2023:


	Fair Value as of
Location on Balance Sheet (1):	March 31, 2024		December 31, 2023
Dollars in thousands
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap(2)	$	14,188	$	14,675
Cross-currency swap	680		537
Net Investment Hedges
Cross-currency swap	4,084		2,938
Other assets
Cash Flow Hedges
Interest rate swap(2)	40,998		30,710
Cross-currency swap	—		—
Net Investment Hedges
Cross-currency swap	2,454		1,470
Total derivatives designated as hedges — Assets	$	62,404	$	50,330

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	540	$	579
Cross-currency swap	2,578		4,813
Foreign currency forward contracts	629		—
Net Investment Hedges
Cross-currency swap	—		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	1,586		1,250
Cross-currency swap	10,582		36,396
Net Investment Hedges
Cross-currency swap	33,427		51,114
Total derivatives designated as hedges — Liabilities	$	49,342	$	97,055

(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, 2024 and December 31, 2023, the total notional amounts related to the Company’s interest rate swaps were $1.5 billion.

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

The following presents the effect of derivative instruments designated as cash flow hedges and net investment hedges on the accompanying condensed consolidated statement of operations during the three months ended March 31, 2024 and 2023:


Dollars in thousands	Balance in AOCI Beginning of Quarter		Amount of Gain (Loss) Recognized in AOCI		Amount of Gain (Loss) Reclassified from AOCI into Earnings		Balance in AOCI End of Quarter		Location in Statements of Operations

















Three Months Ended March 31, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	14,723	$	5,219	$	53,060	Interest expense
Cross-currency swap	(15,763)		29,532		31,473		(17,704)		Other income (expense), net
Foreign currency forward contract	—		(629)		(110)		(519)		Cost of sales
Net Investment Hedges
Cross-currency swap	(45,498)		24,920		2,202		(22,780)		Interest income
	$	(17,705)	$	68,546	$	38,784	$	12,057
Three Months Ended March 31, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	(10,534)	$	3,500	$	42,678	Interest expense
Cross-currency swap	(20,271)		2,191		(3,504)		(14,576)		Other income (expense), net
Foreign currency forward contract			$	(69)			$	(69)
Net Investment Hedges
Cross-currency swap	(6,914)		950		2,096		(8,060)		Interest income
	$	29,527	$	(7,462)	$	2,092	$	19,973

Derivatives Not Designated as Hedging Instruments

The following table summarizes the gains (losses) on derivative instruments not designated as hedges on the condensed consolidated statements of income, which was included in other income:


Dollars in thousands	Three Months Ended March 31,
		2024		2023

Foreign currency swaps		273		55
Total		$	273	$	55

- Definition

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

+ References + Details

STOCK-BASED COMPENSATION	3 Months Ended
STOCK-BASED COMPENSATION	Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of March 31, 2024, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under the Integra LifeSciences Holdings Corporation Fifth Amended and Restated 2003 Equity Incentive Plan (the “2003 Plan”). 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, within one year from date of grant for directors which generally expire eight years from the grant date for employees, and from six to ten years for directors and certain executive officers, except in certain instances that result in accelerated vesting due to death, disability, retirement age or change in-control provisions within their grant agreements. The Company values stock option grants using the binomial distribution model. Restricted stock issued under the 2003 Plan vests over specified periods, generally three years after the date of grant. The vesting of performance stock issued under the 2003 Plan is subject to service and performance conditions. Stock Options As of March 31, 2024, there were approximately $4.9 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 243,964 stock options granted during the three months ended March 31, 2024. For the three months ended March 31, 2024, the weighted average grant date fair value for stock options granted was $15.68 per option. Awards of Restricted Stock and Performance Stock Performance stock and restricted stock awards generally have requisite service periods of three years, except in certain instances that result in accelerated vesting due to death, disability, retirement age provision or change in-control provisions in their grant agreements. 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, 2024, there was approximately $48.6 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 532,379 restricted stock awards and 263,350 performance stock awards during the three months ended March 31, 2024. For the three months ended March 31, 2024, the weighted average grant date fair value for restricted stock awards and performance stock units granted was $36.46 and $36.22 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. CEO Separation On February 27th, 2024, the Company announced that Mr. De Witte would retire from his position as President and Chief Executive Officer and director of the Company following the completion of a succession process and entered into a letter agreement with Mr. De Witte to modify his current employment agreement and put forth the form of a post-employment consulting agreement. The Company applied modification accounting to the outstanding equity-based awards granted to Mr. De Witte as of that date, which revalued and accelerated stock-based compensation associated with equity-based awards granted to him over his expected service period to the Company. Pursuant to this letter agreement, Mr. De Witte’s unvested equity-based awards will continue to vest during his continued service period to the Company and vested stock options were modified such that they will remain exercisable until the lesser of (a) the stated term of the stock options and (b) six months following his cessation of continued service to the Company. As a result of the modifications, the Company recorded incremental stock-based compensation expense of $0.2 million during the three months ended March 31, 2024. The Company will record a total of $1.9 million in accelerated stock-based compensation expenses for the twelve months ended 2024 that would not have been recognized if Mr. De Witte had not announced his retirement from Integra.

ACQUISITIONS AND DIVESTITURES - Narrative (Details) - Acclarent Inc. - USD ($) $ in Millions		1 Months Ended
	Apr. 01, 2024	Dec. 31, 2023
Business Acquisition [Line Items]
Purchase price of business combination		$ 275.0
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)		$ 5.0
Subsequent Event
Business Acquisition [Line Items]
Purchase price of business combination	$ 282.0
Percentage of shares acquired	100.00%

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	3 Months Ended
	Mar. 31, 2024 Segment product
Segment Reporting Information [Line Items]
Number of reportable segments \| Segment	2
Codman Specialty Surgical
Segment Reporting Information [Line Items]
Number of products offered (more than) \| product	40,000

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Net Sales
Total Revenues	$ 368,872	$ 380,846
Segment Profit
Operating income	3,964	36,382
Amortization	(10,107)	(3,108)
Operating Segments
Segment Profit
Operating income	134,158	163,214
Corporate and other
Segment Profit
Operating income	(120,087)	(123,724)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	256,434	248,136
Codman Specialty Surgical \| Operating Segments
Segment Profit
Operating income	103,492	110,933
Tissue Technologies
Segment Net Sales
Total Revenues	112,438	132,710
Tissue Technologies \| Operating Segments
Segment Profit
Operating income	$ 30,666	$ 52,281

- 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.

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+ Details

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

3 Months Ended

Mar. 31, 2024

Equity [Abstract]

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

Comprehensive income for the three months ended March 31, 2024 and 2023:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
Net (loss) income		$	(3,281)	$	24,226
Foreign currency translation adjustment		730		3,192
Change in unrealized loss/(gain) on derivatives, net of tax		3,735		(6,493)
Pension liability adjustment, net of tax		(5)		103
Comprehensive income, net		$	1,179	$	21,028

Changes in accumulated other comprehensive income by component between December 31, 2023 and March 31, 2024 are presented in the table below, net of tax:


Dollars in thousands	Gains and Losses on Derivatives		Defined Benefit Pension Items		Foreign Currency Items		Total
Balance at January 1, 2024	$	21,489	$	2,712	$	(39,307)	$	(15,106)
Other comprehensive gain (loss)	34,939		(5)		2,425		37,359
Less: Amounts reclassified from accumulated other comprehensive income, net	31,204		—		1,695		32,899
Net current-period other comprehensive gain (loss)	3,735		(5)		730		4,460
Balance at March 31, 2024	$	25,224	$	2,707	$	(38,577)	$	(10,646)

For the three months ended March 31, 2024, the Company reclassified a gain of $27.2 million and $5.7 million from accumulated other comprehensive income to other income, net and interest income, respectively.

DEBT (Tables)

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios

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 Ending						Maximum Consolidated Total Leverage Ratio
March 31, 2023 through December 31, 2024						4.50 to 1.00
March 31, 2025 through June 30, 2026						4.25 to 1.00
September 30, 2026 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:


As of March 31, 2024	Principal Repayment
Dollars in thousands
Remainder of 2024	$	14,531
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,532
	$	775,000

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Total Revenues	$ 368,872	$ 380,846
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	256,434	248,136
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	202,268	192,870
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	54,166	55,266
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	112,438	132,710
Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	80,877	100,940
Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 31,561	$ 31,770

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

+ References

+ Details

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 591,906	$ 276,402
Short-term investments	71,194	32,694
Trade accounts receivable, net of allowances of $5,050 and $4,879	241,092	259,327
Inventories, net	403,422	389,608
Prepaid Expenses	72,667	67,362
Other Current Assets	35,369	32,643
Total current assets	1,415,650	1,058,036
Property, plant and equipment, net	345,356	340,199
Right of use asset - operating leases	151,834	156,184
Intangible assets, net	1,022,609	1,067,833
Goodwill	1,040,235	1,055,462
Deferred tax assets, net	34,175	46,080
Other assets	68,365	58,194
Total assets	4,078,224	3,781,988
Current liabilities:
Current portion of borrowings under senior credit facility	19,375	14,531
Current portion of lease liability - operating leases	16,303	15,284
Accounts payable, trade	94,397	92,326
Contract liabilities	7,841	8,540
Accrued compensation	52,582	75,455
Accrued expenses and other current liabilities	111,896	100,844
Total current liabilities	302,394	306,980
Long-term borrowings under senior credit facility	1,171,036	825,563
Long-term borrowings under securitization facility	94,600	89,200
Long-term convertible securities	570,984	570,255
Lease liability - operating leases	170,082	166,849
Deferred tax liabilities	31,431	35,317
Other liabilities	139,745	199,940
Total liabilities	2,480,272	2,194,104
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; 91,484 and 90,920 issued at March 31, 2024 and December 31, 2023, respectively	915	909
Additional paid-in capital	1,310,527	1,302,484
Treasury stock, at cost; 12,735 shares and 12,751 shares at March 31, 2024 and December 31, 2023, respectively	(646,422)	(647,262)
Accumulated other comprehensive loss	(10,646)	(15,106)
Retained earnings	943,578	946,859
Total stockholders’ equity	1,597,952	1,587,884
Total liabilities and stockholders’ equity	$ 4,078,224	$ 3,781,988

BASIS OF PRESENTATION (Policies)	3 Months Ended
BASIS OF PRESENTATION (Policies)	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis Of Presentation	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the March 31, 2024 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 shareholders’ 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 in the United States (“GAAP”) 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, 2023 included in the Company’s Annual Report on Form 10-K. The December 31, 2023 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by GAAP. Operating results for the three-month period ended March 31, 2024 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with 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 condensed 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.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In March 2020, the Financial Accounting Standards Board (“FASB”) issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, and, in January 2021, subsequently amended the initial guidance in: ASU 2021-01, Reference Rate Reform (Topic 848): Scope (collectively, “Topic 848”). Topic 848 provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criteria are met. The amendments apply only to 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. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which delayed the effective date from December 31, 2022 to December 31, 2024. The Alternative Reference Rates Committee, a group of private-market participants convened by the U.S. Federal Reserve Board and the New York Federal Reserve, has recommended the use of the Secured Overnight Financing Rate (“SOFR”) as a more robust reference rate alternative to LIBOR. On March 24, 2023, the Company entered into the seventh amendment and restatement (the “March 2023 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. In connection with the March 2023 Amendment, the Company replaced all LIBOR-based contracts with SOFR, which is calculated based on overnight transactions under repurchase agreements backed by Treasury securities. In addition, on April 17, 2023 the Company entered into an amendment (the “April 2023 Amendment”) of the Securitization Facility (as defined below) and amended the interest rate from LIBOR to SOFR indexed rate. (See Note 6, Debt). In March 2023, the Company entered into a basis swap where the Company receives Term SOFR and pays LIBOR to convert the portfolio of interest rate swaps from LIBOR to SOFR. Integra has elected to adopt the optional expedient under Topic 848, which will allow the interest rate swap hedging relationship to continue, without de-designation, due to the change in the indexed rate from LIBOR to SOFR. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures which enhances the transparency of income tax disclosures by expanding annual disclosure requirements related to the rate reconciliation and income taxes paid. The amendments are effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company does not plan to early adopt and is currently evaluating this ASU to determine its impact on the Company’s disclosures. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which updates reportable segment disclosure requirements primarily through enhanced disclosures about significant segment expenses. The amendments are effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company does not plan to early adopt and is currently evaluating this ASU to determine its impact on the Company’s disclosures. There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company’s financial position, results of operations or cash flows.
Summary of Accounting Policies on Revenue Recognition and Shipping and Handling Fees	Summary of Accounting Policies on Revenue Recognition Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services. 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 Estimates Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company’s strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant. The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract. The Company’s return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally 90 days. In 2023, due to the voluntary recall of all products manufactured at the Boston facility, including PriMatrix®, SurgiMend®, Revize™, and TissueMend™ (the “Boston recall”), the Company recorded a total of $18.7 million provision for product returns. As of March 31, 2024, the Company has credited $16.7 million to customers and holds a remaining return reserve of $2.0 million. 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 other current assets account in the consolidated balance sheets. Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability. Shipping and Handling Fees The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in the cost of goods sold.
Product Warranties	Product Warranties Certain of the Company’s medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet.
Taxes Collected from Customers	Taxes Collected from Customers The Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer.

- Definition

Disclosure of accounting policy for revenue from contract with customer.

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+ Details

DEBT

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

DEBT

Amendment to the Seventh Amended and Restated Senior Credit Agreement

On March 24, 2023, the Company entered into the seventh amendment and restatement (the “March 2023 Amendment”) of the Senior Credit Facility (the “Senior Credit Facility”) with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The March 2023 Amendment extended the maturity date to March 24, 2028, amended the contractual repayments of the term loan component, and amended the interest rate from LIBOR to SOFR-indexed interest. The Company continues to have the aggregate principal amount of up to approximately $2.1 billion available to it through the following facilities: (i) a $775.0 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.

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 Ending						Maximum Consolidated Total Leverage Ratio
March 31, 2023 through December 31, 2024						4.50 to 1.00
March 31, 2025 through June 30, 2026						4.25 to 1.00
September 30, 2026 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.Term SOFR in effect from time to time plus 0.10% plus the applicable rate (ranging from 1.00% to 1.75%), or

ii.The highest of:

1.the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50%;

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

3.the one-month Term SOFR 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 amended Seventh Amended and Restated Credit Agreement (the “Credit Agreement”)), 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, 2024, the Company was in compliance with all such covenants. The Company capitalized $7.6 million in deferred financing costs in connection with the modification of the Senior Credit Facility and wrote off $0.2 million of previously capitalized financing costs during the first quarter of 2023.

At March 31, 2024 and December 31, 2023 there was $420.0 million and $70.0 million, respectively, outstanding under the revolving portion of the Senior Credit Facility. At March 31, 2024 and December 31, 2023, there was $775.0 million outstanding under the term loan component of the Senior Credit Facility at a weighted average interest rate of 6.8% and 6.8%, respectively. As of March 31, 2024 and December 31, 2023 there was $19.4 million and $14.5 million, respectively, of the term loan component of the Senior Credit Facility classified as current on the condensed consolidated balance sheet.

The fair value of outstanding borrowings of the Senior Credit Facility’s term loan component at March 31, 2024 was $765.5 million. This fair value was 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, 2024 and December 31, 2023 totaled $1.7 million. There were no amounts drawn under the letters of credit outstanding as of March 31, 2024.

Contractual repayments of the term loan component of the Senior Credit Facility are due as follows:


As of March 31, 2024	Principal Repayment
Dollars in thousands
Remainder of 2024	$	14,531
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,532
	$	775,000

Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $39.3 million for the remainder of 2024, $50.8 million in 2025, $48.1 million in 2026, $45.0 million in 2027, and $10.0 million thereafter. Interest is calculated on the term loan portion of the Senior Credit Facility based on SOFR plus the certain amounts set forth in the Credit Agreement. As the revolving credit facility and Securitization Facility (defined below) can be repaid at any time, no interest has been included in the calculation.

Any outstanding borrowings on the revolving credit component of the Senior Credit Facility are due on March 24, 2028.

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 2025 Notes. 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 an 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 $1,000 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) if the Company calls the notes for optional redemption as defined in the indenture; or (4) if specified corporate transactions occur. As of March 31, 2024, none of these conditions existed and the 2025 Notes are classified as long term obligations.

On December 9, 2020, the Company entered into the First Supplemental Indenture to the original indenture dated as of February 4, 2020 (the “Indenture”) 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 (as defined in the indenture) for a conversion of the 2025 Notes, the Specified Dollar Amount (as defined in the indenture) 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 2025 Notes will have the right to require the Company to repurchase for cash all or a portion of their 2025 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 2025 Notes). The Company will also be required to increase the conversion rate for holders who convert their 2025 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 March 31, 2024, the carrying amount of the liability was $575.0 million. The fair value of the 2025 Notes at March 31, 2024 was $549.7 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quotes. The 2025 Notes are valued based on Level 1 measurements in the fair value hierarchy.

Securitization Facility

In 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”) 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, 2024, the Company was in compliance with the covenants and none of the termination events had occurred.

On December 15, 2023, the Company entered into an amendment (the “December 2023 Amendment”) of the Securitization Facility which extended the maturity date from May 28, 2024 to December 15, 2026. The Company incurred approximately $0.3 million of new issuance costs associated with the December Amendment which will be amortized over 3 years, the length of the Securitization Agreement as amended by the December 2023 Amendment. Due to the increase in borrowing capacity, the remaining $0.1 million of unamortized costs from the previous agreement will also be amortized over the length of the amended agreement, 3 years. In addition, on April 17, 2023 the Company entered into an amendment (the “April 2023 Amendment”) of the Securitization Facility and amended the interest rate from LIBOR to SOFR-indexed rate. The December 2023 Amendment and April 2023 Amendment did not increase the Company’s total indebtedness.

At March 31, 2024 and December 31, 2023, the Company had $94.6 million and $89.2 million, respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 6.5% and 5.9%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at March 31, 2024 was $92.7 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.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2024	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate	37.30%	18.60%
Income tax benefit, tax credit, research and development	$ 1.5

COMMITMENTS AND CONTINGENCIES

3 Months Ended

Mar. 31, 2024

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

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

In the ordinary course of its business, the Company is involved in, from time to time, various legal actions, including any matters described below, involving product liability, employment, intellectual property and commercial disputes, shareholder related matters, environmental proceedings, tax disputes, and governmental proceedings and investigations, some of which have been settled by the Company. In the opinion of management, such matters 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.

On December 21, 2023, Fortis Advisors, LLC (representative of the security holders of ACell, Inc. (“ACell”)) filed for arbitration against Integra Life Sciences claiming breach of contract related to the earnout consideration from the 2021 acquisition of ACell. Refer below for additional information on the ACell contingent considerations. The Company believes that it has strong defenses to the allegations in the arbitration and intends to defend the matter vigorously.

On September 12, 2023, a securities class action complaint, captioned Pembroke Pines Firefighters & Police Officers Pension Fund v. Integra LifeSciences Holdings Corporation, No. 23-cv-20321 (D.N.J.), was filed by a purported stockholder of the Company in the United States District Court for the District of New Jersey (the “Pembroke Litigation”) against the Company and certain of the Company’s current and former executive officers. The Pembroke Litigation, filed on behalf of a putative class of stockholders who purchased or acquired the Company’s common stock between March 11, 2019 and May 22, 2023, inclusive, alleges violations of Sections 10(b) and 20(a) of the Securities Exchange Act of 1934, as amended, and Rule 10b-5 promulgated thereunder, on the basis of purportedly materially false and misleading statements and omissions relating to certain quality systems issues identified by the U.S. Food and Drug Administration at the Company’s Boston, Massachusetts manufacturing facility, the Company’s efforts to remediate those issues, and the Company’s forecasts for certain products in its Tissue Technologies segment. The complaint seeks, among other things, compensatory damages, attorneys’ fees, expert fees, and other costs. The Company believes that it has strong defenses to the allegations in the Pembroke Litigation, and intends to defend the matter vigorously.

Contingent Consideration

The Company determined the fair value of contingent consideration during the three month period ended March 31, 2024 and March 31, 2023 to reflect the change in estimate, additions, payments, transfers and the time value of money during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the three months ended March 31, 2024 and March 31, 2023 is as follows (in thousands):


Three Months Ended March 31, 2024	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates (SIA), Inc.			Location in Financial Statements
Balance as of January 1, 2024	$	15,755		$	2,557	$	300		68,700
Change in fair value of contingent consideration liabilities	(83)		Research and development	39		—			500			Selling, general and administrative
Balance as of March 31, 2024	15,672			2,596		300			69,200

Short-Term	$	7,562		$	—	$	—		$	29,300		Accrued expenses and other current liabilities
Long-Term	8,110			2,596		300			39,900			Other liabilities
Total	15,672			2,596		300			69,200


Three Months Ended March 31, 2023	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates (SIA), Inc.		Location in Financial Statements
Balance as of January 1, 2023	$	12,895		$	230	$	3,700	$	57,607
Change in fair value of contingent consideration liabilities	3,299		Research and development	—		(2,200)		3,600		Selling, general and administrative
Balance as of March 31, 2023	$	16,194		$	230	$	1,500	$	61,207

Short-Term	$	4,388		$	—	$	—	$	12,500	Accrued expenses and other current liabilities
Long-Term	11,806			230		1,500		48,707		Other liabilities
Total	16,194			230		1,500		61,207

Arkis BioSciences Inc.

As part of the acquisition of Arkis BioSciences Inc. (“Arkis”), 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.

Derma Sciences, Inc.

The Company assumed contingent consideration incurred by Derma Sciences, Inc. (“Derma Sciences”) related to its acquisitions of BioD, LLC and the intellectual property related to Medihoney® products. The Company accounted for the contingent liabilities by recording the 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 milestone 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.

ACell, Inc.

As part of the acquisition of ACell, the Company is required to make payments to the former shareholders of ACell up to $100 million in total for years 2022, 2023, and 2025 based on the achievement by the Company of certain revenue-based performance milestones. The 2022 and 2023 milestones were not achieved, leaving only one contingent milestone remaining. 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.

Surgical Innovations Associates, Inc.

As part of the acquisition of Surgical Innovations Associates, Inc. (“SIA”), the Company is required to pay to the former shareholders of SIA up to $90.0 million for two separate payments, which are dependent on 1) achieving certain revenue-based performance milestones in 2023, 2024, and 2025 (up to $50.0 million in additional payments), as well as 2) the approval by the FDA of the PMA for DuraSorb for certain uses by certain timing targets (up to $40.0 million in additional payments). The Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration for the revenue-based milestone that considered the possible outcomes of scenarios related to each specific milestone for the revenue based performance milestone. The Company used probabilities of achieving the conditions to calculate the fair value of the contingent consideration for the PMA approval milestone. The Company estimated the fair value of the contingent consideration for the revenue based milestone to be $32.6 million at the acquisition date and $25.0 million for the PMA approval milestone at the acquisition date.

LEASES AND RELATED PARTY LEASES (Tables)

3 Months Ended

Mar. 31, 2024

Leases [Abstract]

Supplemental Balance Sheet Information

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


Dollars in thousands, except lease term and discount rate	March 31, 2024			December 31, 2023
ROU assets	$	151,834		$	156,184

Current lease liabilities	16,303			15,284
Non-current lease liabilities	170,082			166,849
Total lease liabilities	$	186,385		$	182,133

Weighted average remaining lease term (in years):
Leased facilities	16.5 years			16.3 years
Leased vehicles	2.1 years			1.9 years

Weighted average discount rate:
Leased facilities	5.7		%	5.9		%
Leased vehicles	2.7		%	2.7		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases for the three months ended March 31, 2024 and 2023 were as follows:


Dollars in thousands	March 31, 2024		March 31, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	5,734	$	4,319

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	746	$	1,721

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at March 31, 2024 were as follows:


Dollars in thousands	Related Parties		Third Parties		Total
Remainder of 2024	$	222	$	17,884	$	18,106
2025	296		22,859		23,155
2026	296		20,210		20,506
2027	296		18,892		19,188
2028	296		16,603		16,899
2029	246		15,771		16,017
Thereafter	—		163,479		163,479
Total minimum lease payments	$	1,652	$	275,698	$	277,350
Less: Imputed interest					90,965
Total lease liabilities					186,385
Less: Current lease liabilities					16,303
Long-term lease liabilities					170,082

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2024
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grants in period, net of forfeitures (in shares)	243,964
Options, weighted average grant date fair value (in dollars per share)	$ 15.68
Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Plan modification, expiration period (in months)	6 months
Plan modification, compensation expense	$ 0.2
Chief Executive Officer \| Forecast
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Accelerated stock based compensation expenses		$ 1.9
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs	$ 4.9
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	$ 48.6
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares)	532,379
Other than options, weighted average grant date fair value (in dollars per share)	$ 36.46
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)	263,350
Other than options, weighted average grant date fair value (in dollars per share)	$ 36.22
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

INVENTORIES

3 Months Ended

Mar. 31, 2024

Inventory Disclosure [Abstract]

INVENTORIES

Inventories, net consisted of the following:


Dollars in thousands	March 31, 2024		December 31, 2023
Finished goods	$	192,287	$	196,402
Work in process	83,334		74,035
Raw materials	127,801		119,171
Total inventories, net	$	403,422	$	389,608

BASIS OF PRESENTATION	3 Months Ended
BASIS OF PRESENTATION	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BASIS OF PRESENTATION	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the March 31, 2024 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 shareholders’ 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 in the United States (“GAAP”) 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, 2023 included in the Company’s Annual Report on Form 10-K. The December 31, 2023 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by GAAP. Operating results for the three-month period ended March 31, 2024 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with 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 condensed 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. Recent Accounting Pronouncements In March 2020, the Financial Accounting Standards Board (“FASB”) issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, and, in January 2021, subsequently amended the initial guidance in: ASU 2021-01, Reference Rate Reform (Topic 848): Scope (collectively, “Topic 848”). Topic 848 provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criteria are met. The amendments apply only to 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. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which delayed the effective date from December 31, 2022 to December 31, 2024. The Alternative Reference Rates Committee, a group of private-market participants convened by the U.S. Federal Reserve Board and the New York Federal Reserve, has recommended the use of the Secured Overnight Financing Rate (“SOFR”) as a more robust reference rate alternative to LIBOR. On March 24, 2023, the Company entered into the seventh amendment and restatement (the “March 2023 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. In connection with the March 2023 Amendment, the Company replaced all LIBOR-based contracts with SOFR, which is calculated based on overnight transactions under repurchase agreements backed by Treasury securities. In addition, on April 17, 2023 the Company entered into an amendment (the “April 2023 Amendment”) of the Securitization Facility (as defined below) and amended the interest rate from LIBOR to SOFR indexed rate. (See Note 6, Debt). In March 2023, the Company entered into a basis swap where the Company receives Term SOFR and pays LIBOR to convert the portfolio of interest rate swaps from LIBOR to SOFR. Integra has elected to adopt the optional expedient under Topic 848, which will allow the interest rate swap hedging relationship to continue, without de-designation, due to the change in the indexed rate from LIBOR to SOFR. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures which enhances the transparency of income tax disclosures by expanding annual disclosure requirements related to the rate reconciliation and income taxes paid. The amendments are effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company does not plan to early adopt and is currently evaluating this ASU to determine its impact on the Company’s disclosures. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which updates reportable segment disclosure requirements primarily through enhanced disclosures about significant segment expenses. The amendments are effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company does not plan to early adopt and is currently evaluating this ASU to determine its impact on the Company’s 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.

NET INCOME PER SHARE (Tables)

3 Months Ended

Mar. 31, 2024

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,
Dollars in thousands, except per share amounts		2024		2023
Basic net (loss) income per share:
Net (loss) income		$	(3,281)	$	24,226
Weighted average common shares outstanding		77,735		81,871

Basic net (loss) income per common share		$	(0.04)	$	0.30

Diluted net (loss) income per share:
Net (loss) income		$	(3,281)	$	24,226

Weighted average common shares outstanding — Basic		77,735		81,871
Effect of dilutive securities:
Stock options and restricted stock		—		452
Weighted average common shares for diluted earnings per share		77,735		82,323

Diluted net (loss) income per common share		$	(0.04)	$	0.29

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 5,734	$ 4,319
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 746	$ 1,721

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Total revenue, net	$ 368,872	$ 380,846
Costs and expenses:
Cost of goods sold	162,038	147,975
Research and development	26,965	26,724
Selling, general and administrative	165,798	166,657
Intangible asset amortization	10,107	3,108
Total costs and expenses	364,908	344,464
Operating income	3,964	36,382
Interest income	5,040	4,107
Interest expense	(13,624)	(12,100)
Other (expense) income, net	(610)	1,389
(Loss) income before income taxes	(5,230)	29,778
(Benefit) provision for income taxes	(1,949)	5,552
Net (loss) income	$ (3,281)	$ 24,226
Net (loss) income per share
Basic (in dollars per share)	$ (0.04)	$ 0.30
Diluted (in dollars per share)	$ (0.04)	$ 0.29
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	77,735	81,871
Diluted (in shares)	77,735	82,323
Comprehensive income (See Note 14)	$ 1,179	$ 21,028

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Equity [Abstract]
Net (loss) income	$ (3,281)	$ 24,226
Foreign currency translation adjustment	730	3,192
Change in unrealized loss/(gain) on derivatives, net of tax	3,735	(6,493)
Pension liability adjustment, net of tax	(5)	103
Comprehensive income, net	$ 1,179	$ 21,028

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/exampleRef
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-URI https://asc.fasb.org//1943274/2147480167/946-830-55-10

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 5,050	$ 4,879
Preferred stock, par value (in dollars per share)	$ 0	$ 0
Preferred stock, authorized shares (in shares)	15,000,000	15,000,000
Preferred stock, outstanding shares (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, authorized shares (in shares)	240,000,000	240,000,000
Common stock, issued shares (in shares)	91,484,000	90,920,000
Treasury stock (in shares)	12,735,000	12,751,000

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) € in Thousands, SFr in Thousands, $ in Thousands	Mar. 31, 2024 USD ($)	Mar. 31, 2024 CHF (SFr)	Mar. 31, 2024 EUR (€)	Dec. 31, 2023 USD ($)	Dec. 31, 2023 CHF (SFr)	Dec. 31, 2023 EUR (€)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount							$ 471,600	SFr 420,100
Designated as Hedging Instrument \| Net Investment Hedges \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ (26,891)			$ (49,609)
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,459			2,475
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 \| €			€ 38,820			€ 38,820
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000			45,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ (29,614)			(48,047)
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 \| €			€ 288,210			€ 288,210
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	1.94%	1.94%	1.94%
Aggregate Notional Amount	$ 300,000			300,000
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ (736)			(4,037)
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 \| SFr		SFr 66,525			SFr 66,525
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Rate	2.54%	2.54%	2.54%
Aggregate Notional Amount	$ 75,000			$ 75,000

NET INCOME PER SHARE

3 Months Ended

Mar. 31, 2024

Earnings Per Share [Abstract]

NET INCOME PER SHARE

Basic and diluted net income per share was as follows:


	Three Months Ended March 31,
Dollars in thousands, except per share amounts		2024		2023
Basic net (loss) income per share:
Net (loss) income		$	(3,281)	$	24,226
Weighted average common shares outstanding		77,735		81,871

Basic net (loss) income per common share		$	(0.04)	$	0.30

Diluted net (loss) income per share:
Net (loss) income		$	(3,281)	$	24,226

Weighted average common shares outstanding — Basic		77,735		81,871
Effect of dilutive securities:
Stock options and restricted stock		—		452
Weighted average common shares for diluted earnings per share		77,735		82,323

Diluted net (loss) income per common share		$	(0.04)	$	0.29

Basic earnings per share is computed by dividing net income by the weighted-average common shares outstanding during the period. Diluted earnings per share is computed based on the weighted-average common shares outstanding plus the effect of dilutive potential common shares outstanding during the period calculated using the treasury stock method. Dilutive potential common shares include employee equity share options, non-vested shares, and similar equity instruments granted by the Company. Potential common share equivalents have been excluded where their inclusion would be anti-dilutive.

Common stock of approximately 1.3 million and 0.3 million shares at March 31, 2024, and 2023, respectively, were not included in the computation of diluted net (loss) income per share because their effect would have been anti-dilutive.

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) $ in Thousands, SFr in Millions	Mar. 31, 2024 USD ($)	Mar. 31, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 62,404		$ 50,330
Total derivatives designated as hedges — Liabilities	49,342		97,055
Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,475,000		1,475,000
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,500,000		1,500,000
Interest rate 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	14,188		14,675
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	40,998		30,710
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	540		579
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	1,586		1,250
Cross-currency swap
Derivatives, Fair Value [Line Items]
Current notional amount				$ 471,600	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	680		537
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	0		0
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	2,578		4,813
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	10,582		36,396
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	4,084		2,938
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	2,454		1,470
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	0		2,903
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	33,427		51,114
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount \| SFr		SFr 13.3
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 629		$ 0

REVENUES FROM CONTRACTS WITH CUSTOMERS

3 Months Ended

Mar. 31, 2024

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 Estimates

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

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

The Company’s return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally 90 days.

In 2023, due to the voluntary recall of all products manufactured at the Boston facility, including PriMatrix®, SurgiMend®, Revize™, and TissueMend™ (the “Boston recall”), the Company recorded a total of $18.7 million provision for product returns. As of March 31, 2024, the Company has credited $16.7 million to customers and holds a remaining return reserve of $2.0 million.

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 other current assets account in the consolidated balance sheets.

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, 2024:




Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2024	$	9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)

Contract asset, net of transferred to trade receivables on contracts during the period	7,478
Contract asset, March 31, 2024	$	7,478

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(3,523)
Contract liability, net of revenue recognized on contracts during the period	2,017
Foreign currency translation	(63)
Contract liability, March 31, 2024	$	14,683

At March 31, 2024, the short-term portion of the contract liability of $7.8 million and the long-term portion of $6.9 million are included in current liabilities and other liabilities, respectively, in the consolidated balance sheets.

As of March 31, 2024, the Company is expected to recognize revenue of approximately 53% of unsatisfied (or partially unsatisfied) performance obligations as revenue within 12 months, with the remaining balance to be recognized 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, 2024 and 2023 (dollar amounts in thousands):


	Three Months Ended March 31, 2024		Three Months Ended March 31, 2023
Neurosurgery	$	202,268	$	192,870
Instruments	54,166		55,266
Total Codman Specialty Surgical	256,434		248,136

Wound Reconstruction and Care	80,877		100,940
Private Label	31,561		31,770
Total Tissue Technologies	112,438		132,710
Total revenue	$	368,872	$	380,846

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.

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Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

3 Months Ended

Mar. 31, 2024

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, 2024 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at December 31, 2023	$	666,937	$	388,525	$	1,055,462

Foreign currency translation	(9,622)		(5,605)		(15,227)
Goodwill at March 31, 2024	$	657,315	$	382,920	$	1,040,235

Schedule of Finite-Lived Intangible Assets

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


	March 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,209,921	$	(460,545)	$	749,376
Customer relationships	12 years	$	167,360	$	(134,587)	$	32,773
Trademarks/brand names	28 years	$	97,668	$	(39,330)	$	58,338
Codman tradename	Indefinite	$	168,678	$	—	$	168,678
Supplier relationships	30 years	$	30,211	$	(18,393)	$	11,818
All other	11 years	$	6,052	$	(4,426)	$	1,626
		$	1,679,890	$	(657,281)	$	1,022,609


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman tradename	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

Schedule of Indefinite-Lived Intangible Assets

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


	March 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,209,921	$	(460,545)	$	749,376
Customer relationships	12 years	$	167,360	$	(134,587)	$	32,773
Trademarks/brand names	28 years	$	97,668	$	(39,330)	$	58,338
Codman tradename	Indefinite	$	168,678	$	—	$	168,678
Supplier relationships	30 years	$	30,211	$	(18,393)	$	11,818
All other	11 years	$	6,052	$	(4,426)	$	1,626
		$	1,679,890	$	(657,281)	$	1,022,609


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman tradename	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

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+ Details

INCOME TAXES

3 Months Ended

Mar. 31, 2024

Income Tax Disclosure [Abstract]

INCOME TAXES

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


	Three Months Ended March 31,
		2024		2023
Reported tax rate		37.3	%	18.6	%

The Company’s effective income tax rates for the three months ended March 31, 2024 and 2023 were 37.3% and 18.6%, respectively. For the three months ended March 31, 2024, the higher tax rate is attributable to a $1.5 million shortfall from stock based compensation, offset by a tax benefit for the intangible asset impairment, as compared to previous year. The Company does not have tax basis in the impaired intangible asset and has treated the tax impact as a discrete event in this quarter.

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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-Section 50
-Paragraph 13
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+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Number of days from shipment to issue a credit	90 days
Product returns provision	$ 18,700
Product returns, payments	16,700
Product returns, reserve	2,000
Short-term portion of contract liability	7,841	$ 8,540
Long-term portion of contract liability	$ 6,900
Product warranty period (up to)	2 years

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023	Oct. 18, 2023	Aug. 15, 2023	Jul. 18, 2023	Jun. 30, 2023	Jan. 26, 2023	Apr. 26, 2022
Class of Stock [Line Items]
Treasury stock (in shares)	12,735,000	12,751,000
Treasury stock	$ 646,422	$ 647,262
Treasury stock, average cost per share (in dollars per share)	$ 50.76	$ 50.76
Accelerated share repurchase program, receipt (payment)				$ 125,000			$ 150,000
Accelerated share repurchases, shares received at inception (in shares)				2,300,000			2,100,000
Accelerated share repurchases, percentage of expected total repurchased				80.00%			80.00%
Accelerated share repurchases, additional shares received (in shares)			900,000			600,000
2022 Share Repurchase Program
Class of Stock [Line Items]
Stock repurchase program, authorized amount								$ 225,000
Remaining amount under share repurchase					$ 75,000
2023 Share Repurchase Program
Class of Stock [Line Items]
Stock repurchase program, authorized amount					$ 225,000
Remaining amount under share repurchase	$ 100,000

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Total Revenues	$ 368,872	$ 380,846
United States
Segment Reporting Information [Line Items]
Total Revenues	256,229	271,002
Europe
Segment Reporting Information [Line Items]
Total Revenues	41,596	41,064
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	49,545	50,473
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 21,502	$ 18,307

- Definition

+ References

+ Details

DEBT - Contractual Maturity Table (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Debt Disclosure [Abstract]
Remainder of 2024	$ 14,531
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,532
Total long-term debt	$ 775,000

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)
Contract asset, net of transferred to trade receivables on contracts during the period	7,478
Contract asset, End of Period	7,478
Contract Liability
Contract liability, beginning of period	16,252
Recognition of revenue included in beginning of year contract liability	(3,523)
Contract liability, net of revenue recognized on contracts during the period	2,017
Foreign currency translation	(63)
Contract liability, end of period	$ 14,683

INCOME TAXES (Tables)

3 Months Ended

Mar. 31, 2024

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,
		2024		2023
Reported tax rate		37.3	%	18.6	%

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

3 Months Ended

Mar. 31, 2024

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, 2024:




Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2024	$	9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)

Contract asset, net of transferred to trade receivables on contracts during the period	7,478
Contract asset, March 31, 2024	$	7,478

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(3,523)
Contract liability, net of revenue recognized on contracts during the period	2,017
Foreign currency translation	(63)
Contract liability, March 31, 2024	$	14,683

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three months ended March 31, 2024 and 2023 (dollar amounts in thousands):


	Three Months Ended March 31, 2024		Three Months Ended March 31, 2023
Neurosurgery	$	202,268	$	192,870
Instruments	54,166		55,266
Total Codman Specialty Surgical	256,434		248,136

Wound Reconstruction and Care	80,877		100,940
Private Label	31,561		31,770
Total Tissue Technologies	112,438		132,710
Total revenue	$	368,872	$	380,846

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, 2024	Mar. 31, 2023
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 15,755	$ 12,895
Change in fair value of contingent consideration liabilities	(83)	3,299
Balance, End of Period	15,672	16,194
Arkis \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	7,562	4,388
Arkis \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	8,110	11,806
Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	2,557	230
Change in fair value of contingent consideration liabilities	39	0
Balance, End of Period	2,596	230
Derma Sciences \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	0	0
Derma Sciences \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	2,596	230
ACell
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	300	3,700
Change in fair value of contingent consideration liabilities	0	(2,200)
Balance, End of Period	300	1,500
ACell \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	0	0
ACell \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	300	1,500
Surgical Innovation Associates, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	68,700	57,607
Change in fair value of contingent consideration liabilities	500	3,600
Balance, End of Period	69,200	61,207
Surgical Innovation Associates, Inc. \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	29,300	12,500
Surgical Innovation Associates, Inc. \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	$ 39,900	$ 48,707

NET INCOME PER SHARE - Narrative (Details) - shares shares in Millions	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Shares excluded from computation as their effect would be antidilutive (in shares)	1.3	0.3

DEBT - Maximum Total Leverage Ratio Table (Details) - Senior Credit Facility	Mar. 24, 2023
March 31, 2023 through December 31, 2024
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.50
March 31, 2025 through June 30, 2026
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.25
September 30, 2026 and the last day of each fiscal quarter thereafter
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.00

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 835
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Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-04-01	Mar. 31, 2024
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation, percentage	53.00%
Performance obligations expected to be satisfied, expected timing	12 months

RETIREMENT PLANS	3 Months Ended
RETIREMENT PLANS	Mar. 31, 2024
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, 2024 were $0.4 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, 2024 are included in other income, 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, 2023 were $0.3 million. The components of the net periodic benefit costs other than the service cost component of $0.5 million for the three months ended March 31, 2023 are included in other income, net in the consolidated statements of operations. The estimated fair values of plan assets were $40.4 million and $45.7 million as of March 31, 2024 and December 31, 2023, respectively. The net plan assets of the pension plans are invested in common trusts as of March 31, 2024 and December 31, 2023. 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. 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 were $5.7 million and $6.1 million as of March 31, 2024 and December 31, 2023, respectively. Offsetting liabilities relating to the deferred compensation plan are included in other liabilities.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 1
-Subparagraph (l)
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+ Details

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

3 Months Ended

Mar. 31, 2024

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, 2024 and 2023 are as follows:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
Segment Net Sales
Codman Specialty Surgical		$	256,434	$	248,136
Tissue Technologies		112,438		132,710
Total revenues		$	368,872	$	380,846
Segment Profit
Codman Specialty Surgical		$	103,492	$	110,933
Tissue Technologies		30,666		52,281
Segment profit		134,158		163,214
Amortization		(10,107)		(3,108)
Corporate and other		(120,087)		(123,724)
Operating income		$	3,964	$	36,382

Total revenue by major geographic area consisted of the following:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
United States		$	256,229	$	271,002
Europe		41,596		41,064
Asia Pacific		49,545		50,473
Rest of World		21,502		18,307
Total Revenues		$	368,872	$	380,846

Schedule of Geographic Revenue by Area

Net sales and profit by each reportable segment for the three months ended March 31, 2024 and 2023 are as follows:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
Segment Net Sales
Codman Specialty Surgical		$	256,434	$	248,136
Tissue Technologies		112,438		132,710
Total revenues		$	368,872	$	380,846
Segment Profit
Codman Specialty Surgical		$	103,492	$	110,933
Tissue Technologies		30,666		52,281
Segment profit		134,158		163,214
Amortization		(10,107)		(3,108)
Corporate and other		(120,087)		(123,724)
Operating income		$	3,964	$	36,382

Total revenue by major geographic area consisted of the following:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
United States		$	256,229	$	271,002
Europe		41,596		41,064
Asia Pacific		49,545		50,473
Rest of World		21,502		18,307
Total Revenues		$	368,872	$	380,846

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Lessee, Lease, Description [Line Items]
ROU assets	$ 151,834	$ 156,184
Current lease liabilities	16,303	15,284
Non-current lease liabilities	170,082	166,849
Total lease liabilities	$ 186,385	$ 182,133
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	16 years 6 months	16 years 3 months 18 days
Weighted average discount rate	5.70%	5.90%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 1 month 6 days	1 year 10 months 24 days
Weighted average discount rate	2.70%	2.70%

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net (Loss) Income	$ (3,281)	$ 24,226

- Definition

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

+ References

+ Details

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Finished goods	$ 192,287	$ 196,402
Work in process	83,334	74,035
Raw materials	127,801	119,171
Inventories, net	$ 403,422	$ 389,608

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ 32,899
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	31,204
Other Income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	27,200
Interest income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ 5,700

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

COMMITMENTS AND CONTINGENCIES (Tables)

3 Months Ended

Mar. 31, 2024

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, 2024 and March 31, 2023 is as follows (in thousands):


Three Months Ended March 31, 2024	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates (SIA), Inc.			Location in Financial Statements
Balance as of January 1, 2024	$	15,755		$	2,557	$	300		68,700
Change in fair value of contingent consideration liabilities	(83)		Research and development	39		—			500			Selling, general and administrative
Balance as of March 31, 2024	15,672			2,596		300			69,200

Short-Term	$	7,562		$	—	$	—		$	29,300		Accrued expenses and other current liabilities
Long-Term	8,110			2,596		300			39,900			Other liabilities
Total	15,672			2,596		300			69,200


Three Months Ended March 31, 2023	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates (SIA), Inc.		Location in Financial Statements
Balance as of January 1, 2023	$	12,895		$	230	$	3,700	$	57,607
Change in fair value of contingent consideration liabilities	3,299		Research and development	—		(2,200)		3,600		Selling, general and administrative
Balance as of March 31, 2023	$	16,194		$	230	$	1,500	$	61,207

Short-Term	$	4,388		$	—	$	—	$	12,500	Accrued expenses and other current liabilities
Long-Term	11,806			230		1,500		48,707		Other liabilities
Total	16,194			230		1,500		61,207

ACQUISITIONS AND DIVESTITURES	3 Months Ended
ACQUISITIONS AND DIVESTITURES	Mar. 31, 2024
Mergers, Acquisitions and Dispositions [Abstract]
ACQUISITIONS AND DIVESTITURES	ACQUISITIONS AND DIVESTITURES Acquisition of Acclarent Inc. In December 2023, the Company entered into a definitive agreement to acquire Acclarent, Inc. (“Acclarent”) from Ethicon, Inc., a subsidiary of Johnson & Johnson, for $275.0 million in cash at closing, subject to customary purchase price adjustments, and an additional $5.0 million contingent upon the achievement of a regulatory milestone, which was achieved prior to closing. Acclarent is a developer and marketer of medical devices used in Ear, Nose, Throat (“ENT”) procedures. Acclarent’s results of operations will be reported in the Company’s Codman Specialty Surgical reportable segment from the date of acquisition. On April 1, 2024, the Company successfully completed the acquisition of 100% of Acclarent for approximately $282.0 million in cash, subject to customary adjustments set forth in the purchase agreement related to working capital balances transferred to the Company. To facilitate the completion of the acquisition of Acclarent, the Company drew from the revolving portion of the Senior Credit Facility during the three months ended March 31, 2024. For further detail on the Company’s additional borrowings, see Note 6. Debt.

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended
INCOME TAXES - Summary of Effective Tax Rate (Details)	Mar. 31, 2024	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Reported tax rate	37.30%	18.60%

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, 2024	Mar. 31, 2023
Basic net (loss) income per share:
Net (loss) income	$ (3,281)	$ 24,226
Weighted average common shares outstanding - basic (in shares)	77,735	81,871
Basic net (loss) income per common share (in dollars per share)	$ (0.04)	$ 0.30
Diluted net (loss) income per share:
Net (loss) income	$ (3,281)	$ 24,226
Weighted average common shares outstanding - basic (in shares)	77,735	81,871
Effect of dilutive securities:
Stock options and restricted stock (in shares)	0	452
Weighted average common shares for diluted earnings per share (in shares)	77,735	82,323
Diluted net (loss) income per common share (in dollars per share)	$ (0.04)	$ 0.29

- Definition

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

+ References

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- 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.

+ References

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+ Details

- Definition

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

+ References

+ Details

DERIVATIVE INSTRUMENTS - Narrative (Details) $ in Thousands, SFr in Millions	3 Months Ended
	Mar. 31, 2024 USD ($)	Mar. 31, 2024 CHF (SFr)	Mar. 31, 2023 USD ($)	May 02, 2024 USD ($)	May 02, 2024 CHF (SFr)	Mar. 31, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Sep. 22, 2023 USD ($)	Sep. 22, 2023 CHF (SFr)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Derivative [Line Items]
Gain expected to be reclassified to earnings in the next twelve months	$ 4,100
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCI, change in fair value	68,546		$ (7,462)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	38,784		2,092
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount	1,475,000						$ 1,475,000
Estimated Fair Value	53,059						43,556
Cross-currency swap
Derivative [Line Items]
Gain (loss) reclassified into other income	1,300		1,500
Gain expected to be reclassified to earnings in the next twelve months	(1,900)
Current notional amount											$ 471,600	SFr 420.1
Intercompany loan quarterly payments \| SFr		SFr 5.8
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	30,100		4,900
Cross-currency swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other income, net
Derivative [Line Items]
Gain (loss) recorded in AOCI, change in fair value	29,532		2,191
Amount of Gain (Loss) Reclassified from AOCI into Earnings	31,473		(3,504)
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	2,200		2,100
Estimated Fair Value	(26,891)						(49,609)
Cross-currency swap \| Codman
Derivative [Line Items]
Notional amount settled \| SFr									SFr 20.0
Cross-currency swap \| Codman \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Estimated Fair Value	(12,480)						(40,672)
Cross-currency swap \| Short \| Codman
Derivative [Line Items]
Notional amount terminated								$ 48,500
Current notional amount								$ 31,500	SFr 28.5
Foreign currency swaps \| Not Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount	5,500									$ 7,300
Estimated Fair Value	1,500						1,200
Foreign currency swaps \| Net Investment Hedges \| Designated as Hedging Instrument \| Subsequent Event
Derivative [Line Items]
Current notional amount				$ 75,000	SFr 68.5
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount \| SFr						SFr 13.3
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Cost of Sales
Derivative [Line Items]
Gain (loss) recorded in AOCI, change in fair value	(629)		(69)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(110)
Interest Rate Swap
Derivative [Line Items]
Gain expected to be reclassified to earnings in the next twelve months	13,600
Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Other comprehensive income (loss), cash flow hedge, gain (loss), after reclassification and tax	14,700		(10,500)
Gain (loss) reclassified into other income	5,200		$ 3,500
Current notional amount	$ 1,500,000						$ 1,500,000

RETIREMENT PLANS - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Retirement Benefits [Abstract]
Net periodic benefit costs	$ 0.4	$ 0.3
Service cost component	0.8	$ 0.5
Estimated fair value of plan assets	$ 40.4		$ 45.7
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	$ 5.7		$ 6.1

- 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

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDERS' EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Retained Earnings
Balance, beginning of period, (in shares) at Dec. 31, 2022		90,476,000
Balance, beginning of period at Dec. 31, 2022	$ 1,804,403	$ 905	$ (362,862)	$ 1,276,977	$ 10,265	$ 879,118
Balance, beginning of period, treasury stock (in shares) at Dec. 31, 2022			(6,823,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (Loss) Income	24,226					24,226
Other comprehensive income (loss), net of tax	(3,198)				(3,198)
Issuance of common stock through employee stock purchase plan (in shares)		21,000
Issuance of common stock through employee stock purchase plan	1,107			1,107
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		316,000	16,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(4,011)	$ 1	$ 846	(4,858)
Share-based compensation	3,611	$ 2		3,609
Accelerated shares repurchased (shares)			(2,111,000)
Accelerated shares repurchased	(151,200)		$ (119,662)	(31,538)
Balance, end of period (in shares) at Mar. 31, 2023		90,813,000
Balance, end of period at Mar. 31, 2023	1,674,938	$ 908	$ (481,678)	1,245,297	7,067	903,344
Balance, beginning of period, treasury stock (in shares) at Mar. 31, 2023			(8,918,000)
Balance, beginning of period, (in shares) at Dec. 31, 2023		90,920,000
Balance, beginning of period at Dec. 31, 2023	$ 1,587,884	$ 909	$ (647,262)	1,302,484	(15,106)	946,859
Balance, beginning of period, treasury stock (in shares) at Dec. 31, 2023	(12,751,000)		(12,751,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (Loss) Income	$ (3,281)					(3,281)
Other comprehensive income (loss), net of tax	4,460				4,460
Issuance of common stock through employee stock purchase plan (in shares)		23,000
Issuance of common stock through employee stock purchase plan	965			965
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		541,000	16,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	2,312	$ 2	$ 840	1,470
Share-based compensation	5,612	$ 4		5,608
Accelerated shares repurchased	0
Balance, end of period (in shares) at Mar. 31, 2024		91,484,000
Balance, end of period at Mar. 31, 2024	$ 1,597,952	$ 915	$ (646,422)	$ 1,310,527	$ (10,646)	$ 943,578
Balance, beginning of period, treasury stock (in shares) at Mar. 31, 2024	(12,735,000)		(12,735,000)

DERIVATIVE INSTRUMENTS - Schedule of Derivative Instruments (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Derivative [Line Items]
Notional Amount	$ 1,475,000	$ 1,475,000
Estimated Fair Value	53,059	43,556
Interest Rate Swap Designated March 31, 2023
Derivative [Line Items]
Notional Amount	0	0
Estimated Fair Value	(2,127)	(1,829)
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 150,000	150,000
Fixed Interest Rate	2.423%
Estimated Fair Value	$ 1,125	2,105
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional Amount	$ 200,000	200,000
Fixed Interest Rate	2.313%
Estimated Fair Value	$ 4,341	4,978
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.22%
Estimated Fair Value	$ 1,556	1,349
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.199%
Estimated Fair Value	$ 1,548	1,312
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.209%
Estimated Fair Value	$ 1,548	1,346
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 100,000	100,000
Fixed Interest Rate	2.885%
Estimated Fair Value	$ 4,512	3,015
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 100,000	100,000
Fixed Interest Rate	2.867%
Estimated Fair Value	$ 4,519	3,052
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 15, 2020 Tranche 1
Derivative [Line Items]
Notional Amount	$ 575,000	575,000
Fixed Interest Rate	1.415%
Estimated Fair Value	$ 29,267	22,965
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Interest Rate Swap Designated December 15, 2020 Tranche 2
Derivative [Line Items]
Notional Amount	$ 125,000	125,000
Fixed Interest Rate	1.404%
Estimated Fair Value	$ 6,770	$ 5,263

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

LEASES AND RELATED PARTY LEASES - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($) renewalOption	Mar. 31, 2023 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewalOption	1
Operating lease expense	$ 6.3	$ 6.0
Related Party
Operating Leased Assets [Line Items]
Operating lease expense	$ 0.3	$ 0.3
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
Related Party \| 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
Related Party \| 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

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
OPERATING ACTIVITIES:
Net (Loss) Income	$ (3,281)	$ 24,226
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	30,566	31,143
Non-cash impairment charges	7,064	0
Deferred income tax provision (benefit)	(2,856)	1,953
Share-based compensation	5,599	3,620
Amortization of debt issuance costs and expenses associated with debt refinancing	1,398	1,890
Non-cash lease expense	149	1,260
Loss (gain) on disposal of property and equipment	12	(23)
Change in fair value of contingent consideration and others	456	4,699
Changes in assets and liabilities:
Accounts receivable	16,827	10,041
Inventories	(19,021)	(25,423)
Prepaid expenses and other current assets	(2,676)	(2,164)
Other non-current assets	339	(6,009)
Accounts payable, accrued expenses and other current liabilities	(19,210)	(4,984)
Contract liabilities	(1,498)	430
Other non-current liabilities	1,888	(14,503)
Net cash provided by operating activities	15,756	26,156
INVESTING ACTIVITIES:
Purchases of property and equipment	(15,465)	(13,704)
Purchases of Investments	(38,500)	0
Net cash used in investing activities	(53,965)	(13,704)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	370,500	10,200
Payments on debt	(15,100)	(12,400)
Payment of debt issuance costs	0	(7,578)
Purchases of treasury stock	0	(150,000)
Proceeds from exercised stock options	6,398	2,326
Cash taxes paid in net equity settlement	(3,122)	(5,231)
Net cash provided by (used in) financing activities	358,676	(162,683)
Effect of exchange rate changes on cash and cash equivalents	(4,963)	937
Net increase (decrease) in cash and cash equivalents	315,504	(149,294)
Cash and cash equivalents at beginning of period	276,402	456,661
Cash and cash equivalents at end of period	$ 591,906	$ 307,367

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)
Goodwill [Roll Forward]
Beginning of period	$ 1,055,462
Foreign currency translation	(15,227)
End of period	1,040,235
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of period	666,937
Foreign currency translation	(9,622)
End of period	657,315
Tissue Technologies
Goodwill [Roll Forward]
Beginning of period	388,525
Foreign currency translation	(5,605)
End of period	$ 382,920

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

GOODWILL AND OTHER INTANGIBLE ASSETS

3 Months Ended

Mar. 31, 2024

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, 2024 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at December 31, 2023	$	666,937	$	388,525	$	1,055,462

Foreign currency translation	(9,622)		(5,605)		(15,227)
Goodwill at March 31, 2024	$	657,315	$	382,920	$	1,040,235

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

The Company tests for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass this qualitative evaluation for some or all of its reporting units and perform a quantitative test. The quantitative test estimates the fair value of the reporting unit using a

discounted cash flow model, which incorporates significant estimates and assumptions made by management which, by their nature, are characterized by uncertainty.

Due to third-party audit findings and an update to the estimated timeframe to resume the commercial distribution of products manufactured in the Boston facility, the Company elected to perform a quantitative analysis of its Tissue Technologies reporting unit in the first quarter of 2024 in accordance with ASC 350. The quantitative test estimates the fair value of the reporting unit using a discounted cash flow model, which incorporates significant estimates and assumptions made by management with respect to future revenue and expense growth rates and discount rates which, by their nature, are characterized by uncertainty. An impairment loss is recognized when the reporting unit’s carrying amount exceeds its estimated fair value. The quantitative test utilized a terminal growth rate of 2%, a discount rate of 15%, and a range and application of the company guideline multiples. The Company determined, after performing the quantitative analysis, that the fair value of the Tissue Technologies reporting unit was not less than its carrying amount, with 20% headroom.

Other Intangible Assets

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


	March 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,209,921	$	(460,545)	$	749,376
Customer relationships	12 years	$	167,360	$	(134,587)	$	32,773
Trademarks/brand names	28 years	$	97,668	$	(39,330)	$	58,338
Codman tradename	Indefinite	$	168,678	$	—	$	168,678
Supplier relationships	30 years	$	30,211	$	(18,393)	$	11,818
All other	11 years	$	6,052	$	(4,426)	$	1,626
		$	1,679,890	$	(657,281)	$	1,022,609


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman tradename	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

Total amortization of intangible assets for the three months ended March 31, 2024 was $27.7 million. Of these amounts, $17.6 million was related to amortization of technology based intangibles and included in cost of goods sold. $7.1 million related to the impairment of a customer relationship intangible and the remainder were included in intangible amortization in the statement of operations.

Total amortization of intangible assets for the three months ended March 31, 2023 was $20.6 million. Of these amounts, $17.5 million was related to amortization of technology based intangibles and included in cost of goods sold, with the remainder included in intangible amortization in the statement of operations.

Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of goods sold) is expected to be approximately $60.1 million for the remainder of 2024, $80.2 million in 2025, $80.0 million in 2026, $79.1 million in 2027, $78.7 million in 2028, $74.9 million in 2029 and $403.5 million thereafter.

The Company periodically performs testing for impairment on certain long-lived assets whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable.

LEASES AND RELATED PARTY LEASES

3 Months Ended

Mar. 31, 2024

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, 2024. 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, 2024 and March 31, 2023 was $6.3 million and $6.0 million, respectively, which includes $0.3 million, in related party operating lease expense.

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


Dollars in thousands, except lease term and discount rate	March 31, 2024			December 31, 2023
ROU assets	$	151,834		$	156,184

Current lease liabilities	16,303			15,284
Non-current lease liabilities	170,082			166,849
Total lease liabilities	$	186,385		$	182,133

Weighted average remaining lease term (in years):
Leased facilities	16.5 years			16.3 years
Leased vehicles	2.1 years			1.9 years

Weighted average discount rate:
Leased facilities	5.7		%	5.9		%
Leased vehicles	2.7		%	2.7		%

Supplemental cash flow information related to leases for the three months ended March 31, 2024 and 2023 were as follows:


Dollars in thousands	March 31, 2024		March 31, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	5,734	$	4,319

ROU assets obtained in exchange for lease liabilities:
Operating leases	$	746	$	1,721

Future minimum lease payments under operating leases at March 31, 2024 were as follows:


Dollars in thousands	Related Parties		Third Parties		Total
Remainder of 2024	$	222	$	17,884	$	18,106
2025	296		22,859		23,155
2026	296		20,210		20,506
2027	296		18,892		19,188
2028	296		16,603		16,899
2029	246		15,771		16,017
Thereafter	—		163,479		163,479
Total minimum lease payments	$	1,652	$	275,698	$	277,350
Less: Imputed interest					90,965
Total lease liabilities					186,385
Less: Current lease liabilities					16,303
Long-term lease liabilities					170,082

There were no future minimum lease payments under finance leases at March 31, 2024.

Related Party Leases

The Company leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a principal stockholder of the Company. The term of the current lease agreement is through October 31, 2029 at an annual rate of approximately $0.3 million. 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.

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)
Goodwill [Line Items]
Amortization	$ 27,700	$ 20,600
Expected annual amortization expense, remainder of 2024	60,100
Expected annual amortization expense, in 2025	80,200
Expected annual amortization expense, in 2026	80,000
Expected annual amortization expense, in 2027	79,100
Expected annual amortization expense, in 2028	78,700
Expected annual amortization expense, in 2029	74,900
Expected annual amortization expense, thereafter	403,500
Non-cash impairment charges	7,064	0
Intangible assets, net	$ 1,022,609		$ 1,067,833
Tissue Technologies
Goodwill [Line Items]
Fair value in excess of carrying amount, percent	20.00%
Measurement Input, Long-Term Revenue Growth Rate \| Valuation Technique, Discounted Cash Flow
Goodwill [Line Items]
Reporting unit, measurement input	0.02
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow
Goodwill [Line Items]
Reporting unit, measurement input	0.15
Customer Relationships
Goodwill [Line Items]
Non-cash impairment charges	$ 7,100
Completed technology
Goodwill [Line Items]
Cost, amortization	17,600	$ 17,500
Completed technology \| Completed Technology, Surgimend
Goodwill [Line Items]
Intangible assets, net	38,300
Completed technology \| Completed Technology, PriMatrix
Goodwill [Line Items]
Intangible assets, net	$ 27,700

DEBT - Narrative (Details)		3 Months Ended
DEBT - Narrative (Details)	Feb. 04, 2020 USD ($) $ / shares	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)	Dec. 15, 2023 USD ($)	Mar. 24, 2023 USD ($)	Dec. 09, 2020 USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility		$ 19,375,000		$ 14,531,000
Interest payments, remainder of fiscal year		39,300,000
Interest payments, year one		50,800,000
Interest payments, year two		48,100,000
Interest payments, year three		45,000,000
Interest payments, after year three		10,000,000
Securitization program outstanding borrowings, maximum limit		150,000,000
Transferor's interests in transferred financial assets, issuance costs					$ 300,000
Debt instrument, securitization facility, agreement term					3 years
Transferor's interests in transferred financial assets, unamortized issuance costs					$ 100,000
Secured long-term debt, securitization program		$ 94,600,000		$ 89,200,000
Weighted average interest rate, accounts receivable securitization revolving loan facility		6.50%		5.90%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value		$ 92,700,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity						$ 1,300,000,000
Debt issuance costs capitalized		7,600,000
Write off of debt issuance costs			$ 200,000
Line of credit facility outstanding		$ 420,000,000		$ 70,000,000
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						2,100,000,000
Senior Credit Facility \| Overnight Federal Funds
Debt Instrument [Line Items]
Interest rates available		0.50%
Senior Credit Facility \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Debt Instrument [Line Items]
Interest rate adjustment		0.10%
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 \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
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 \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Debt Instrument [Line Items]
Interest rates available		1.75%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding		$ 0
Letters of credit outstanding		1,700,000		1,700,000
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity						$ 775,000,000
Line of credit facility outstanding		$ 775,000,000		$ 775,000,000
Weighted average interest rate on debt		6.80%		6.80%
Term loan component of senior credit facility		$ 19,400,000		$ 14,500,000
Term Loan Facility \| Secured Debt \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		765,500,000
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Convertible notes, maximum borrowing capacity	$ 575,000,000	575,000,000.0
Convertible notes, interest rate	0.50%
Incremental financing costs capitalized	$ 13,200,000
Initial conversion rate	0.0135739
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%
Minimum settled in cash per principal amount							$ 1,000
Redemption price, percentage	100.00%
Warrant strike price (in dollars per share) \| $ / shares	$ 113.34
Fair value		$ 549,700,000
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

DERIVATIVE INSTRUMENTS - Schedule of Derivatives Not Designated as Hedging Instruments (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 273	$ 55
Foreign currency swaps
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 273	$ 55

INVENTORIES (Tables)

3 Months Ended

Mar. 31, 2024

Inventory Disclosure [Abstract]

Schedule of Inventories, Net

Inventories, net consisted of the following:


Dollars in thousands	March 31, 2024		December 31, 2023
Finished goods	$	192,287	$	196,402
Work in process	83,334		74,035
Raw materials	127,801		119,171
Total inventories, net	$	403,422	$	389,608

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details) SFr in Thousands, $ in Thousands	Mar. 31, 2024 USD ($)	Mar. 31, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Dec. 31, 2023 CHF (SFr)	Sep. 22, 2023 USD ($)	Sep. 22, 2023 CHF (SFr)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount							$ 471,600	SFr 420,100
Cross-currency swap \| Short \| Codman
Derivative [Line Items]
Aggregate Notional Amount					$ 31,500	SFr 28,500
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	$ 1,475,000		$ 1,475,000
Fair Value Asset (Liability)	53,059		43,556
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-currency swap \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	(12,480)		(40,672)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap One \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	$ (9,902)		(38,324)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap One \| Long \| Codman
Derivative [Line Items]
Fixed Rate	3.00%	3.00%
Aggregate Notional Amount \| SFr		SFr 333,887		SFr 351,137
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap One \| Short \| Codman
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 374,817		394,183
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Two \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	$ (2,578)		(2,348)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Two \| Long \| Codman
Derivative [Line Items]
Fixed Rate	2.40%	2.40%
Aggregate Notional Amount \| SFr		SFr 28,500		SFr 28,500
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Two \| Short \| Codman
Derivative [Line Items]
Fixed Rate	6.27%	6.27%
Aggregate Notional Amount	$ 31,457		$ 31,457

SEGMENT AND GEOGRAPHIC INFORMATION

3 Months Ended

Mar. 31, 2024

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, plastics & surgical reconstruction products, bone grafts, and nerve and tendon repair products.

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

The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions, and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by each reportable segment for the three months ended March 31, 2024 and 2023 are as follows:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
Segment Net Sales
Codman Specialty Surgical		$	256,434	$	248,136
Tissue Technologies		112,438		132,710
Total revenues		$	368,872	$	380,846
Segment Profit
Codman Specialty Surgical		$	103,492	$	110,933
Tissue Technologies		30,666		52,281
Segment profit		134,158		163,214
Amortization		(10,107)		(3,108)
Corporate and other		(120,087)		(123,724)
Operating income		$	3,964	$	36,382

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,
Dollars in thousands		2024		2023
United States		$	256,229	$	271,002
Europe		41,596		41,064
Asia Pacific		49,545		50,473
Rest of World		21,502		18,307
Total Revenues		$	368,872	$	380,846

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//280/tableOfContent

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 26
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-26

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 34
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-34

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

+ Details

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,679,890	$ 1,729,837
Accumulated Amortization	(657,281)	(662,004)
Net	1,022,609	1,067,833
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	168,678	174,531
Net	$ 168,678	$ 174,531
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	18 years	18 years
Cost	$ 1,209,921	$ 1,226,128
Accumulated Amortization	(460,545)	(448,519)
Net	$ 749,376	$ 777,609
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 167,360	$ 193,895
Accumulated Amortization	(134,587)	(152,160)
Net	$ 32,773	$ 41,735
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 97,668	$ 98,892
Accumulated Amortization	(39,330)	(38,754)
Net	$ 58,338	$ 60,138
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	30 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(18,393)	(18,148)
Net	$ 11,818	$ 12,063
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	11 years	11 years
Cost	$ 6,052	$ 6,180
Accumulated Amortization	(4,426)	(4,423)
Net	$ 1,626	$ 1,757

TREASURY STOCK	3 Months Ended
TREASURY STOCK	Mar. 31, 2024
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of March 31, 2024 and December 31, 2023, there were 12.7 million and 12.8 million shares of treasury stock outstanding with a cost of $646.4 million and $647.3 million, at a weighted average cost per share of $50.76 and $50.76, respectively. On August 15, 2023, the Company entered into a $125 million accelerated share repurchase (“August 2023 ASR”) and received 2.3 million shares of common stock at inception of the August 2023 ASR, which represented approximately 80% of the expected total shares under the August 2023 ASR. On October 18, 2023 the early exercise provision was exercised by the August 2023 ASR counterparty. The Company received an additional 0.9 million shares determined using the volume-weighted average price of the Company’s common stock during the term of the August 2023 ASR. On January 26, 2023, the Company entered into a $150 million accelerated share repurchase (“January 2023 ASR”) and received 2.1 million shares of common stock at inception of the January 2023 ASR, which represented approximately 80% of the expected total shares under the January 2023 ASR. The settlement of the January 2023 ASR agreement was completed in the second quarter of 2023, where the Company received 0.6 million shares, determined using the volume-weighted average price of the Company’s common stock during the term of the January 2023 ASR. On August 16, 2022, the Inflation Reduction Act of 2022 (the “Inflation Act”) was signed into law. The Inflation Act implements a new excise tax of 1% on the net share repurchases made by the Company effective for share repurchases performed January 1, 2023, or after. On July 18, 2023, the Board of Directors authorized a new $225 million share repurchase program, replacing the existing $225 million program authorized in April 2022, under which $75 million remained authorized at the time of its replacement. As of March 31, 2024, $100 million remained authorized. The program authorized in July 2023 allows the Company to repurchase its shares opportunistically from time to time. The Company may utilize various methods to effect any repurchases, including open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, including accelerated share repurchases, or a combination of the foregoing, some of which may be effected through Rule 10b5-1 plans. 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, and such repurchases may be discontinued at any time.

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Tables)

3 Months Ended

Mar. 31, 2024

Equity [Abstract]

Schedule of Comprehensive Income (Loss)

Comprehensive income for the three months ended March 31, 2024 and 2023:


	Three Months Ended March 31,
Dollars in thousands		2024		2023
Net (loss) income		$	(3,281)	$	24,226
Foreign currency translation adjustment		730		3,192
Change in unrealized loss/(gain) on derivatives, net of tax		3,735		(6,493)
Pension liability adjustment, net of tax		(5)		103
Comprehensive income, net		$	1,179	$	21,028

Schedule of Changes in Accumulated Other Comprehensive Loss by Component

Changes in accumulated other comprehensive income by component between December 31, 2023 and March 31, 2024 are presented in the table below, net of tax:


Dollars in thousands	Gains and Losses on Derivatives		Defined Benefit Pension Items		Foreign Currency Items		Total
Balance at January 1, 2024	$	21,489	$	2,712	$	(39,307)	$	(15,106)
Other comprehensive gain (loss)	34,939		(5)		2,425		37,359
Less: Amounts reclassified from accumulated other comprehensive income, net	31,204		—		1,695		32,899
Net current-period other comprehensive gain (loss)	3,735		(5)		730		4,460
Balance at March 31, 2024	$	25,224	$	2,707	$	(38,577)	$	(10,646)

DERIVATIVE INSTRUMENTS

3 Months Ended

Mar. 31, 2024

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 SOFR-indexed borrowings. In March 2023, the Company entered into a basis swap where the Company receives Term SOFR and pays daily compounded SOFR to convert the portfolio of swaps from daily compounded SOFR to term SOFR.

The Company held the following interest rate swaps as of March 31, 2024 and December 31, 2023 (dollar amounts in thousands):


	March 31, 2024		December 31, 2023							March 31, 2024			December 31, 2023
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month Term SOFR Loan	150,000		150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1,125			2,105
1-month Term SOFR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	4,341			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,556			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,548			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,548			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,512			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,519			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	29,267			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	6,770			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(2,127)		0	(1,829)
	$	1,475,000	$	1,475,000						$	53,059		$	43,556
(1) The notional of the basis swap amortizes to match the total notional of the interest rate swap portfolio over time

The interest rate 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 accumulated other comprehensive income (“AOCI”). For the three months ended March 31, 2024 and 2023, the Company recorded a gain of $14.7 million and a loss of $10.5 million, respectively, in AOCI related to the change in fair value of the interest rate swaps.

For the three months ended March 31, 2024 and 2023, the Company recorded gains of $5.2 million and $3.5 million, respectively, in the consolidated statements of operations related to the interest rate differential of the interest rate swaps. The estimated gain that is expected to be reclassified to interest income from AOCI as of March 31, 2024 within the next twelve months is $13.6 million.

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 AOCI, 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 AOCI 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 AOCI, net of tax. Those amounts are subsequently reclassified to earnings from AOCI 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.

The success of the Company’s hedging anticipated 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

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 (“CHFs”) and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in CHFs and receive U.S. dollars from the counterparties.

On September 22, 2023, the Company amended the Swiss franc denominated intercompany loan to partially settle CHF 20.0 million and extend the termination date to September 2024 and as a result, the Company terminated the cross-currency swap designated as cash flow hedge of an intercompany loan with aggregate notional amount of $48.5 million. Simultaneously, the Company entered into a cross-currency swap agreement to hedge a notional amount of CHF 28.5 million equivalent to $31.5 million of this amended intercompany loan into U.S. dollars. The loss recorded by the Company upon the settlement of the swap was not material for the period.

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 Company held the following cross-currency rate swaps as of March 31, 2024 and December 31, 2023 (dollar amounts in thousands):


					March 31, 2024	December 31, 2023	March 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	333,887	351,137	(9,902)		(38,324)
Receive U.S.$			3.98%	$	374,817	394,183




Pay CHF	September 22, 2023	September 29, 2024	2.40%	CHF	28,500	28,500	(2,578)		(2,348)
Receive U.S.$			6.27%	$	31,457	31,457

Total							$	(12,480)	$	(40,672)

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 AOCI. For the three months ended March 31, 2024 the Company recorded a gain of $30.1 million in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans. For the three months ended March 31, 2023, the Company recorded a loss of $4.9 million in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans.

For the three months ended March 31, 2024, the Company recorded a gain of $29.5 million in AOCI related to change in fair value of the cross-currency swaps. For the three months ended March 31, 2023, the Company recorded a gain of $2.2 million in AOCI related to change in fair value of the cross-currency swaps.

For the three months ended March 31, 2024, the Company recorded a gain of $1.3 million in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three months ended March 31, 2023, the Company recorded a gain of $1.5 million in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated loss that is expected to be reclassified to other income (expense), net from AOCI as of March 31, 2024 within the next twelve months is $1.9 million. As of March 31, 2024, the Company does not expect any gains or losses will be reclassified into earnings because the original forecasted transactions 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 May 24, 2022, and November 17, 2023, 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, 2024 and December 31, 2023, respectively (dollar amounts in thousands):


					March 31, 2024	December 31, 2023	March 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	3,459		2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	288,210	(29,614)		(48,047)
Receive U.S.$			1.94%	$	300,000	300,000

Pay CHF	November 21, 2023	December 17, 2029	—%	CHF	66,525	66,525	(736)		(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Total							$	(26,891)	$	(49,609)

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 AOCI. For the three months ended March 31, 2024, the Company recorded a gain of $24.9 million in AOCI related to the change in fair value of the cross-currency swaps. For the three months ended March 31, 2023, the Company recorded a gain of $1.0 million in AOCI related to change in fair value of the cross-currency swaps.

For the three months ended March 31, 2024, the Company recorded a gain of $2.2 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three months ended March 31, 2023, the Company recorded a gain of $2.1 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 AOCI as of March 31, 2024 within the next twelve months is $4.1 million.

On May 2, 2024, the Company entered into a cross-currency swap agreement with a notional amount of CHF 68.5 million, equivalent to $75.0 million, where the Company agreed with third-parties to sell Swiss francs in exchange for U.S. dollars at a specified rate at the maturity of the contract. The new cross-currency swap agreement was designated as a net investment hedge to partially offset the effects of foreign currency on foreign subsidiaries.

Foreign Currency Forward Contracts

The Company has entered into a hedge for forecasted intercompany purchases denominated in foreign currencies through the use of forward contracts designated as cash flow hedges. To the extent these forward contracts meet hedge accounting criteria, changes in their fair value are not included in accumulated comprehensive loss. These changes in fair value will be recognized into earnings as a component of cost of sales when the forecasted-transaction occurs.

In the first quarter of 2024, the Company entered into foreign currency forwards to mitigate the exchange rate risk of Swiss franc denominated intercompany purchases. These contracts typically settle at various dates within twelve months of execution. As of March 31, 2024 the notional amount of foreign currency forward contracts was CHF13.3 million. For the three months ended March 31, 2024 the Company recorded a loss of $0.6 million in AOCI related to the change in fair value of the foreign currency forward contracts and a loss of $0.1 million in cost of goods sold included in the consolidated statements of operations.

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, 2024 and December 31, 2023:


	Fair Value as of
Location on Balance Sheet (1):	March 31, 2024		December 31, 2023
Dollars in thousands
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap(2)	$	14,188	$	14,675
Cross-currency swap	680		537
Net Investment Hedges
Cross-currency swap	4,084		2,938
Other assets
Cash Flow Hedges
Interest rate swap(2)	40,998		30,710
Cross-currency swap	—		—
Net Investment Hedges
Cross-currency swap	2,454		1,470
Total derivatives designated as hedges — Assets	$	62,404	$	50,330

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	540	$	579
Cross-currency swap	2,578		4,813
Foreign currency forward contracts	629		—
Net Investment Hedges
Cross-currency swap	—		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	1,586		1,250
Cross-currency swap	10,582		36,396
Net Investment Hedges
Cross-currency swap	33,427		51,114
Total derivatives designated as hedges — Liabilities	$	49,342	$	97,055

(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, 2024 and December 31, 2023, the total notional amounts related to the Company’s interest rate swaps were $1.5 billion.


Dollars in thousands	Balance in AOCI Beginning of Quarter		Amount of Gain (Loss) Recognized in AOCI		Amount of Gain (Loss) Reclassified from AOCI into Earnings		Balance in AOCI End of Quarter		Location in Statements of Operations

















Three Months Ended March 31, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	14,723	$	5,219	$	53,060	Interest expense
Cross-currency swap	(15,763)		29,532		31,473		(17,704)		Other income (expense), net
Foreign currency forward contract	—		(629)		(110)		(519)		Cost of sales
Net Investment Hedges
Cross-currency swap	(45,498)		24,920		2,202		(22,780)		Interest income
	$	(17,705)	$	68,546	$	38,784	$	12,057
Three Months Ended March 31, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	(10,534)	$	3,500	$	42,678	Interest expense
Cross-currency swap	(20,271)		2,191		(3,504)		(14,576)		Other income (expense), net
Foreign currency forward contract			$	(69)			$	(69)
Net Investment Hedges
Cross-currency swap	(6,914)		950		2,096		(8,060)		Interest income
	$	29,527	$	(7,462)	$	2,092	$	19,973

Derivative Instruments not Designated Hedges:

During the second quarter of 2021, the Company entered into a foreign currency swap, with a notional amount of $7.3 million to mitigate the risk from fluctuations in foreign currency exchange rates associated with an intercompany loan denominated in Japanese yen. In a foreign currency swap transaction, the Company agrees with another party to exchange, at specified intervals, the difference between one currency and another currency at a fixed exchange rate, generally set at inception, calculated by reference to an agreed upon notional amount. The notional amount of each currency is exchanged at the inception and termination of the currency swap by each party. The Company subsequently paid down a portion of this swap, bringing the notional amount down to $5.5 million as of March 31, 2024.

The fair value of the foreign currency swaps not designated as hedges was $1.5 million and $1.2 million as of March 31, 2024 and December 31, 2023, respectively. The following table summarizes the gains (losses) on derivative instruments not designated as hedges on the condensed consolidated statements of income, which was included in other income:


Dollars in thousands	Three Months Ended March 31,
		2024		2023

Foreign currency swaps		273		55
Total		$	273	$	55

Cover - shares	3 Months Ended
Cover - shares	Mar. 31, 2024	May 03, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
Document Transition Report	false
Entity File Number	000-26224
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 Common Stock, Shares Outstanding (in shares)		78,799,694
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	$ 1,587,884	$ 1,804,403
Balance, end of period	1,597,952	1,674,938
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(15,106)	10,265
Balance, end of period	(10,646)	7,067
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	68,546	(7,462)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	38,784	2,092
Designated as Hedging Instrument \| Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(17,705)	29,527
Balance, end of period	12,057	19,973
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	43,556	56,712
Amount of Gain (Loss) Recognized in AOCI	14,723	(10,534)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	5,219	3,500
Balance, end of period	53,060	42,678
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(15,763)	(20,271)
Amount of Gain (Loss) Recognized in AOCI	29,532	2,191
Amount of Gain (Loss) Reclassified from AOCI into Earnings	31,473	(3,504)
Balance, end of period	(17,704)	(14,576)
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(45,498)	(6,914)
Amount of Gain (Loss) Recognized in AOCI	24,920	950
Amount of Gain (Loss) Reclassified from AOCI into Earnings	2,202	2,096
Balance, end of period	(22,780)	(8,060)
Designated as Hedging Instrument \| Foreign currency forward contracts \| Cash Flow Hedges \| Cost of Sales
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	0
Amount of Gain (Loss) Recognized in AOCI	(629)	(69)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(110)
Balance, end of period	$ (519)	$ (69)

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Operating Leased Assets [Line Items]
Remainder of 2024	$ 18,106
2025	23,155
2026	20,506
2027	19,188
2028	16,899
2029	16,017
Thereafter	163,479
Total minimum lease payments	277,350
Less: Imputed interest	90,965
Total lease liabilities	186,385	$ 182,133
Less: Current lease liabilities	16,303	15,284
Long-term lease liabilities	170,082	$ 166,849
Related Parties
Operating Leased Assets [Line Items]
Remainder of 2024	222
2025	296
2026	296
2027	296
2028	296
2029	246
Thereafter	0
Total minimum lease payments	1,652
Third Parties
Operating Leased Assets [Line Items]
Remainder of 2024	17,884
2025	22,859
2026	20,210
2027	18,892
2028	16,603
2029	15,771
Thereafter	163,479
Total minimum lease payments	$ 275,698

COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Millions		3 Months Ended
	Dec. 06, 2022 USD ($) payment	Mar. 31, 2024 USD ($) liability	Jan. 20, 2021 USD ($)	Jul. 29, 2019 USD ($)
Arkis
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value				$ 25.5
Contingent consideration				13.1
Arkis \| Development Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value				10.0
Arkis \| Commercial Sales Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value				$ 15.5
Derma Sciences
Loss Contingencies [Line Items]
Number of contingent liabilities remaining \| liability		1
Contingent consideration, maximum undiscounted payment amount		$ 3.0
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 33.3
ACell, Inc.
Loss Contingencies [Line Items]
Contingent consideration			$ 23.9
Contingent consideration, maximum undiscounted payment amount			$ 100.0
Surgical Innovation Associates, Inc.
Loss Contingencies [Line Items]
Contingent consideration, maximum undiscounted payment amount	$ 90.0
Number of contingent liabilities \| payment	2
Surgical Innovation Associates, Inc. \| Revenue Based Performance Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	$ 32.6
Contingent consideration, maximum undiscounted payment amount	50.0
Surgical Innovation Associates, Inc. \| FDA Approval Of Premarket Approval
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	25.0
Contingent consideration, maximum undiscounted payment amount	$ 40.0

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	$ 1,587,884	$ 1,804,403
Other comprehensive gain (loss)	37,359
Less: Amounts reclassified from accumulated other comprehensive income, net	32,899
Net current-period other comprehensive gain (loss)	4,460	(3,198)
Balance, end of period	1,597,952	1,674,938
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	(15,106)	10,265
Net current-period other comprehensive gain (loss)	4,460	(3,198)
Balance, end of period	(10,646)	$ 7,067
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	21,489
Other comprehensive gain (loss)	34,939
Less: Amounts reclassified from accumulated other comprehensive income, net	31,204
Net current-period other comprehensive gain (loss)	3,735
Balance, end of period	25,224
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	2,712
Other comprehensive gain (loss)	(5)
Less: Amounts reclassified from accumulated other comprehensive income, net	0
Net current-period other comprehensive gain (loss)	(5)
Balance, end of period	2,707
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	(39,307)
Other comprehensive gain (loss)	2,425
Less: Amounts reclassified from accumulated other comprehensive income, net	1,695
Net current-period other comprehensive gain (loss)	730
Balance, end of period	$ (38,577)

- Definition

Amount of equity (deficit) attributable to parent. Excludes temporary equity and equity attributable to noncontrolling interest.

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+ Details