0000917520-24-000094 | 10-Q | XBRL Viewer | Integra Lifesciences Holdings Corp

REVENUES FROM CONTRACTS WITH CUSTOMERS

6 Months Ended

Jun. 30, 2024

Revenue from Contract with Customer [Abstract]

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.

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 six months ended June 30, 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	6,623
Contract asset, June 30, 2024	$	6,623

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(5,365)
Contract liability, net of revenue recognized on contracts during the period	7,519
Foreign currency translation	(77)
Contract liability, June 30, 2024	$	18,329

At June 30, 2024, the short-term portion of the contract liability of $9.9 million and the long-term portion of $8.4 million are included in current liabilities and other liabilities, respectively, in the consolidated balance sheets.

As of June 30, 2024, the Company is expected to recognize revenue of approximately 54% 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 and six months ended June 30, 2024 and 2023 (dollar amounts in thousands):


	Three Months Ended June 30, 2024		Three Months Ended June 30, 2023		Six Months Ended June 30, 2024		Six Months Ended June 30, 2023
Neurosurgery	$	205,502	$	205,803	$	407,770	$	398,673
Instruments	54,537		56,365		98,910		102,603
ENT(1)	41,722		8,862		51,515		17,890
Total Codman Specialty Surgical	301,761		271,030		558,195		519,166

Wound Reconstruction and Care	87,695		91,118		168,572		192,058
Private Label	28,719		19,119		60,280		50,889
Total Tissue Technologies	116,414		110,237		228,852		242,947
Total revenue	$	418,175	$	381,267	$	787,047	$	762,113

(1) Prior period revenues included within our instruments business have been reclassified under the ENT business.

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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+ Details

INCOME TAXES

6 Months Ended

Jun. 30, 2024

Income Tax Disclosure [Abstract]

INCOME TAXES

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


	Three Months Ended June 30,		Six Months Ended June 30,
	2024	2023	2024		2023
Reported tax rate	18.3%	(9.4)%	23.2	%	15.5	%

The Company’s effective income tax rates for the three months ended June 30, 2024 and 2023 were 18.3% and (9.4)%, respectively. For the three months ended June 30, 2024, the higher tax rate is primarily driven by lower three month book income as compared to the previous year. For the three months ended June 30, 2023, the lower rate was partially driven by a $1.1 million benefit associated with the Federal R&D credit.

The Company’s effective income tax rates for the six months ended June 30, 2024 and 2023 were 23.2% and 15.5%, respectively. For the six months ended June 30, 2024, the higher tax rate is primarily driven by lower book income and a $1.7 million shortfall from stock-based compensation, as compared to the prior year. For the six months ended June 30, 2023, the lower tax rate was primarily due to a $1.1 million benefit associated with the Federal R&D credit, offset by $0.3 million shortfall from stock-based compensation.

Changes to income tax laws and regulations, in any of the tax jurisdictions in which the Company operates, could impact the effective tax rate. Various governments, both U.S. and non-U.S., are increasingly focused on tax reform and revenue-raising legislation. On August 16, 2022, the Inflation Act was signed into law. The Company did not experience a material impact on the Company’s effective tax rate under the Inflation Act. Further, legislation in foreign jurisdictions may be enacted, in continued response to the base erosion and profit-sharing (“BEPS”) project begun by the Organization for Economic Cooperation and Development (“OECD”).

The OECD released model rules related to a new 15% global minimum tax regime (“Pillar 2”). Several of the jurisdictions that the Company operates in have already adopted some form of the model rules, which could impact the amount of taxes that the Company pays after 2023. However, the rules are complex and provide for delays for implementing the tax during the early transition years, if certain conditions are met. At this time, the Company is projecting an immaterial amount related to Pillar 2 tax liability for the 2024 year. Such changes in U.S. and Non-U.S. jurisdictions could have an adverse effect on the Company’s effective tax rate.

- Definition

The entire disclosure for income tax.

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+ Details

DERIVATIVE INSTRUMENTS - Schedule of Derivatives Not Designated as Hedging Instruments (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 135	$ 588	$ 408	$ 643
Foreign currency swaps
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 135	$ 588	$ 408	$ 643

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Number of days from shipment to issue a credit	90 days
Short-term portion of contract liability	$ 9,905	$ 8,540
Long-term portion of contract liability	$ 8,400
Product warranty period (up to)	2 years

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Statement [Abstract]
Total revenue, net	$ 418,175	$ 381,267	$ 787,047	$ 762,113
Costs and expenses:
Cost of goods sold	192,258	174,241	354,296	322,216
Research and development	29,767	26,588	56,732	53,312
Selling, general and administrative	195,472	164,908	361,270	331,565
Intangible asset amortization	3,707	3,026	13,814	6,134
Total costs and expenses	421,204	368,763	786,112	713,227
Operating income	(3,029)	12,504	935	48,886
Interest income	5,058	3,939	10,098	8,046
Interest expense	(18,651)	(12,464)	(32,275)	(24,564)
Other (expense) income, net	1,437	(155)	827	1,234
(Loss) income before income taxes	(15,185)	3,824	(20,415)	33,602
(Benefit) provision for income taxes	(2,783)	(360)	(4,732)	5,192
Net (loss) income	$ (12,402)	$ 4,184	$ (15,683)	$ 28,410
Net (loss) income per share
Basic (in dollars per share)	$ (0.16)	$ 0.05	$ (0.20)	$ 0.35
Diluted (in dollars per share)	$ (0.16)	$ 0.05	$ (0.20)	$ 0.35
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	77,409	80,966	77,572	81,418
Diluted (in shares)	77,409	81,151	77,572	81,739
Comprehensive income (See Note 14)	$ (20,482)	$ 1,947	$ (19,303)	$ 22,975

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	6 Months Ended
	Jun. 30, 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

LEASES AND RELATED PARTY LEASES - Narrative (Details) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2024 USD ($)	Jun. 30, 2024 USD ($) renewalOption	Jun. 30, 2023 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewalOption		1
Operating lease expense		$ 12.8	$ 11.8
Asset impairment charges	$ 4.6
Operating lease, impairment loss	1.7
Impairment, long-lived asset, held-for-use	$ 2.9
Related Party
Operating Leased Assets [Line Items]
Operating lease expense		$ 0.1	$ 0.1
Percent of manufacturing facility owned by corporation whose shareholders are trusts whose beneficiaries include family members of company's former director		50.00%
Annual rate of lease agreement		$ 0.3
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	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	5 years
Period for extended lease		November 1, 2034 through October 31, 2039

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME

6 Months Ended

Jun. 30, 2024

Equity [Abstract]

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME

Comprehensive (loss) income for the three and six months ended June 30, 2024 and 2023:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410
Foreign currency translation adjustment	(8,674)		(10,029)		(7,945)		(6,838)
Change in unrealized loss/(gain) on derivatives, net of tax	594		7,561		4,330		1,069
Pension liability adjustment, net of tax			231		(5)		334
Comprehensive (loss) income, net	$	(20,482)	$	1,947	$	(19,303)	$	22,975

Changes in accumulated other comprehensive (loss) income by component between December 31, 2023 and June 30, 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)	39,109		(5)		(4,361)		34,743
Less: Amounts reclassified from accumulated other comprehensive income, net	34,779		—		3,584		38,363
Net current-period other comprehensive gain (loss)	4,330		(5)		(7,945)		(3,620)
Balance at June 30, 2024	$	25,819	$	2,707	$	(47,252)	$	(18,726)

For the six months ended June 30, 2024, the Company reclassified a gain of $26.9 million and $11.5 million from accumulated other comprehensive income to other income, net and interest income, respectively.

INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate	18.30%	(9.40%)	23.20%	15.50%
Income tax benefit, tax credit, research and development		$ 1.1		$ 1.1
Income tax benefit from excess tax benefits from share-based payment arrangement			$ 1.7	$ 0.3

INVENTORIES

6 Months Ended

Jun. 30, 2024

Inventory Disclosure [Abstract]

INVENTORIES

Inventories, net consisted of the following:


Dollars in thousands	June 30, 2024		December 31, 2023
Finished goods	$	220,844	$	196,402
Work in process	76,509		74,035
Raw materials	124,422		119,171
Total inventories, net	$	421,775	$	389,608

COMMITMENTS AND CONTINGENCIES

6 Months Ended

Jun. 30, 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. If the reasonable estimate of a probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is recorded. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded and actual results may differ from these estimates. 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.

On March 17, 2021, a complaint was filed against the Company in the Court of Common Pleas of Philadelphia County in Pennsylvania asserting product liability claims relating to a surgical procedure in which the Company’s CUSA® Clarity allegedly was used. The plaintiff seeks damages against the Company based upon plaintiff’s claim that the CUSA® Clarity did not function as intended. The plaintiff also asserts separate claims against the surgeon and the hospital. The outcome of this legal action is not within the Company’s control and may not be known for a prolonged period of time. The Company believes it has meritorious defenses and the plaintiff’s claims are adequately covered by insurance. Consequently, this matter is not expected to result in a material, adverse effect on the Company’s financial condition, results of operations and cash flows. Notwithstanding the foregoing, in the event damages exceed the aggregate coverage limits of the Company’s insurance policies, or if the Company’s insurance carriers disclaim coverage, it is possible that costs associated with these claims could have a material impact on the consolidated financial condition, results of operations and cash flows of the Company.

Contingent Consideration

The Company determined the fair value of contingent consideration during the six month period ended June 30, 2024 and June 30, 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 six months ended June 30, 2024 and June 30, 2023 is as follows (in thousands):


Six Months Ended June 30, 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
Payment									(12,400)
Change in fair value of contingent consideration liabilities	(934)		Research and development	75		—			3,200			Selling, general and administrative
Balance as of June 30, 2024	14,821			2,632		300			59,500

Short-Term	$	8,244		$	—	$	—		$	19,200		Accrued expenses and other current liabilities
Long-Term	6,577			2,632		300			40,300			Other liabilities
Total	14,821			2,632		300			59,500


Six Months Ended June 30, 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	3,081		Research and development			(2,200)		5,200		Selling, general and administrative
Balance as of June 30, 2023	$	15,976		$	230	$	1,500	$	62,807

Short-Term	$	4,389		$	—	$	—	$	12,700	Accrued expenses and other current liabilities
Long-Term	11,587			230		1,500		50,107		Other liabilities
Total	15,976			230		1,500		62,807

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). In the second quarter of 2024, The Company paid out $12.4 million related to the 2023 performance year. 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.

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		6 Months Ended
INCOME TAXES - Summary of Effective Tax Rate (Details)	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Reported tax rate	18.30%	(9.40%)	23.20%	15.50%

BASIS OF PRESENTATION	6 Months Ended
BASIS OF PRESENTATION	Jun. 30, 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 June 30, 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 consolidated balance sheet as of December 31, 2023 was derived from audited financial statements, but does not include all disclosures required by GAAP. Operating results for the three and six-month period ended June 30, 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 unaudited 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 a SOFR-indexed rate. (See Note 6. Debt). In March 2023, the Company entered into a basis swap contract by which the Company receives Term SOFR and pays LIBOR to convert its portfolio of interest rate swaps from LIBOR to SOFR. The Company 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, 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. Cash and cash equivalents The Company had cash and cash equivalents, primarily consisting of cash on-hand as well as time deposits with original maturities of three months or less and money market funds which are highly liquid and readily convertible to cash, totaling approximately $215.2 million and $276.4 million at June 30, 2024 and December 31, 2023 respectively. Time deposits with original maturities of three months or less and money market funds are valued based on Level 1 measurements in the fair value hierarchy established within FASB Topic 820, Fair Value Measurement (“ASC 820”). Level 1 inputs represent quoted prices in active markets for identical assets or liabilities. Short-term investments The Company had short term investments, primarily consisting of time deposits with original maturities between three months and one year, which are valued based on Level 1 measurements in the fair value hierarchy, totaling approximately $81.7 million at June 30, 2024 compared to $32.7 million at December 31, 2023.

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details) SFr in Thousands, $ in Thousands	Jun. 30, 2024 USD ($)	Jun. 30, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	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	$ 1,325,000		$ 1,475,000
Fair Value Asset (Liability)	53,115		43,556
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-currency swap \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	(13,177)		(40,672)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap One \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	$ (12,894)		(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 339,637		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	$ 381,272		394,183
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap Two \| Codman
Derivative [Line Items]
Fair Value Asset (Liability)	$ (283)		(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

DEBT

6 Months Ended

Jun. 30, 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 terms of the Senior Credit Facility limit the amount of dividends we may pay.

The Company’s maximum Consolidated Total Leverage Ratio (as defined in the March 2023 Amendment) in the financial covenants 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 of any date of determination, as the ratio of (a) Consolidated Funded Indebtedness as of such date (as defined in the Credit Agreement) less cash that is not subject to any restriction on the use or investment thereof to (b) Consolidated EBITDA (as defined by the 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 component of the Senior 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 June 30, 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 June 30, 2024 and December 31, 2023 there was $410.0 million and $70.0 million, respectively, outstanding under the revolving credit facility component of the Senior Credit Facility. At June 30, 2024 and December 31, 2023, there was $770.2 million and $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 June 30, 2024 and December 31, 2023 there was $24.2 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 the term loan and revolving portion of the Senior Credit Facility at June 30, 2024 was $759.8 million, and $404.2 million, respectively. The 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 June 30, 2024 and December 31, 2023 totaled $1.7 million. There were no amounts drawn under the letters of credit outstanding as of June 30, 2024.

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


As of June 30, 2024	Principal Repayment
Dollars in thousands
Remainder of 2024	$	9,688
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,531
	$	770,156

Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $26.2 million for the remainder of 2024, $50.9 million in 2025, $48.2 million in 2026, $45.1 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 facility 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”) pursuant to an indenture, dated as of February 4, 2020 (the “Original Indenture”), between the Company and Citibank, N.A., as trustee. 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 specified in the Original Indenture; (3) if the Company calls the notes for optional redemption as described in the Original Indenture; or (4) if specified corporate transactions occur. As of June 30, 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 (the “First Supplemental Indenture” and, together with Original Indenture, the “Indenture”), pursuant to which 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 First Supplemental Indenture) for a conversion of the 2025 Notes, the Specified Dollar Amount (as defined in the First Supplemental 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). 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 June 30, 2024, the carrying amount of the liability of the 2025 Notes was $575.0 million. The fair value of the 2025 Notes at June 30, 2024 was $539.6 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. Level 1 inputs represent quoted prices in active markets for identical assets or liabilities.

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 June 30, 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 June 30, 2024 and December 31, 2023, the Company had $77.7 million and $89.2 million, respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 6.8% and 5.9%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at June 30, 2024 was $76.1 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481544/470-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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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 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 1
-Subparagraph (SX 210.4-08(c))
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-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
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-URI https://asc.fasb.org/470/tableOfContent

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/disclosureRef
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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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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1E

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1I

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1I

Reference 21: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1I

+ Details

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 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	(934)	3,081
Balance, End of Period	14,821	15,976
Arkis \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	8,244	4,389
Arkis \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	6,577	11,587
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	75
Balance, End of Period	2,632	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	2,632	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
Payment	(12,400)
Change in fair value of contingent consideration liabilities	3,200	5,200
Balance, End of Period	59,500	62,807
Surgical Innovation Associates, Inc. \| Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	19,200	12,700
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	$ 40,300	$ 50,107

RETIREMENT PLANS - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Retirement Benefits [Abstract]
Net periodic benefit costs	$ 0.4	$ 0.3	$ 0.9	$ 0.6
Service cost component	0.8	$ 0.5	1.6	$ 1.1
Estimated fair value of plan assets	41.7		$ 41.7		$ 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	$ 6.0		$ 6.0		$ 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

DEBT - Narrative (Details)		3 Months Ended	6 Months Ended
DEBT - Narrative (Details)	Feb. 04, 2020 USD ($) $ / shares	Mar. 31, 2023 USD ($)	Jun. 30, 2024 USD ($)	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			$ 24,219,000	$ 14,531,000
Interest payments, remainder of fiscal year			26,200,000
Interest payments, year one			50,900,000
Interest payments, year two			48,200,000
Interest payments, year three			45,100,000
Interest payments, after year three			10,000,000.0
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			$ 77,700,000	$ 89,200,000
Weighted average interest rate, accounts receivable securitization revolving loan facility			6.80%	5.90%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value			$ 76,100,000
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			$ 410,000,000.0	$ 70,000,000.0
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)
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)
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)
Debt Instrument [Line Items]
Interest rates available			1.75%
Senior Credit Facility \| Revolving Credit Facility \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				404,200,000
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						$ 775,000,000.0
Line of credit facility outstanding			$ 770,200,000	$ 775,000,000.0
Weighted average interest rate on debt			6.80%	6.80%
Term loan component of senior credit facility			$ 24,200,000	$ 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			759,800,000
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Convertible notes, maximum borrowing capacity	$ 575,000,000.0		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			$ 539,600,000
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

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Lessee, Lease, Description [Line Items]
ROU assets	$ 147,472	$ 156,184
Current lease liabilities	14,613	15,284
Non-current lease liabilities	169,561	166,849
Total lease liabilities	$ 184,174	$ 182,133
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	16 years 4 months 24 days	16 years 3 months 18 days
Weighted average discount rate	5.40%	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	2.80%	2.70%

STOCK-BASED COMPENSATION	6 Months Ended
STOCK-BASED COMPENSATION	Jun. 30, 2024
Share-Based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of June 30, 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 June 30, 2024, there were approximately $4.1 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 six months ended June 30, 2024. For the six months ended June 30, 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 June 30, 2024, there was approximately $43.5 million of total unrecognized compensation costs related to these unvested awards. The Company expects to recognize these costs over a weighted-average period of approximately two years. The Company granted 702,687 restricted stock awards and 308,467 performance stock awards during the six months ended June 30, 2024. For the six months ended June 30, 2024, the weighted average grant date fair value for restricted stock awards and performance stock units granted was $34.90 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 27, 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 $0.8 million during the six months ended June 30, 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.

Cover - shares	6 Months Ended
Cover - shares	Jun. 30, 2024	Jul. 26, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 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)		77,582,027
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2024 USD ($)
Goodwill [Roll Forward]
Goodwill at beginning of period	$ 1,055,462
Foreign currency translation	(16,401)
Goodwill at end of period	1,104,640
Acclarent Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	65,579
Codman Specialty Surgical
Goodwill [Roll Forward]
Goodwill at beginning of period	666,937
Foreign currency translation	(10,717)
Goodwill at end of period	721,799
Codman Specialty Surgical \| Acclarent Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	65,579
Tissue Technologies
Goodwill [Roll Forward]
Goodwill at beginning of period	388,525
Foreign currency translation	(5,684)
Goodwill at end of period	382,841
Tissue Technologies \| Acclarent Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	$ 0

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 49
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-49

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-100

Reference 4: http://www.xbrl.org/2003/role/exampleRef
-Topic 852
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481372/852-10-55-10

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 210
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(15))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 45
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482598/350-20-45-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 210
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-03(10)(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478546/942-210-S99-1

+ Details

DERIVATIVE INSTRUMENTS - Schedule of Derivative Instruments (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Derivative [Line Items]
Notional Amount	$ 1,325,000	$ 1,475,000
Estimated Fair Value	53,115	43,556
Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 0	150,000
Fixed Interest Rate	2.423%
Estimated Fair Value	$ 0	2,105
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	$ 3,063	4,978
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	$ 1,367	1,349
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	$ 1,356	1,312
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	$ 1,339	1,346
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	$ 4,366	3,015
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	$ 4,572	3,052
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	$ 31,747	22,965
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	$ 7,240	5,263
Interest Rate Swap Designated March 31, 2023
Derivative [Line Items]
Notional Amount	0	0
Estimated Fair Value	$ (1,935)	$ (1,829)

NET INCOME PER SHARE - Narrative (Details) - shares shares in Millions	Jun. 30, 2024	Jun. 30, 2023
Earnings Per Share [Abstract]
Shares excluded from computation as their effect would be antidilutive (in shares)	1.3	0.6

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
OPERATING ACTIVITIES:
Net (Loss) Income	$ (15,683)	$ 28,410
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	67,343	61,969
Non-cash impairment charges	12,144	0
Deferred income tax provision (benefit)	(4,700)	1,726
Share-based compensation	12,843	8,891
Amortization of debt issuance costs and expenses associated with debt refinancing	2,858	3,314
Non-cash lease expense	696	1,751
Loss (gain) on disposal of property and equipment	1,265	(104)
Change in fair value of contingent consideration and others	1,804	6,081
Changes in assets and liabilities:
Accounts receivable	10,111	4,826
Inventories	(17,278)	(27,555)
Prepaid expenses and other current assets	(16,773)	(10,512)
Other non-current assets	9,521	(8,184)
Accounts payable, accrued expenses and other current liabilities	(4,140)	(15,899)
Contract liabilities	2,169	724
Other non-current liabilities	(6,023)	(1,003)
Net cash provided by operating activities	56,157	54,435
INVESTING ACTIVITIES:
Purchases of property and equipment	(45,172)	(29,252)
Cash (paid) for business acquisitions, net of cash acquired	(281,994)	0
Purchases of Investments	(48,997)	0
Net cash used in investing activities	(376,163)	(29,252)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	429,300	15,200
Payments on debt	(105,644)	(29,100)
Payment of debt issuance costs	0	(7,578)
Purchases of treasury stock	(50,000)	(150,000)
Payments for Contingent Consideration	(11,923)	0
Proceeds from exercised stock options	6,398	3,437
Cash taxes paid in net equity settlement	(3,203)	(5,335)
Net cash provided by (used in) financing activities	264,928	(173,376)
Effect of exchange rate changes on cash and cash equivalents	(6,088)	724
Net (decrease) in cash and cash equivalents	(61,166)	(147,469)
Cash and cash equivalents at beginning of period	276,402	456,661
Cash and cash equivalents at end of period	$ 215,236	$ 309,192

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2024	Dec. 31, 2023	May 16, 2024	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)	14,008,000	12,751,000
Treasury stock	$ 680,753	$ 647,262
Treasury stock, average cost per share (in dollars per share)	$ 48.60	$ 50.76
Accelerated share repurchase program, receipt (payment)			$ 50,000		$ 125,000			$ 150,000
Accelerated share repurchases, shares received at inception (in shares)			1,300,000		2,300,000			2,100,000
Accelerated share repurchases, percentage of expected total repurchased			70.00%		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	$ 50,000

ACQUISITIONS AND DIVESTITURES (Tables)

6 Months Ended

Jun. 30, 2024

Mergers, Acquisitions and Dispositions [Abstract]

Schedule of Assets Acquired and Liabilities Assumed

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


Dollars in thousands	Estimated Fair Value		Estimated Useful Life
Current assets:
Cash	$	—
Trade accounts receivable, net	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	$	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	989
Intangible assets, net
Completed technology	202,000		12 years
Trademarks/brand names	3,000		5 years
All other	17,000		4 years
Goodwill	65,579
Deferred tax assets	6,863
Total assets acquired	$	347,906

Current liabilities:
Accounts payable, trade	$	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	$	11,653
Lease liability - operating leases	624
Deferred tax liabilities	53,635
Total liabilities assumed	65,912

Net assets acquired	$	281,994

NET INCOME PER SHARE

6 Months Ended

Jun. 30, 2024

Earnings Per Share [Abstract]

NET INCOME PER SHARE

Basic and diluted net income per share was as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands, except per share amounts	2024		2023		2024		2023
Basic net (loss) income per share:
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410
Weighted average common shares outstanding	77,409		80,966		77,572		81,418

Basic net (loss) income per common share	$	(0.16)	$	0.05	$	(0.20)	$	0.35

Diluted net (loss) income per share:
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410

Weighted average common shares outstanding — Basic	77,409		80,966		77,572		81,418
Effect of dilutive securities:
Stock options and restricted stock	—		185		—		321
Weighted average common shares for diluted earnings per share	77,409		81,151		77,572		81,739

Diluted net (loss) income per common share	$	(0.16)	$	0.05	$	(0.20)	$	0.35

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 0.6 million shares at June 30, 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.

DEBT (Tables)

6 Months Ended

Jun. 30, 2024

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios

The Company’s maximum Consolidated Total Leverage Ratio (as defined in the March 2023 Amendment) in the financial covenants 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 June 30, 2024	Principal Repayment
Dollars in thousands
Remainder of 2024	$	9,688
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,531
	$	770,156

- 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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NET INCOME PER SHARE - Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Basic net (loss) income per share:
Net (loss) income	$ (12,402)	$ (3,281)	$ 4,184	$ 24,226	$ (15,683)	$ 28,410
Weighted average common shares outstanding - basic (in shares)	77,409		80,966		77,572	81,418
Basic net (loss) income per common share (in dollars per share)	$ (0.16)		$ 0.05		$ (0.20)	$ 0.35
Diluted net (loss) income per share:
Net (loss) income	$ (12,402)	$ (3,281)	$ 4,184	$ 24,226	$ (15,683)	$ 28,410
Weighted average common shares outstanding - basic (in shares)	77,409		80,966		77,572	81,418
Effect of dilutive securities:
Stock options and restricted stock (in shares)	0		185		0	321
Weighted average common shares for diluted earnings per share (in shares)	77,409		81,151		77,572	81,739
Diluted net (loss) income per common share (in dollars per share)	$ (0.16)		$ 0.05		$ (0.20)	$ 0.35

- Definition

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

+ References

+ Details

- Definition

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

+ References

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- Definition

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

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+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

6 Months Ended

Jun. 30, 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 six months ended June 30, 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	6,623
Contract asset, June 30, 2024	$	6,623

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(5,365)
Contract liability, net of revenue recognized on contracts during the period	7,519
Foreign currency translation	(77)
Contract liability, June 30, 2024	$	18,329

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three and six months ended June 30, 2024 and 2023 (dollar amounts in thousands):


	Three Months Ended June 30, 2024		Three Months Ended June 30, 2023		Six Months Ended June 30, 2024		Six Months Ended June 30, 2023
Neurosurgery	$	205,502	$	205,803	$	407,770	$	398,673
Instruments	54,537		56,365		98,910		102,603
ENT(1)	41,722		8,862		51,515		17,890
Total Codman Specialty Surgical	301,761		271,030		558,195		519,166

Wound Reconstruction and Care	87,695		91,118		168,572		192,058
Private Label	28,719		19,119		60,280		50,889
Total Tissue Technologies	116,414		110,237		228,852		242,947
Total revenue	$	418,175	$	381,267	$	787,047	$	762,113

(1) Prior period revenues included within our instruments business have been reclassified under the ENT business.

COMMITMENTS AND CONTINGENCIES (Tables)

6 Months Ended

Jun. 30, 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 six months ended June 30, 2024 and June 30, 2023 is as follows (in thousands):


Six Months Ended June 30, 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
Payment									(12,400)
Change in fair value of contingent consideration liabilities	(934)		Research and development	75		—			3,200			Selling, general and administrative
Balance as of June 30, 2024	14,821			2,632		300			59,500

Short-Term	$	8,244		$	—	$	—		$	19,200		Accrued expenses and other current liabilities
Long-Term	6,577			2,632		300			40,300			Other liabilities
Total	14,821			2,632		300			59,500


Six Months Ended June 30, 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	3,081		Research and development			(2,200)		5,200		Selling, general and administrative
Balance as of June 30, 2023	$	15,976		$	230	$	1,500	$	62,807

Short-Term	$	4,389		$	—	$	—	$	12,700	Accrued expenses and other current liabilities
Long-Term	11,587			230		1,500		50,107		Other liabilities
Total	15,976			230		1,500		62,807

ACQUISITIONS AND DIVESTITURES - Narrative (Details) - Acclarent Inc. - USD ($) $ in Millions		3 Months Ended
	Apr. 01, 2024	Jun. 30, 2024
Business Acquisition [Line Items]
Purchase price of business combination	$ 282.0
Revenue of acquiree since acquisition date		$ 31.3
Estimated Useful Life	11 years
Intangible asset acquired, discount rate (percent)	12.20%

LEASES AND RELATED PARTY LEASES (Tables)

6 Months Ended

Jun. 30, 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	June 30, 2024			December 31, 2023
ROU assets	$	147,472		$	156,184

Current lease liabilities	14,613			15,284
Non-current lease liabilities	169,561			166,849
Total lease liabilities	$	184,174		$	182,133

Weighted average remaining lease term (in years):
Leased facilities	16.4 years			16.3 years
Leased vehicles	2.1 years			1.9 years

Weighted average discount rate:
Leased facilities	5.4		%	5.9		%
Leased vehicles	2.8		%	2.7		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases for the six months ended June 30, 2024 and 2023 were as follows:


Dollars in thousands	June 30, 2024		June 30, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	12,029	$	9,505

ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$	68	$	7,582

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at June 30, 2024 were as follows:


Dollars in thousands	Related Parties		Third Parties		Total
Remainder of 2024	$	148	$	11,736	$	11,884
2025	296		22,472		22,768
2026	296		20,397		20,693
2027	296		19,090		19,386
2028	296		16,971		17,267
2029	246		16,168		16,414
Thereafter	—		164,718		164,718
Total minimum lease payments	$	1,578	$	271,552	$	273,130
Less: Imputed interest					88,956
Total lease liabilities					184,174
Less: Current lease liabilities					14,613
Long-term lease liabilities					169,561

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME - Schedule of Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Equity [Abstract]
Net (loss) income	$ (12,402)	$ (3,281)	$ 4,184	$ 24,226	$ (15,683)	$ 28,410
Foreign currency translation adjustment	(8,674)		(10,029)		(7,945)	(6,838)
Change in unrealized loss/(gain) on derivatives, net of tax	594		7,561		4,330	1,069
Pension liability adjustment, net of tax			231		(5)	334
Comprehensive (loss) income, net	$ (20,482)		$ 1,947		$ (19,303)	$ 22,975

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income, attributable to parent entity. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

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

+ References

+ Details

LEASES AND RELATED PARTY LEASES

6 Months Ended

Jun. 30, 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 June 30, 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 six months ended June 30, 2024 and June 30, 2023 was $12.8 million and $11.8 million, respectively, which includes $0.1 million, in related party operating lease expense.

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


Dollars in thousands, except lease term and discount rate	June 30, 2024			December 31, 2023
ROU assets	$	147,472		$	156,184

Current lease liabilities	14,613			15,284
Non-current lease liabilities	169,561			166,849
Total lease liabilities	$	184,174		$	182,133

Weighted average remaining lease term (in years):
Leased facilities	16.4 years			16.3 years
Leased vehicles	2.1 years			1.9 years

Weighted average discount rate:
Leased facilities	5.4		%	5.9		%
Leased vehicles	2.8		%	2.7		%

Supplemental cash flow information related to leases for the six months ended June 30, 2024 and 2023 were as follows:


Dollars in thousands	June 30, 2024		June 30, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	12,029	$	9,505

ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$	68	$	7,582

Future minimum lease payments under operating leases at June 30, 2024 were as follows:


Dollars in thousands	Related Parties		Third Parties		Total
Remainder of 2024	$	148	$	11,736	$	11,884
2025	296		22,472		22,768
2026	296		20,397		20,693
2027	296		19,090		19,386
2028	296		16,971		17,267
2029	246		16,168		16,414
Thereafter	—		164,718		164,718
Total minimum lease payments	$	1,578	$	271,552	$	273,130
Less: Imputed interest					88,956
Total lease liabilities					184,174
Less: Current lease liabilities					14,613
Long-term lease liabilities					169,561

There were no future minimum lease payments under finance leases at June 30, 2024.

Related Party Leases

The Company leases one of its manufacturing facilities 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.

Lease Impairment Charge

During the three months ended June 30, 2024, the Company approved a plan to transition the commercial distribution of PriMatrix® and SurgiMend® from the Boston facility to the Company’s manufacturing facility in Braintree, Massachusetts and permanently cease use of the Boston facility. As a result, the Company recorded a $4.6 million impairment charge for the three months ended June 30, 2024 as the carrying amounts of the operating lease right-of-use asset and fixed assets related to the Boston facility exceeded their fair values based on the Company’s estimates of future discounted cash flows through the end of the lease term and the end of their remaining useful lives, respectively. The $4.6 million impairment charge was comprised of a $1.7 million impairment of an operating lease right-of-use asset and a $2.9 million write-off of fixed assets, which was recorded as a component of cost of goods sold in the condensed consolidated statements of operations.

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) € in Thousands, SFr in Thousands, $ in Thousands	Jun. 30, 2024 USD ($)	Jun. 30, 2024 CHF (SFr)	Jun. 30, 2024 EUR (€)	Dec. 31, 2023 USD ($)	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)	$ (33,577)			$ (49,609)
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,566			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)	$ (32,105)			(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 \| SFr		SFr 288,210			SFr 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)	$ (1,960)			(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			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
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ (3,078)			0
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr		SFr 68,483			SFr 0
Designated as Hedging Instrument \| Net Investment Hedges \| Cross Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Rate	2.74%	2.74%	2.74%
Aggregate Notional Amount	$ 75,000			$ 0

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net (Loss) Income	$ (12,402)	$ (3,281)	$ 4,184	$ 24,226	$ (15,683)	$ 28,410

- Definition

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

+ References

+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Line Items]
Total Revenues	$ 418,175	$ 381,267	$ 787,047	$ 762,113
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	301,761	271,030	558,195	519,166
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	205,502	205,803	407,770	398,673
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	54,537	56,365	98,910	102,603
Codman Specialty Surgical \| ENT
Disaggregation of Revenue [Line Items]
Total Revenues	41,722	8,862	51,515	17,890
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	116,414	110,237	228,852	242,947
Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	87,695	91,118	168,572	192,058
Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 28,719	$ 19,119	$ 60,280	$ 50,889

- 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

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

+ References

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+ Details

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2024 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ 38,363
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	34,779
Other Income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	26,900
Interest income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ 11,500

- 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

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Jun. 30, 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

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) $ in Thousands, SFr in Millions	Jun. 30, 2024 USD ($)	Jun. 30, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 66,509		$ 50,330
Total derivatives designated as hedges — Liabilities	60,394		97,055
Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,325,000		1,475,000
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,300,000		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	11,602		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	43,448		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	612		579
Interest rate swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	1,323		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	2,950		537
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	283		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	15,843		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	5,946		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	2,563		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	42,086		51,114
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount \| SFr		SFr 6.5
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	$ 247		$ 0

BASIS OF PRESENTATION - Narrative (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 215,236	$ 276,402
Short-term investments	$ 81,691	$ 32,694

DERIVATIVE INSTRUMENTS

6 Months Ended

Jun. 30, 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 June 30, 2024 and December 31, 2023 (dollar amounts in thousands):


	June 30, 2024		December 31, 2023							June 30, 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		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	—			2,105
1-month Term SOFR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	3,063			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,367			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,356			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,339			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,366			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,572			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	31,747			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	7,240			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(1,935)		0	(1,829)
	$	1,325,000	$	1,475,000						$	53,115		$	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 and six months ended June 30, 2024, the Company recorded a gain of $5.1 million and $19.8 million, respectively, in AOCI related to the change in fair value of the interest rate swaps. For the three and six months ended June 30, 2023 the Company recorded a gain of $18.7 million and $8.2 million, respectively, in AOCI related to the change in fair value of the interest rate swaps.

For the three and six months ended June 30, 2024, the Company recorded gains of $5.0 million and $10.3 million, respectively, in the consolidated statements of operations related to the interest rate differential of the interest rate swaps. For the three and six months ended June 30, 2023 the Company recorded gains of $4.5 million and $8.0 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 June 30, 2024 within the next twelve months is $11.0 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 June 30, 2024 and December 31, 2023 (dollar amounts in thousands):


					June 30, 2024	December 31, 2023	June 30, 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	CHF 339,637	351,137	(12,894)		(38,324)
Receive U.S.$			3.98%	$	381,272	394,183




Pay CHF	September 22, 2023	September 29, 2024	2.40%	CHF	CHF 28,500	28,500	(283)		(2,348)
Receive U.S.$			6.27%	$	31,457	31,457

Total							$	(13,177)	$	(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 and six months ended June 30, 2024, the Company recorded a gain of $0.6 million and $30.1 million, respectively, in AOCI related to change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2023, the Company recorded a loss of $12.9 million and $10.7 million in AOCI related to change in fair value of the cross-currency swaps.

For the three and six months ended June 30, 2024 the Company recorded a loss of $1.5 million and a gain of $28.6 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans. For the three and six months ended June 30, 2023, the Company recorded a loss of $10.0 million and $14.9 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans.

For the three and six months ended June 30, 2024, the Company recorded a gain of $1.3 million and $2.6 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2023, the Company recorded a gain of $1.4 million and $2.9 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated loss that is expected to be reclassified to other income (expense), net from AOCI as of June 30, 2024 within the next twelve months is $2.7 million. As of June 30, 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 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.

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 June 30, 2024 and December 31, 2023, respectively (dollar amounts in thousands):


					June 30, 2024	December 31, 2023	June 30, 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	3,566	2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	288,210	(32,105)	(48,047)
Receive U.S.$			1.94%	$	300,000	300,000

Pay CHF	November 21, 2023	December 17, 2029	—%	CHF	CHF 66,525	66,525	(1,960)	(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Pay CHF	May 6, 2024	December 18, 2030	—%	CHF	CHF 68,483	—	(3,078)	—
Receive U.S.$			2.74%	$	75,000	—

Total							(33,577)	(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 and six months ended June 30, 2024, the Company recorded a loss of $4.2 million and a gain of $20.7 million, respectively, in AOCI related to the change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2023, the Company recorded a loss of $11.1 million and $10.1 million, respectively, in AOCI related to change in fair value of the cross-currency swaps.

For the three and six months ended June 30, 2024, the Company recorded a gain of $2.5 million and $4.7 million, respectively, in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2023, the Company recorded a gain of $2.1 million and $4.2 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated gain that is expected to be reclassified to interest income from AOCI as of June 30, 2024 within the next twelve months is $9.7 million.

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 June 30, 2024 the notional amount of foreign currency forward contracts was 6.5 million CHF. For the three and six months ended June 30, 2024 the Company recorded an immaterial loss and a loss of $0.6 million, respectively, in AOCI related to the change in fair value of the foreign currency forward contracts and a loss of $0.1 million and $0.2 million, respectively in cost of goods sold included in the consolidated statements of operations.

For the three and six months ended June 30, 2023 the Company recorded a gain of $0.3 million and $0.2 million, respectively, in AOCI related to the change in fair value of the foreign currency forward contracts and a gain of $0.4 million and $0.4 million, respectively, in cost of goods sold included in the consolidated statements of operations.

On July 3, 2024, the Company entered into forward currency forwards with a notional amount of 5.2 million CHF to mitigate the exchange rate risk of Swiss franc denominated intercompany purchases. These contracts settle at various dates within twelve months of execution.

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 June 30, 2024 and December 31, 2023:


	Fair Value as of
Location on Balance Sheet (1):	June 30, 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)	$	11,602	$	14,675
Cross-currency swap	2,950		537
Net Investment Hedges
Cross-currency swap	5,946		2,938
Other assets
Cash Flow Hedges
Interest rate swap(2)	43,448		30,710

Net Investment Hedges
Cross-currency swap	2,563		1,470
Total derivatives designated as hedges — Assets	$	66,509	$	50,330

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	612	$	579
Cross-currency swap	283		4,813
Foreign currency forward contracts	247		—
Net Investment Hedges
Cross-currency swap	—		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	1,323		1,250
Cross-currency swap	15,843		36,396
Net Investment Hedges
Cross-currency swap	42,086		51,114
Total derivatives designated as hedges — Liabilities	$	60,394	$	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 June 30, 2024 and December 31, 2023, the total notional amounts related to the Company’s interest rate swaps were $1.3 billion, and $1.5 billion, respectively.

The following presents the effect of derivative instruments designated as cash flow hedges and net investment hedges on the accompanying condensed consolidated statement of operations during the three and six months ended June 30, 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 June 30, 2024
Cash Flow Hedges
Interest rate swap	$	53,060	$	5,088	$	5,032	$	53,116	Interest expense
Cross-currency swap	(17,704)		598		(239)		(16,867)		Other income, net
Foreign Currency Forward Contract	(519)		(4)		(93)		(430)		Cost of Sales
Net Investment Hedges
Cross-currency swap	(22,780)		(4,233)		2,453		(29,466)		Interest income
	$	12,057	$	1,449	$	7,153	$	6,353
Three Months Ended June 30, 2023
Cash Flow Hedges
Interest rate swap	$	42,678	$	18,694	$	4,471	$	56,901	Interest expense
Cross-currency swap	(14,576)		(12,873)		(8,524)		(18,925)		Other income, net
Foreign Currency Forward Contract	$	(69)	$	304	$	358	$	(123)
Net Investment Hedges
Cross-currency swap	(8,060)		(11,067)		2,112		(21,239)		Interest income
	$	19,973	$	(4,942)	$	(1,583)	$	16,614

Dollars in thousands	Balance in AOCI Beginning of Year		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
Six Months Ended June 30, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	19,811	$	10,251	$	53,116	Interest expense
Cross-currency swap	(15,763)		30,130		31,234		(16,867)		Other income (expense), net
Foreign currency forward contract	—		(633)		(203)		(430)		Cost of sales
Net Investment Hedges
Cross-currency swap	(45,498)		20,687		4,655		(29,466)		Interest income
	$	(17,705)	$	69,995	$	45,937	$	6,353
Six Months Ended June 30, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	8,160	$	7,971	$	56,901	Interest expense
Cross-currency swap	(20,271)		(10,682)		(12,028)		(18,925)		Other income (expense), net
Foreign currency forward contract	—		$	235	$	358	(123)
Net Investment Hedges
Cross-currency swap	(6,914)		(10,117)		4,208		(21,239)		Interest income
	$	29,527	$	(12,404)	$	509	$	16,614

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 $4.6 million as of June 30, 2024.

The fair value of the foreign currency swaps not designated as hedges was $1.5 million and $1.2 million as of June 30, 2024 and December 31, 2023, respectively. The following table summarizes the gains 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 June 30,				Six Months Ended June 30,
	2024		2023		2024		2023

Foreign currency swaps	135		588		408		643
Total	$	135	$	588	$	408	$	643

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

6 Months Ended

Jun. 30, 2024

Segment Reporting [Abstract]

Schedule of Net Sales and Profit by Segments

Net sales and profit by each reportable segment for the three and six months ended June 30, 2024 and 2023 are as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
Segment Net Sales
Codman Specialty Surgical	$	301,761	$	271,030	$	558,195	$	519,166
Tissue Technologies	116,414		110,237		228,852		242,947
Total revenues	$	418,175	$	381,267	$	787,047	$	762,113
Segment Profit
Codman Specialty Surgical	$	164,141	$	116,341	$	267,633	$	227,274
Tissue Technologies	37,187		8,062		67,853		60,343
Segment profit	201,328		124,403		335,486		287,617
Amortization	(3,707)		(3,026)		(13,814)		(6,134)
Corporate and other	(200,650)		(108,873)		(320,737)		(232,597)
Operating income	$	(3,029)	$	12,504	$	935	$	48,886

Total revenue by major geographic area consisted of the following:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
United States	$	310,225	$	276,782	$	566,454	$	547,784
Europe	40,689		37,452		82,285		78,516
Asia Pacific	45,951		47,706		95,496		98,179
Rest of World	21,310		19,327		42,812		37,634
Total Revenues	$	418,175	$	381,267	$	787,047	$	762,113

Schedule of Geographic Revenue by Area

Net sales and profit by each reportable segment for the three and six months ended June 30, 2024 and 2023 are as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
Segment Net Sales
Codman Specialty Surgical	$	301,761	$	271,030	$	558,195	$	519,166
Tissue Technologies	116,414		110,237		228,852		242,947
Total revenues	$	418,175	$	381,267	$	787,047	$	762,113
Segment Profit
Codman Specialty Surgical	$	164,141	$	116,341	$	267,633	$	227,274
Tissue Technologies	37,187		8,062		67,853		60,343
Segment profit	201,328		124,403		335,486		287,617
Amortization	(3,707)		(3,026)		(13,814)		(6,134)
Corporate and other	(200,650)		(108,873)		(320,737)		(232,597)
Operating income	$	(3,029)	$	12,504	$	935	$	48,886

Total revenue by major geographic area consisted of the following:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
United States	$	310,225	$	276,782	$	566,454	$	547,784
Europe	40,689		37,452		82,285		78,516
Asia Pacific	45,951		47,706		95,496		98,179
Rest of World	21,310		19,327		42,812		37,634
Total Revenues	$	418,175	$	381,267	$	787,047	$	762,113

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME - Schedule of Changes in Accumulated Other Comprehensive Income (Loss) by Component (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	$ 1,597,952	$ 1,587,884	$ 1,674,938	$ 1,804,403	$ 1,587,884
Other comprehensive gain (loss)					34,743
Less: Amounts reclassified from accumulated other comprehensive income, net					38,363
Net current-period other comprehensive gain (loss)	(8,080)	4,460	(2,237)	(3,198)	(3,620)
Balance, end of period	1,534,195	1,597,952	1,683,160	1,674,938	1,534,195
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	(10,646)	(15,106)	7,067	10,265	(15,106)
Net current-period other comprehensive gain (loss)	(8,080)	4,460	(2,237)	(3,198)
Balance, end of period	(18,726)	(10,646)	$ 4,830	$ 7,067	(18,726)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period		21,489			21,489
Other comprehensive gain (loss)					39,109
Less: Amounts reclassified from accumulated other comprehensive income, net					34,779
Net current-period other comprehensive gain (loss)					4,330
Balance, end of period	25,819				25,819
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period		2,712			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				2,707
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period		$ (39,307)			(39,307)
Other comprehensive gain (loss)					(4,361)
Less: Amounts reclassified from accumulated other comprehensive income, net					3,584
Net current-period other comprehensive gain (loss)					(7,945)
Balance, end of period	$ (47,252)				$ (47,252)

- Definition

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

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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 13: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

ACCUMULATED OTHER COMPREHENSIVE (LOSS) INCOME (Tables)

6 Months Ended

Jun. 30, 2024

Equity [Abstract]

Schedule of Comprehensive Income (Loss)

Comprehensive (loss) income for the three and six months ended June 30, 2024 and 2023:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410
Foreign currency translation adjustment	(8,674)		(10,029)		(7,945)		(6,838)
Change in unrealized loss/(gain) on derivatives, net of tax	594		7,561		4,330		1,069
Pension liability adjustment, net of tax			231		(5)		334
Comprehensive (loss) income, net	$	(20,482)	$	1,947	$	(19,303)	$	22,975

Schedule of Changes in Accumulated Other Comprehensive Loss by Component

Changes in accumulated other comprehensive (loss) income by component between December 31, 2023 and June 30, 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)	39,109		(5)		(4,361)		34,743
Less: Amounts reclassified from accumulated other comprehensive income, net	34,779		—		3,584		38,363
Net current-period other comprehensive gain (loss)	4,330		(5)		(7,945)		(3,620)
Balance at June 30, 2024	$	25,819	$	2,707	$	(47,252)	$	(18,726)

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,902,738	$ 1,729,837
Accumulated Amortization	(682,796)	(662,004)
Net	1,219,942	1,067,833
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	168,969	174,531
Net	$ 168,969	$ 174,531
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	17 years	18 years
Cost	$ 1,412,670	$ 1,226,128
Accumulated Amortization	(482,499)	(448,519)
Net	$ 930,171	$ 777,609
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 167,273	$ 193,895
Accumulated Amortization	(135,789)	(152,160)
Net	$ 31,484	$ 41,735
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	28 years
Cost	$ 100,600	$ 98,892
Accumulated Amortization	(40,351)	(38,754)
Net	$ 60,249	$ 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	(18,637)	(18,148)
Net	$ 11,574	$ 12,063
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	6 years	11 years
Cost	$ 23,015	$ 6,180
Accumulated Amortization	(5,520)	(4,423)
Net	$ 17,495	$ 1,757

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 215,236	$ 276,402
Short-term investments	81,691	32,694
Trade accounts receivable, net of allowances of $10,992 and $4,879	271,155	259,327
Inventories, net	421,775	389,608
Prepaid Expenses	93,639	67,362
Other Current Assets	28,790	32,643
Total current assets	1,112,286	1,058,036
Property, plant and equipment, net	373,570	340,199
Right of use asset - operating leases	147,472	156,184
Intangible assets, net	1,219,942	1,067,833
Goodwill	1,104,640	1,055,462
Deferred tax assets, net	45,763	46,080
Other assets	70,822	58,194
Total assets	4,074,495	3,781,988
Current liabilities:
Current portion of borrowings under senior credit facility	24,219	14,531
Current portion of lease liability - operating leases	14,613	15,284
Accounts payable, trade	107,492	92,326
Contract liabilities	9,905	8,540
Accrued compensation	69,600	75,455
Accrued expenses and other current liabilities	102,487	100,844
Total current liabilities	328,316	306,980
Long-term borrowings under senior credit facility	1,151,665	825,563
Long-term borrowings under securitization facility	77,700	89,200
Long-term convertible securities	571,713	570,255
Lease liability - operating leases	169,561	166,849
Deferred tax liabilities	86,525	35,317
Other liabilities	154,820	199,940
Total liabilities	2,540,300	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; 91,591 and 90,920 issued at June 30, 2024 and December 31, 2023, respectively	916	909
Additional paid-in capital	1,301,582	1,302,484
Treasury stock, at cost; 14,008 shares and 12,751 shares at June 30, 2024 and December 31, 2023, respectively	(680,753)	(647,262)
Accumulated other comprehensive loss	(18,726)	(15,106)
Retained earnings	931,176	946,859
Total stockholders’ equity	1,534,195	1,587,884
Total liabilities and stockholders’ equity	$ 4,074,495	$ 3,781,988

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, 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	28,410
Balance, end of period (in shares) at Jun. 30, 2023		90,881,000
Balance, end of period at Jun. 30, 2023	1,683,160	$ 909	$ (513,782)	1,283,675	4,830	907,528
Balance, beginning of period, treasury stock (in shares) at Jun. 30, 2023			(9,527,000)
Balance, beginning of period, (in shares) at Mar. 31, 2023		90,813,000
Balance, beginning 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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (Loss) Income	4,184					4,184
Other comprehensive income (loss), net of tax	(2,237)				(2,237)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		68,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	1,007	$ 1	$ 21	985
Share-based compensation	5,268			5,268
Accelerated shares repurchased (shares)			(609,000)
Accelerated shares repurchased	0		$ (32,125)	32,125
Balance, end of period (in shares) at Jun. 30, 2023		90,881,000
Balance, end of period at Jun. 30, 2023	1,683,160	$ 909	$ (513,782)	1,283,675	4,830	907,528
Balance, beginning of period, treasury stock (in shares) at Jun. 30, 2023			(9,527,000)
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
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)
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	$ (15,683)
Other comprehensive income (loss), net of tax	(3,620)
Balance, end of period (in shares) at Jun. 30, 2024		91,591,000
Balance, end of period at Jun. 30, 2024	$ 1,534,195	$ 916	$ (680,753)	1,301,582	(18,726)	931,176
Balance, beginning of period, treasury stock (in shares) at Jun. 30, 2024	(14,008,000)		(14,008,000)
Balance, beginning of period, (in shares) at Mar. 31, 2024		91,484,000
Balance, beginning 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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (Loss) Income	(12,402)					(12,402)
Other comprehensive income (loss), net of tax	(8,080)				(8,080)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		107,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(80)	$ 1	$ 20	(101)
Share-based compensation	7,305			7,305
Accelerated shares repurchased (shares)			(1,273,000)
Accelerated shares repurchased	(50,500)		$ (34,351)	(16,149)
Balance, end of period (in shares) at Jun. 30, 2024		91,591,000
Balance, end of period at Jun. 30, 2024	$ 1,534,195	$ 916	$ (680,753)	$ 1,301,582	$ (18,726)	$ 931,176
Balance, beginning of period, treasury stock (in shares) at Jun. 30, 2024	(14,008,000)		(14,008,000)

GOODWILL AND OTHER INTANGIBLE ASSETS

6 Months Ended

Jun. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the six-month period ended June 30, 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
Acclarent Acquisition	65,579		—		65,579
Foreign currency translation	(10,717)		(5,684)		(16,401)
Goodwill at June 30, 2024	$	721,799	$	382,841	$	1,104,640

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 Company’s manufacturing facility located in Boston, Massachusetts (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:


	June 30, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,412,670	$	(482,499)	$	930,171
Customer relationships	12 years	167,273		(135,789)		31,484
Trademarks/brand names	27 years	100,600		(40,351)		60,249
Codman tradename	Indefinite	168,969		—		168,969
Supplier relationships	30 years	30,211		(18,637)		11,574
All other	6 years	23,015		(5,520)		17,495
		$	1,902,738	$	(682,796)	$	1,219,942


	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 and six months ended June 30, 2024 was $25.4 million and $53.1 million, respectively. Of these amounts, $21.7 million and $39.3 million, respectively, 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 and six months ended June 30, 2023 was $20.6 million and $41.3 million, respectively. Of these amounts, $17.6 million and $35.1 million, respectively, 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 $50.8 million for the remainder of 2024, $101.6 million in 2025, $101.4 million in 2026, $100.4 million in 2027, $96.9 million in 2028, $91.6 million in 2029 and $506.8 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.

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 impairment testing on certain definite-lived intangible assets including completed technology and customer relationships in accordance with FASB ASC Topic 360, Property, Plant and Equipment. In the first quarter of 2024, the Company recorded an impairment charge related to the definite-lived intangible asset associated with the customer relationships of $7.1 million in intangible asset amortization in the consolidated statement of operations. With respect to the definite-lived intangible assets associated with the completed technology of SurgiMend® and PriMatrix®, the Company determined that the carrying amount of these definite-lived intangible assets were recoverable and, therefore, the intangible assets were not deemed to be impaired. The carrying values of SurgiMend® and PriMatrix® are $36.5 million and $26.6 million, respectively, as of June 30, 2024.

BASIS OF PRESENTATION (Policies)	6 Months Ended
BASIS OF PRESENTATION (Policies)	Jun. 30, 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 June 30, 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 consolidated balance sheet as of December 31, 2023 was derived from audited financial statements, but does not include all disclosures required by GAAP. Operating results for the three and six-month period ended June 30, 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 unaudited 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 a SOFR-indexed rate. (See Note 6. Debt). In March 2023, the Company entered into a basis swap contract by which the Company receives Term SOFR and pays LIBOR to convert its portfolio of interest rate swaps from LIBOR to SOFR. The Company 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, 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.
Cash and cash equivalents	Cash and cash equivalents The Company had cash and cash equivalents, primarily consisting of cash on-hand as well as time deposits with original maturities of three months or less and money market funds which are highly liquid and readily convertible to cash, totaling approximately $215.2 million and $276.4 million at June 30, 2024 and December 31, 2023 respectively. Time deposits with original maturities of three months or less and money market funds are valued based on Level 1 measurements in the fair value hierarchy established within FASB Topic 820, Fair Value Measurement (“ASC 820”). Level 1 inputs represent quoted prices in active markets for identical assets or liabilities.
Short-term investments	Short-term investments The Company had short term investments, primarily consisting of time deposits with original maturities between three months and one year, which are valued based on Level 1 measurements in the fair value hierarchy, totaling approximately $81.7 million at June 30, 2024 compared to $32.7 million at December 31, 2023.
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. 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 investment in financial asset.

+ References + Details

- Definition

Disclosure of accounting policy for revenue from contract with customer.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-17

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
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-Name Accounting Standards Codification
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-Paragraph 19
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
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-Paragraph 18
-Subparagraph (a)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org/606/tableOfContent

+ Details

INCOME TAXES (Tables)

6 Months Ended

Jun. 30, 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 June 30,		Six Months Ended June 30,
	2024	2023	2024		2023
Reported tax rate	18.3%	(9.4)%	23.2	%	15.5	%

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 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	6,623
Contract asset, End of Period	6,623
Contract Liability
Contract liability, beginning of period	16,252
Recognition of revenue included in beginning of year contract liability	(5,365)
Contract liability, net of revenue recognized on contracts during the period	7,519
Foreign currency translation	(77)
Contract liability, end of period	$ 18,329

RETIREMENT PLANS	6 Months Ended
RETIREMENT PLANS	Jun. 30, 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 and six months ended June 30, 2024 were $0.4 million and $0.9 million. The components of the net periodic benefit costs other than the service cost component of $0.8 million and $1.6 million for the three and six months ended June 30, 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 and six months June 30, 2023 were $0.3 million and $0.6 million. The components of the net periodic benefit costs other than the service cost component of $0.5 million and $1.1 million for the three and six months ended June 30, 2023 are included in other income, net in the consolidated statements of operations. The estimated fair values of plan assets were $41.7 million and $45.7 million as of June 30, 2024 and December 31, 2023, respectively. The net plan assets of the pension plans are invested in common trusts as of June 30, 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 $6.0 million and $6.1 million as of June 30, 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
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
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-Name Accounting Standards Codification
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-Paragraph 17
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-URI https://asc.fasb.org/1943274/2147480482/715-20-55-17

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iv)(03)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480506/715-20-50-1

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-Paragraph 1
-Subparagraph (q)
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-URI https://asc.fasb.org/1943274/2147480506/715-20-50-1

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-URI https://asc.fasb.org/1943274/2147480506/715-20-50-1

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-Topic 715
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-URI https://asc.fasb.org/715/tableOfContent

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Subparagraph (d)(iii)
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480266/715-60-50-3

+ Details

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	$ 1,597,952	$ 1,674,938	$ 1,587,884	$ 1,804,403
Balance, end of period	1,534,195	1,683,160	1,534,195	1,683,160
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(10,646)	7,067	(15,106)	10,265
Balance, end of period	(18,726)	4,830	(18,726)	4,830
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	1,449	(4,942)	69,995	(12,404)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	7,153	(1,583)	45,937	509
Designated as Hedging Instrument \| Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	12,057	19,973	(17,705)	29,527
Balance, end of period	6,353	16,614	6,353	16,614
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	53,060	42,678	43,556	56,712
Amount of Gain (Loss) Recognized in AOCI	5,088	18,694	19,811	8,160
Amount of Gain (Loss) Reclassified from AOCI into Earnings	5,032	4,471	10,251	7,971
Balance, end of period	53,116	56,901	53,116	56,901
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(17,704)	(14,576)	(15,763)	(20,271)
Amount of Gain (Loss) Recognized in AOCI	598	(12,873)	30,130	(10,682)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(239)	(8,524)	31,234	(12,028)
Balance, end of period	(16,867)	(18,925)	(16,867)	(18,925)
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(22,780)	(8,060)	(45,498)	(6,914)
Amount of Gain (Loss) Recognized in AOCI	(4,233)	(11,067)	20,687	(10,117)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	2,453	2,112	4,655	4,208
Balance, end of period	(29,466)	(21,239)	(29,466)	(21,239)
Designated as Hedging Instrument \| Foreign currency forward contracts \| Cash Flow Hedges \| Cost of Sales
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(519)	(69)	0	0
Amount of Gain (Loss) Recognized in AOCI	(4)	304	(633)	235
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(93)	358	(203)	358
Balance, end of period	$ (430)	$ (123)	$ (430)	$ (123)

SEGMENT AND GEOGRAPHIC INFORMATION

6 Months Ended

Jun. 30, 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; (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; and (iii) the ENT business, which includes instrumentation, balloon technologies for sinus dilation and eustachian tube dilation, as well as surgical navigation systems.

•The Tissue Technologies segment consists of the Wound Reconstruction and Care business, which includes offerings such as skin and wound repair products, plastics and surgical reconstruction products, bone grafts, and nerve and tendon repair products. The Tissue Technologies segment includes the Company’s private label business.

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

The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions, and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by each reportable segment for the three and six months ended June 30, 2024 and 2023 are as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
Segment Net Sales
Codman Specialty Surgical	$	301,761	$	271,030	$	558,195	$	519,166
Tissue Technologies	116,414		110,237		228,852		242,947
Total revenues	$	418,175	$	381,267	$	787,047	$	762,113
Segment Profit
Codman Specialty Surgical	$	164,141	$	116,341	$	267,633	$	227,274
Tissue Technologies	37,187		8,062		67,853		60,343
Segment profit	201,328		124,403		335,486		287,617
Amortization	(3,707)		(3,026)		(13,814)		(6,134)
Corporate and other	(200,650)		(108,873)		(320,737)		(232,597)
Operating income	$	(3,029)	$	12,504	$	935	$	48,886

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 June 30,				Six Months Ended June 30,
Dollars in thousands	2024		2023		2024		2023
United States	$	310,225	$	276,782	$	566,454	$	547,784
Europe	40,689		37,452		82,285		78,516
Asia Pacific	45,951		47,706		95,496		98,179
Rest of World	21,310		19,327		42,812		37,634
Total Revenues	$	418,175	$	381,267	$	787,047	$	762,113

- 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/exampleRef
-Topic 280
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-Name Accounting Standards Codification
-Section 55
-Paragraph 48
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-48

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+ Details

DEBT - Contractual Maturity Table (Details) $ in Thousands	Jun. 30, 2024 USD ($)
Debt Disclosure [Abstract]
Remainder of 2024	$ 9,688
2025	33,906
2026	38,750
2027	53,281
Thereafter	634,531
Total long-term debt	$ 770,156

- Definition

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

+ References + Details

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Segment Reporting Information [Line Items]
Total Revenues	$ 418,175	$ 381,267	$ 787,047	$ 762,113
United States
Segment Reporting Information [Line Items]
Total Revenues	310,225	276,782	566,454	547,784
Europe
Segment Reporting Information [Line Items]
Total Revenues	40,689	37,452	82,285	78,516
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	45,951	47,706	95,496	98,179
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 21,310	$ 19,327	$ 42,812	$ 37,634

- Definition

+ References

+ Details

DERIVATIVE INSTRUMENTS (Tables)

6 Months Ended

Jun. 30, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following interest rate swaps as of June 30, 2024 and December 31, 2023 (dollar amounts in thousands):


	June 30, 2024		December 31, 2023							June 30, 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		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	—			2,105
1-month Term SOFR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	3,063			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,367			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,356			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,339			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,366			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,572			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	31,747			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	7,240			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(1,935)		0	(1,829)
	$	1,325,000	$	1,475,000						$	53,115		$	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 June 30, 2024 and December 31, 2023 (dollar amounts in thousands):


					June 30, 2024	December 31, 2023	June 30, 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	CHF 339,637	351,137	(12,894)		(38,324)
Receive U.S.$			3.98%	$	381,272	394,183




Pay CHF	September 22, 2023	September 29, 2024	2.40%	CHF	CHF 28,500	28,500	(283)		(2,348)
Receive U.S.$			6.27%	$	31,457	31,457

Total							$	(13,177)	$	(40,672)

The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 2024 and December 31, 2023, respectively (dollar amounts in thousands):


					June 30, 2024	December 31, 2023	June 30, 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	3,566	2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	288,210	(32,105)	(48,047)
Receive U.S.$			1.94%	$	300,000	300,000

Pay CHF	November 21, 2023	December 17, 2029	—%	CHF	CHF 66,525	66,525	(1,960)	(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Pay CHF	May 6, 2024	December 18, 2030	—%	CHF	CHF 68,483	—	(3,078)	—
Receive U.S.$			2.74%	$	75,000	—

Total							(33,577)	(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 June 30, 2024 and December 31, 2023:


	Fair Value as of
Location on Balance Sheet (1):	June 30, 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)	$	11,602	$	14,675
Cross-currency swap	2,950		537
Net Investment Hedges
Cross-currency swap	5,946		2,938
Other assets
Cash Flow Hedges
Interest rate swap(2)	43,448		30,710

Net Investment Hedges
Cross-currency swap	2,563		1,470
Total derivatives designated as hedges — Assets	$	66,509	$	50,330

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	612	$	579
Cross-currency swap	283		4,813
Foreign currency forward contracts	247		—
Net Investment Hedges
Cross-currency swap	—		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	1,323		1,250
Cross-currency swap	15,843		36,396
Net Investment Hedges
Cross-currency swap	42,086		51,114
Total derivatives designated as hedges — Liabilities	$	60,394	$	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 June 30, 2024 and December 31, 2023, the total notional amounts related to the Company’s interest rate swaps were $1.3 billion, and $1.5 billion, respectively.

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


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 June 30, 2024
Cash Flow Hedges
Interest rate swap	$	53,060	$	5,088	$	5,032	$	53,116	Interest expense
Cross-currency swap	(17,704)		598		(239)		(16,867)		Other income, net
Foreign Currency Forward Contract	(519)		(4)		(93)		(430)		Cost of Sales
Net Investment Hedges
Cross-currency swap	(22,780)		(4,233)		2,453		(29,466)		Interest income
	$	12,057	$	1,449	$	7,153	$	6,353
Three Months Ended June 30, 2023
Cash Flow Hedges
Interest rate swap	$	42,678	$	18,694	$	4,471	$	56,901	Interest expense
Cross-currency swap	(14,576)		(12,873)		(8,524)		(18,925)		Other income, net
Foreign Currency Forward Contract	$	(69)	$	304	$	358	$	(123)
Net Investment Hedges
Cross-currency swap	(8,060)		(11,067)		2,112		(21,239)		Interest income
	$	19,973	$	(4,942)	$	(1,583)	$	16,614

Dollars in thousands	Balance in AOCI Beginning of Year		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
Six Months Ended June 30, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	19,811	$	10,251	$	53,116	Interest expense
Cross-currency swap	(15,763)		30,130		31,234		(16,867)		Other income (expense), net
Foreign currency forward contract	—		(633)		(203)		(430)		Cost of sales
Net Investment Hedges
Cross-currency swap	(45,498)		20,687		4,655		(29,466)		Interest income
	$	(17,705)	$	69,995	$	45,937	$	6,353
Six Months Ended June 30, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	8,160	$	7,971	$	56,901	Interest expense
Cross-currency swap	(20,271)		(10,682)		(12,028)		(18,925)		Other income (expense), net
Foreign currency forward contract	—		$	235	$	358	(123)
Net Investment Hedges
Cross-currency swap	(6,914)		(10,117)		4,208		(21,239)		Interest income
	$	29,527	$	(12,404)	$	509	$	16,614

Derivatives Not Designated as Hedging Instruments

The following table summarizes the gains 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 June 30,				Six Months Ended June 30,
	2024		2023		2024		2023

Foreign currency swaps	135		588		408		643
Total	$	135	$	588	$	408	$	643

- 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

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-07-01	Jun. 30, 2024
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation, percentage	54.00%
Performance obligations expected to be satisfied, expected timing	12 months

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

6 Months Ended

Jun. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill for the six-month period ended June 30, 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
Acclarent Acquisition	65,579		—		65,579
Foreign currency translation	(10,717)		(5,684)		(16,401)
Goodwill at June 30, 2024	$	721,799	$	382,841	$	1,104,640

Schedule of Finite-Lived Intangible Assets

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


	June 30, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,412,670	$	(482,499)	$	930,171
Customer relationships	12 years	167,273		(135,789)		31,484
Trademarks/brand names	27 years	100,600		(40,351)		60,249
Codman tradename	Indefinite	168,969		—		168,969
Supplier relationships	30 years	30,211		(18,637)		11,574
All other	6 years	23,015		(5,520)		17,495
		$	1,902,738	$	(682,796)	$	1,219,942


	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:


	June 30, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,412,670	$	(482,499)	$	930,171
Customer relationships	12 years	167,273		(135,789)		31,484
Trademarks/brand names	27 years	100,600		(40,351)		60,249
Codman tradename	Indefinite	168,969		—		168,969
Supplier relationships	30 years	30,211		(18,637)		11,574
All other	6 years	23,015		(5,520)		17,495
		$	1,902,738	$	(682,796)	$	1,219,942


	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.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-2

+ Details

ACQUISITIONS AND DIVESTITURES

6 Months Ended

Jun. 30, 2024

Mergers, Acquisitions and Dispositions [Abstract]

ACQUISITIONS AND DIVESTITURES

Acquisition of Acclarent, Inc.

On April 1, 2024, the Company completed the acquisition of all of the outstanding capital stock of Acclarent, Inc. (“Acclarent”), a developer and marketer of medical devices used in ear, nose, throat (“ENT”) procedures, from Ethicon, Inc., a subsidiary of Johnson & Johnson, 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. The addition of Acclarent’s ENT product portfolio, including sinus balloon dilation, eustachian tube balloon dilation, and surgical navigation systems technologies, and dedicated salesforce will enhance the Company’s position in the ENT specialty device market.

Acclarent’s results of operations have been reported in the Company’s Codman Specialty Surgical reportable segment from the date of acquisition. The Company recorded revenue from Acclarent of approximately $31.3 million, in the consolidated statements of operations and comprehensive income for the three months ended June 30, 2024. The net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it is in the process of being integrated into the Company’s operations.

Assets Acquired and Liabilities Assumed at Fair Value

The Acclarent acquisition has been accounted for using the acquisition method of accounting in accordance with FASB Topic ASC 805, Business Combinations (“ASC 805”). This method requires that assets acquired and liabilities assumed in a business combination are recognized at their fair values as of the acquisition date. The Company estimated fair values at the date of acquisition for the preliminary allocation of consideration to the net tangible and intangible assets acquired and liabilities assumed. The Company has not completed its analysis regarding the assets acquired and liabilities assumed. Therefore, the allocation to intangible assets, goodwill, and income taxes are preliminary and subject to finalization. During the measurement period ending no later than one year after the acquisition date, the Company will continue to obtain information to assist in finalizing the fair values of the net assets acquired, which may differ materially from these preliminary estimates. If any measurement period adjustment is material, the Company will record such adjustment, including any related impact on net income, in the reporting period in which the adjustment is determined.

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


Dollars in thousands	Estimated Fair Value		Estimated Useful Life
Current assets:
Cash	$	—
Trade accounts receivable, net	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	$	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	989
Intangible assets, net
Completed technology	202,000		12 years
Trademarks/brand names	3,000		5 years
All other	17,000		4 years
Goodwill	65,579
Deferred tax assets	6,863
Total assets acquired	$	347,906

Current liabilities:
Accounts payable, trade	$	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	$	11,653
Lease liability - operating leases	624
Deferred tax liabilities	53,635
Total liabilities assumed	65,912

Net assets acquired	$	281,994

The carrying value of trade accounts receivable, prepaid expenses, other current assets, accounts payable, contract liabilities, accrued compensation, accrued expenses and other current liabilities, as well as certain other current and non-current assets and liabilities, generally represented the fair value at the date of acquisition.

Intangible Assets

The estimated fair value of the intangible assets acquired was determined using the multi-period, excess earnings method of the income approach, which estimates value based on the present value of future economic benefits attributable to the intangible assets. The significant assumptions used in developing the valuation included the estimated annual net cash flows including application of forecasted revenue, the discount rate that appropriately reflects the risk inherent in each future cash flow stream, and an assessment of the asset’s life cycle, as well as other factors. The assumptions used in the financial forecasts were based on historical data, supplemented by current and anticipated growth rates, management plans, and market-comparable information. Fair-value determinations require considerable judgment and are sensitive to changes in underlying assumptions and factors. Preliminary assumptions may change and may result in significant changes to the final valuation. The intangible assets acquired have a weighted average useful life of 11 years.

The Company used a discount rate of 12.2% to arrive at the present value for the acquired intangible assets to reflect the rate of return a market participant would expect to earn and incremental commercial uncertainty in the cash flow projections. No assurances can be given that the underlying assumptions used to prepare the discounted cash flow analysis will not change. For these and other reasons, actual results may vary significantly from estimated results.

Goodwill

Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected synergies of the combined company and assembled workforce. Goodwill has been allocated to the Codman Specialty Surgical segment, as shown in Note 5. Goodwill and Other Intangible Assets. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

Deferred Tax Liabilities

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

NET INCOME PER SHARE (Tables)

6 Months Ended

Jun. 30, 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 June 30,				Six Months Ended June 30,
Dollars in thousands, except per share amounts	2024		2023		2024		2023
Basic net (loss) income per share:
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410
Weighted average common shares outstanding	77,409		80,966		77,572		81,418

Basic net (loss) income per common share	$	(0.16)	$	0.05	$	(0.20)	$	0.35

Diluted net (loss) income per share:
Net (loss) income	$	(12,402)	$	4,184	$	(15,683)	$	28,410

Weighted average common shares outstanding — Basic	77,409		80,966		77,572		81,418
Effect of dilutive securities:
Stock options and restricted stock	—		185		—		321
Weighted average common shares for diluted earnings per share	77,409		81,151		77,572		81,739

Diluted net (loss) income per common share	$	(0.16)	$	0.05	$	(0.20)	$	0.35

TREASURY STOCK	6 Months Ended
TREASURY STOCK	Jun. 30, 2024
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of June 30, 2024 and December 31, 2023, there were 14.0 million and 12.8 million shares of treasury stock outstanding with a cost of $680.8 million and $647.3 million, at a weighted average cost per share of $48.60 and $50.76, respectively. On May 16, 2024, the Company entered into a $50 million accelerated share repurchase (“May 2024 ASR”) and received 1.3 million shares of common stock at inception of the May 2024 ASR, which represented approximately 70% of the expected total shares under the May 2024 ASR. The remaining repurchase transactions are expected to be completed in the third quarter of 2024. 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 June 30, 2024, $50 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.

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Operating Leased Assets [Line Items]
Remainder of 2024	$ 11,884
2025	22,768
2026	20,693
2027	19,386
2028	17,267
2029	16,414
Thereafter	164,718
Total minimum lease payments	273,130
Less: Imputed interest	88,956
Total lease liabilities	184,174	$ 182,133
Less: Current lease liabilities	14,613	15,284
Long-term lease liabilities	169,561	$ 166,849
Related Parties
Operating Leased Assets [Line Items]
Remainder of 2024	148
2025	296
2026	296
2027	296
2028	296
2029	246
Thereafter	0
Total minimum lease payments	1,578
Third Parties
Operating Leased Assets [Line Items]
Remainder of 2024	11,736
2025	22,472
2026	20,397
2027	19,090
2028	16,971
2029	16,168
Thereafter	164,718
Total minimum lease payments	$ 271,552

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	6 Months Ended	12 Months Ended
	Jun. 30, 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	$ 0.8
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	$ 4.1
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	$ 43.5
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares)	702,687
Other than options, weighted average grant date fair value (in dollars per share)	$ 34.90
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)	308,467
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

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) $ in Thousands	3 Months Ended			6 Months Ended
	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Goodwill [Line Items]
Amortization	$ 25,400		$ 20,600	$ 53,100	$ 41,300
Expected annual amortization expense, remainder of 2024	50,800			50,800
Expected annual amortization expense, in 2025	101,600			101,600
Expected annual amortization expense, in 2026	101,400			101,400
Expected annual amortization expense, in 2027	100,400			100,400
Expected annual amortization expense, in 2028	96,900			96,900
Expected annual amortization expense, in 2029	91,600			91,600
Expected annual amortization expense, thereafter	506,800			506,800
Non-cash impairment charges				12,144	0
Intangible assets, net	$ 1,219,942			$ 1,219,942		$ 1,067,833
Tissue Technologies
Goodwill [Line Items]
Fair value in excess of carrying amount, percent	20.00%			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		$ 7,100
Completed technology
Goodwill [Line Items]
Cost, amortization	$ 21,700		$ 17,600	39,300	$ 35,100
Completed technology \| Completed Technology, Surgimend
Goodwill [Line Items]
Intangible assets, net	36,500			36,500
Completed technology \| Completed Technology, PriMatrix
Goodwill [Line Items]
Intangible assets, net	$ 26,600			$ 26,600

ACQUISITIONS AND DIVESTITURES - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	Apr. 01, 2024	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Goodwill		$ 1,104,640	$ 1,055,462
Acclarent Inc.
Current assets:
Cash	$ 0
Trade accounts receivable, net	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	$ 989
Estimated useful life	11 years
Goodwill	$ 65,579
Deferred tax assets	6,863
Total assets acquired	347,906
Current liabilities:
Accounts payable, trade	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	11,653
Lease liability - operating leases	624
Deferred tax liabilities	53,635
Total liabilities assumed	65,912
Net assets acquired	$ 281,994
Intangible asset acquired, discount rate (percent)	12.20%
Acclarent Inc. \| Completed technology
Current assets:
Intangible assets, net	$ 202,000
Estimated useful life	12 years
Acclarent Inc. \| Trademarks and Trade Names
Current assets:
Intangible assets, net	$ 3,000
Estimated useful life	5 years
Acclarent Inc. \| Other Intangible Assets
Current assets:
Intangible assets, net	$ 17,000
Estimated useful life	4 years

COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Thousands		3 Months Ended	6 Months Ended
	Dec. 06, 2022 USD ($) payment	Jun. 30, 2024 USD ($) liability	Jun. 30, 2024 USD ($) liability	Jun. 30, 2023 USD ($)	Jan. 20, 2021 USD ($)	Jul. 29, 2019 USD ($)
Loss Contingencies [Line Items]
Payment for contingent consideration			$ 11,923	$ 0
Arkis
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value						$ 25,500
Contingent consideration						13,100
Arkis \| Development Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value						10,000
Arkis \| Commercial Sales Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value						$ 15,500
Derma Sciences
Loss Contingencies [Line Items]
Number of contingent liabilities remaining \| liability		1	1
Contingent consideration, maximum undiscounted payment amount		$ 3,000	$ 3,000
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration			$ 33,300
ACell, Inc.
Loss Contingencies [Line Items]
Contingent consideration					$ 23,900
Number of contingent liabilities remaining \| liability		1	1
Contingent consideration, maximum undiscounted payment amount					$ 100,000
Surgical Innovation Associates, Inc.
Loss Contingencies [Line Items]
Contingent consideration, maximum undiscounted payment amount	$ 90,000
Number of contingent liabilities \| payment	2
Surgical Innovation Associates, Inc. \| Revenue Based Performance Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	$ 32,600
Payment for contingent consideration		$ 12,400
Contingent consideration, maximum undiscounted payment amount	50,000
Surgical Innovation Associates, Inc. \| FDA Approval Of Premarket Approval
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	25,000
Contingent consideration, maximum undiscounted payment amount	$ 40,000

INVENTORIES (Tables)

6 Months Ended

Jun. 30, 2024

Inventory Disclosure [Abstract]

Schedule of Inventories, Net

Inventories, net consisted of the following:


Dollars in thousands	June 30, 2024		December 31, 2023
Finished goods	$	220,844	$	196,402
Work in process	76,509		74,035
Raw materials	124,422		119,171
Total inventories, net	$	421,775	$	389,608

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 10,992	$ 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)	91,591,000	90,920,000
Treasury stock (in shares)	14,008,000	12,751,000

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Inventory Disclosure [Abstract]
Finished goods	$ 220,844	$ 196,402
Work in process	76,509	74,035
Raw materials	124,422	119,171
Inventories, net	$ 421,775	$ 389,608

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 12,029	$ 9,505
ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$ 68	$ 7,582

DERIVATIVE INSTRUMENTS - Narrative (Details) $ in Thousands, SFr in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($)	Jun. 30, 2024 CHF (SFr)	Jun. 30, 2023 USD ($)	Jul. 03, 2024 CHF (SFr)	Jun. 30, 2024 CHF (SFr)	May 02, 2024 USD ($)	May 02, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	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	$ 9,700		$ 9,700
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCI, change in fair value	1,449	$ (4,942)	69,995		$ (12,404)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	7,153	(1,583)	45,937		509
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount	1,325,000		1,325,000							$ 1,475,000
Estimated Fair Value	53,115		53,115							43,556
Cross-currency swap
Derivative [Line Items]
Gain (loss) reclassified into other income	1,300	1,400	2,600		2,900
Gain expected to be reclassified to earnings in the next twelve months	2,700		2,700
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	(1,500)	(10,000)	28,600		(14,900)
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	598	(12,873)	30,130		(10,682)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(239)	(8,524)	31,234		(12,028)
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	2,500	2,100	4,700		4,200
Estimated Fair Value	(33,577)		(33,577)							(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	(13,177)		(13,177)							(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	4,600		4,600										$ 7,300
Estimated Fair Value	1,500		1,500							1,200
Foreign currency swaps \| Net Investment Hedges \| Designated as Hedging Instrument
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 6.5
Foreign currency forward contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Subsequent Event
Derivative [Line Items]
Current notional amount \| SFr						SFr 5.2
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	(4)	304	(633)		235
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(93)	358	(203)		358
Interest Rate Swap
Derivative [Line Items]
Gain expected to be reclassified to earnings in the next twelve months	11,000		11,000
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	5,100	18,700	19,800		8,200
Gain (loss) reclassified into other income	5,000	$ 4,500	10,300		$ 8,000
Current notional amount	$ 1,300,000		$ 1,300,000							$ 1,500,000

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

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+ Details

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Segment Net Sales
Total Revenues	$ 418,175	$ 381,267	$ 787,047	$ 762,113
Segment Profit
Operating income	(3,029)	12,504	935	48,886
Amortization	(3,707)	(3,026)	(13,814)	(6,134)
Operating Segments
Segment Profit
Operating income	201,328	124,403	335,486	287,617
Corporate and other
Segment Profit
Operating income	(200,650)	(108,873)	(320,737)	(232,597)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	301,761	271,030	558,195	519,166
Codman Specialty Surgical \| Operating Segments
Segment Profit
Operating income	164,141	116,341	267,633	227,274
Tissue Technologies
Segment Net Sales
Total Revenues	116,414	110,237	228,852	242,947
Tissue Technologies \| Operating Segments
Segment Profit
Operating income	$ 37,187	$ 8,062	$ 67,853	$ 60,343

- Definition

+ References

+ Details