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Integra LifeSciences Reports Fourth Quarter and Full-Year 2024 Financial Results and Provides 2025 Financial Guidance

1. Q4 revenue increased 11.5% to $442.6M; organic revenue grew 3.5%. 2. Adjusted EPS improved to $0.97 from $0.89; GAAP EPS remained at $0.25. 3. Full-year GAAP earnings turned negative while reported revenues rose 4.5%. 4. A new CEO emphasizes global expansion, supply reliability, and quality improvements. 5. 2025 guidance forecasts modest revenue growth amid production and ship‐hold challenges.

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Why Neutral?

While Q4 showed strong revenue and adjusted EPS improvement, full-year GAAP earnings turned negative and margin pressures persist. Similar mixed reports in the past in the medtech space led to a limited immediate share move.

How important is it?

The detailed earnings, forward guidance, and strategic shifts provide significant insight into IART’s future, likely affecting investors over time.

Why Long Term?

The appointment of a new CEO and strategic investments along with integration of acquisitions signal long-term structural changes, despite near-term operational challenges.

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MDTSYKISRG
PRINCETON, N.J., Feb. 25, 2025 (GLOBE NEWSWIRE) -- Integra LifeSciences Holdings Corporation (NASDAQ: IART) today reported financial results for the fourth quarter and full year ended December 31, 2024. Fourth Quarter 2024 Reported revenues were $442.6 million, representing an increase of 11.5% on a reported basis and an increase of 3.5% on an organic basis compared to the fourth quarter 2023. GAAP earnings per diluted share were $0.25, compared to $0.25 in the fourth quarter 2023. Adjusted earnings per diluted share were $0.97, compared to $0.89 in the fourth quarter 2023. Full-Year 2024 Reported revenues were $1,610.5 million, representing an increase of 4.5% on a reported basis and a decrease of 1.3% on an organic basis compared to full-year 2023. GAAP earnings per diluted share were $(0.09), compared to $0.84 in 2023. Adjusted earnings per diluted share were $2.56, compared to $3.10 in 2023. 2024 Business Highlights Appointed Mojdeh Poul as President & CEOExperienced strong demand for our differentiated portfolio of leading brandsInitiated the Compliance Master Plan, an enterprise-wide approach to enhance quality management systemsMade critical investments in capacity and supply reliabilityIntegrated the Acclarent acquisition successfullyRealized strong market uptake of CereLink®Announced transition of manufacturing of PriMatrix® and SurgiMend® to Braintree, Massachusetts in the first half of 2026Advanced PMA submission for DuraSorb® and received PMA approvable notification pending GMP certification for SurgiMendExpanded international commercial footprint and portfolio; advanced in-China-for-China manufacturing build-out "As I step into my role leading Integra, I am inspired by the strength of our portfolio, the dedication of our team, and the tremendous potential we have to grow and innovate in high-impact specialty markets. Our fourth-quarter results reflect this strength, with sequential revenue growth driven by robust demand for our leading brands, continued progress in expanding our global presence, and our ongoing commitment to improving supply reliability," said Mojdeh Poul, president and chief executive officer. "While there is significant work ahead to enhance our quality system and streamline our processes, I am confident in our ability to address these challenges and position Integra for long-term, sustainable growth. By leveraging our competitive strengths, differentiated technologies, commercial expertise, and global presence, we are poised to unlock new opportunities for innovation and deliver greater value to our customers, patients, and shareholders." Fourth Quarter 2024 Financial Summary Total reported revenues for the fourth quarter were $442.6 million, an increase of 11.5% from the fourth quarter of 2023. Fourth quarter organic revenues were up 3.5% compared to the prior year. The Company reported GAAP net income of $19.4 million, or $0.25 per diluted share, in the fourth quarter of 2024, compared to GAAP net income of $19.8 million, or $0.25 per diluted share, in the prior year. Adjusted EBITDA for the fourth quarter of 2024 was $104.9 million, compared to $100.5 million in the fourth quarter of 2023. As a percentage of revenue, adjusted EBITDA was 23.7%, a decrease of 160 basis points from the prior year period. Adjusted net income for the fourth quarter of 2024 was $73.3 million, or $0.97 per diluted share, compared to adjusted net income of $69.1 million, or $0.89 per diluted share, in the fourth quarter of 2023. Cash flows from operations totaled $50.7 million in the fourth quarter and capital expenditures were $29.6 million. Fourth Quarter 2024 Segment Performance Codman Specialty Surgical (71% of Revenues) Total revenues were $314.7 million, representing reported an increase of 15.8% and 4.1% on an organic basis compared to the fourth quarter of 2023.Sales in Neurosurgery grew 5.1% on an organic basis: CSF management grew low double-digits driven by BactiSeal® and Certas® PlusNeuro monitoring grew high single-digits driven by CereLink ICP monitors, BactiSeal and CerebroFlo® EVD catheters.Advanced energy grew low single-digits driven by CUSA® disposablesDural access and repair declined low single-digits due to the impact from the recall of patties and strips partially offset by growth in DuraGen®, DuraSeal® and Mayfeild®. Sales of Instruments were flat on an organic basis due to growth in hospital sales offset by a decrease in alternative site sales due to order timing.ENT reported revenue growth driven primarily by the Acclarent acquisition. Tissue Technologies (29% of Revenue) Total revenues were $128.0 million, representing an increase of 2.1% on a reported and organic basis compared to the fourth quarter of 2023.Sales in Wound Reconstruction grew 8.2% on an organic basis: Low-double-digit growth in DuraSorb®, MicroMatrix®, Cytal® and AmnioExcel®Mid-single-digit growth in Integra Skin Sales in private label were down 16% on an organic basis due to a component supply delay Full-Year 2024 Financial Summary Total reported revenues for the full-year 2024 were $1,610.5 million, an increase of 4.5%, from the prior year. Organic sales for the full-year 2024 were down 1.3% compared to 2023. 2024 Revenues were driven by three quarters of revenue from the Acclarent acquisition offset by production constraints on Integra Skin and intermittent ship holds on various products. The Company reported GAAP net income of $(6.9) million, or $(0.09) per diluted share, for the full-year 2024, compared to GAAP net income of $67.7 million, or $0.84 per diluted share in 2023. Adjusted EBITDA for the full-year 2024 was $322.2 million, a decrease of $47.4 million versus the prior year. Full- year adjusted EBITDA margins were 20.0%, a decrease of 400 basis points from the prior year. Adjusted net income for the full-year 2024 was $196.9 million, or $2.56 per diluted share, compared to $247.8 million, or $3.10 per diluted share in the prior year. 2024 Balance Sheet, Cash Flow and Capital Allocation The Company generated cash flow from operations of $129.4 million for the full-year 2024. Full-year capital expenditures were $104.0 million. Net debt at the end of the year was $1.5 billion, and the consolidated total leverage ratio was 4.0x. As of year-end, the Company had total liquidity of approximately $1.2 billion, including approximately $273 million in cash plus short-term investments and the remainder available under its revolving credit facility. 2025 Revenue and Adjusted Earnings Per Share Guidance For the full-year 2025, the Company expects revenues to be in the range of $1,650 million to $1,715 million, representing reported growth of 2.4% to 6.5% and organic growth of 1.0% to 5.0%. 2025 revenue guidance reflects the strong demand for the Company’s portfolio and a full year of the Acclarent acquisition offset by the potential for intermittent ship holds as the company continues to implement its Compliance Master Plan and the strength of the U.S. dollar. Adjusted earnings per diluted share are expected to be between $2.41 and $2.51. For the first quarter 2025, the Company expects reported revenues in the range of $375 million to $385 million, representing reported growth of 1.6% to 4.4% and organic growth of -6.2% to -3.5%. First quarter 2025 revenue guidance reflects the benefit of the Acclarent acquisition offset by temporary production delays on Integra Skin, intermittent ship-holds as the company continues to implement its Compliance Master Plan and the strength of the U.S. dollar. Adjusted earnings per diluted share are expected to be in the range of $0.40 to $0.45. Organic sales growth excludes acquisitions as well as the effects of foreign currency. The Company is providing forward-looking guidance regarding adjusted earnings per diluted share but is not providing a reconciliation to GAAP earnings per share, because certain GAAP expense items are highly variable, and management is unable to predict them with reasonable certainty and without unreasonable effort. Specifically, the financial impact and timing of divestitures, acquisitions, integrations, structural optimization and efforts to comply with the EU Medical Device Regulation are uncertain, depend on various dynamic factors and are not reasonably ascertainable at this time. These expense items could have a material impact on GAAP results. Conference Call and Presentation Available Online Integra has scheduled a conference call for 8:30 a.m. ET on Tuesday, February 25, 2025, to discuss fourth quarter and full-year 2024 financial results, and forward-looking financial guidance. The conference call will be hosted by Integra's senior management team and will be open to all listeners. Additional forward-looking information may be discussed in a question-and-answer session following the call. Integra's management team will reference a presentation during the conference call, which can be found on the Investor Relations section of the website at investor.integralife.com. A live webcast will be available on the Investors section of the Company’s website at investor.integralife.com. For those planning to participate on the call, please register here to receive dial-in details and a unique pin. While not required, it is recommended to join 10 minutes prior to the start of the event. A webcast replay of the conference call will be available on the Investor Relations section of the Company’s website following the call. About Integra At Integra LifeSciences, we are driven by our purpose of restoring patients’ lives. We innovate treatment pathways to advance patient outcomes and set new standards of surgical, neurologic, and regenerative care. We offer a comprehensive portfolio of high quality, leadership brands. For the latest news and information about Integra and its products, please visit www.integralife.com. Forward-Looking Statements This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that involve risks and uncertainties and reflect the Company's judgment as of the date of this release. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements. Some of these forward-looking statements may contain words like “will,” “believe,” “may,” “could,” “would,” “might,” “possible,” “should,” “expect,” “intend,” "forecast," "guidance," “plan,” “anticipate,” "target," or “continue,” the negative of these words, other terms of similar meaning or they may use future dates. Forward-looking statements contained in this news release include, but are not limited to, statements concerning future financial performance, including projections for revenues, expected revenue growth (both reported and organic), GAAP and adjusted net income, GAAP and adjusted earnings per diluted share, non-GAAP adjustments such as divestiture, acquisition and integration-related charges, intangible asset amortization, structural optimization charges, EU Medical Device Regulation-related charges, charges related to the voluntary global recall of all products manufactured at the Company’s facility in Boston, Massachusetts and the transition of Boston-related manufacturing operations to the Company’s Braintree, Massachusetts facility, and income tax expense (benefit) related to non-GAAP adjustments and other items, and the Company’s expectations and plans with respect to business and operational performance, strategic initiatives, capabilities, resources, product development, product availability and regulatory approvals, including expectations regarding the efficacy of the Company’s compliance master plan to improve the Company's quality system. It is important to note that the Company’s goals and expectations are not predictions of actual performance. Such forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from predicted or expected results. Such risks and uncertainties include, but are not limited, to the following: the ongoing and possible future effects of global challenges, including macroeconomic uncertainties, inflation, supply chain disruptions, trade regulation and tariffs, bank failures and other economic disruptions, and U.S. and global recession concerns, on the Company’s customers and on the Company’s business, financial condition, results of operations and cash flows; the Company's ability to execute its operating plan effectively; the Company’s ability to successfully integrate Acclarent and other acquired businesses; the Company’s ability to achieve sales growth in a timely fashion; the Company's ability to manufacture and ship sufficient quantities of its products to meet its customers' demands; the ability of third-party suppliers to supply us with raw materials and finished products; global macroeconomic and political conditions, including the war in Ukraine and the conflict in Israel and Gaza; the Company's ability to manage its direct sales channels effectively; the sales performance of third-party distributors on whom the Company relies to generate revenue for certain products and geographic regions; the Company's ability to access and maintain relationships with customers of acquired entities and businesses; physicians' willingness to adopt and third-party payors' willingness to provide or maintain reimbursement for the Company's recently launched, planned and existing products; initiatives launched by the Company's competitors; downward pricing pressures from customers; the Company's ability to secure regulatory approval for products in development; the Company's ability to remediate quality systems violations; difficulties in implementing the Company’s compliance master plan and realizing the benefits contemplated thereby within the anticipated timeframe, or at all; difficulties or delays in obtaining and maintaining required regulatory approvals related to the transition of the manufacturing to the Company’s Braintree manufacturing facility; the possibility that costs or difficulties related to building and the operationalization of the Braintree facility or the transition of manufacturing activities from the Company’s Boston facility to the Braintree facility will be greater than expected; fluctuations in hospitals' spending for capital equipment; uncertainties inherent in the development of new products and the enhancement of existing products, including FDA approval and/or clearance and other regulatory risks, technical risks, cost overruns and delays; the Company's ability to comply with regulations regarding products of human origin and products containing materials derived from animal source; difficulties in controlling expenses, including costs to procure and manufacture the Company’s products; the ability of the Company to successfully manage leadership and organizational changes and the impact of changes in management or staff levels; the impact of goodwill and intangible asset impairment charges if future operating results of acquired businesses are significantly less than the results anticipated at the time of the acquisitions, the Company's ability to leverage its existing selling organizations and administrative infrastructure; the Company's ability to increase product sales and gross margins, and control non-product costs; the Company’s ability to achieve anticipated growth rates, margins and scale and execute its strategy generally; the amount and timing of divestiture, acquisition and integration-related costs; the geographic distribution of where the Company generates its taxable income; new U.S. and foreign government laws and regulations, and changes in existing laws, regulations and enforcement guidance, which affect areas of our operations including, but not limited to, those affecting the health care industry, including the EU Medical Device Regulation; the scope, duration and effect of U.S. and international governmental, regulatory, fiscal, monetary and public health responses to any future public health crises; fluctuations in foreign currency exchange rates; the amount of our bank borrowings outstanding and other factors influencing liquidity; potential negative impacts resulting from environmental, social and governance matters; and the economic, competitive, governmental, technological, and other risk factors and uncertainties identified under the heading “Risk Factors” included in Item 1A of Integra's Annual Report on Form 10-K for the year ended December 31, 2024 to be filed with the Securities and Exchange Commission. These forward-looking statements are made only as of the date hereof, and the Company undertakes no obligation to update or revise the forward-looking statements, whether as a result of new information, future events, or otherwise, except as required by law. Discussion of Adjusted Financial Measures In addition to our GAAP results, we provide certain non-GAAP measures, including organic revenues, adjusted earnings before interest, taxes, depreciation and amortization ("EBITDA"), adjusted EBITDA margin, adjusted net income, adjusted gross profit, adjusted gross margin, adjusted earnings per diluted share, free cash flow, adjusted free cash flow conversion, and net debt. Organic revenues consist of total revenues excluding the effects of currency exchange rates, revenues from current-period acquisitions and product divestitures. Adjusted EBITDA consists of GAAP net income excluding: (i) depreciation and amortization; (ii) other income (expense); (iii) interest income and expense; (iv) income tax expense (benefit); and (v) those operating expenses also excluded from adjusted net income. The measure of adjusted EBITDA margin is calculated by dividing adjusted EBITDA by total revenues. The measure of adjusted net income consists of GAAP net income, excluding: (i) structural optimization charges; (ii) divestiture, acquisition and integration-related charges; (iii) EU Medical Device Regulation-related charges; (iv) charges related to the voluntary global recall of products manufactured at the Company’s Boston, Massachusetts facility and distributed between March 1, 2018 and May 22, 2023, as previously disclosed in the Company’s Current Report on Form 8-K filed with the Securities and Exchange Commission on May 23, 2023 (the “recall”) and the transition of Boston-related manufacturing operations to the Company’s Braintree, Massachusetts facility; (v) intangible asset amortization expense; and (vi) income tax impact from adjustments. The measure of adjusted gross margin is calculated by dividing adjusted gross profit by total revenues. Adjusted gross profit consists of GAAP gross profit adjusted for: (i) structural optimization charges; (ii) divestiture, acquisition and integration-related charges; (iii) charges related to the recall and the transition of Boston-related manufacturing operations to the Company’s Braintree, Massachusetts facility; (iv) EU Medical Device Regulation-related charges; and (v) intangible asset amortization expense. The adjusted earnings per diluted share measure is calculated by dividing adjusted net income attributable to diluted shares by diluted weighted average shares outstanding. The measure of free cash flow consists of GAAP net cash provided by operating activities less purchases of property and equipment. The adjusted free cash flow conversion measure is calculated by dividing free cash flow by adjusted net income. The measure of net debt consists of GAAP total debt (excluding deferred financing costs) less short-term investments, cash and cash equivalents. Reconciliations of GAAP revenues to organic revenues, GAAP net income to adjusted EBITDA and adjusted net income, GAAP gross profit to adjusted gross profit, GAAP gross margin to adjusted gross margin, and GAAP earnings per diluted share to adjusted earnings per diluted share all for the quarters and years ended December 31, 2024 and 2023, GAAP total debt to net debt for the years ended December 31, 2024 and 2024, and the GAAP operating cash flow to free cash flow and adjusted free cash flow conversion for the quarters and years ended December 31, 2024 and 2023, appear in the financial tables in this release. The Company believes that the presentation of organic revenues and the other non-GAAP measures provide important supplemental information to management and investors regarding financial and business trends relating to the Company's financial condition and results of operations. For further information regarding why Integra believes that these non-GAAP financial measures provide useful information to investors, the specific manner in which management uses these measures, and some of the limitations associated with the use of these measures, please refer to the Company's Current Report on Form 8-K regarding this earnings press release filed today with the Securities and Exchange Commission. This Current Report on Form 8-K is available on the SEC's website at www.sec.gov or on our website at www.integralife.com. Investor Relations Contact: Chris Ward (609) 772-7736 chris.ward@integralife.com Media Contact: Laurene Isip (609) 208-8121 laurene.isip@integralife.com     INTEGRA LIFESCIENCES HOLDINGS CORPORATIONCONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS(UNAUDITED)    (In thousands, except per share amounts)        Three Months Ended December 31, Twelve Months Ended December 31, 2024 2023 2024 2023Total revenues442,645  397,039  1,610,527  1,541,573         Costs and expenses:       Cost of goods sold193,573  170,546  728,466  656,838 Research and development31,210  24,284  115,377  104,192 Selling, general and administrative178,520  163,128  716,983  656,641 Intangible asset amortization3,715  3,034  21,290  12,376 Total costs and expenses407,018  360,992  1,582,116  1,430,047 Operating income35,627  36,047  28,411  111,526 Interest income4,893  4,549  20,040  17,202 Interest expense(18,984) (13,751) (70,632) (51,377)Gain (loss) from the sale of business—  —  —  — Other income, net1,005  2,013  3,944  3,718 Income (loss) before taxes22,541  28,858  (18,237) 81,069 Income tax expense (benefit)3,106  9,024  (11,293) 13,328 Net income (loss)19,435  19,834  (6,944) 67,741         Net income (loss) per share:       Diluted net income (loss) per share0.25  0.25  (0.09) 0.84 Weighted average common shares outstanding for diluted net income per share76,419  77,959  77,010  80,337          Segment revenues and growth in total revenues excluding the effects of currency exchange rates, acquisitions and discontinued products are as follows: (In thousands)  Three Months Ended December 31, Twelve Months Ended December 31, 20242023Change 20242023ChangeNeurosurgery220,091 210,204 4.7% 803,816 818,101 (1.7)%Instruments51,029 51,095 (0.1)% 204,177 203,617 0.3%ENT43,540 10,328 321.6% 135,643 37,275 263.9%Total Codman Specialty Surgical314,660 271,627 15.8% 1,143,636 1,058,993 8.0%         Wound Reconstruction and Care101,527 93,859 8.2% 350,565 373,986 (6.3)%Private Label26,458 31,553 (16.1)% 116,326 108,594 7.1%Total Tissue Technologies127,985 125,412 2.1% 466,891 482,580 (3.3)%Total Reported Revenues442,645 397,039 11.5% 1,610,527 1,541,573 4.5%         Impact of changes in currency exchange rates880 — —  6,084 — — Less contribution of revenues from acquisitions(32,763)— —  (95,049)— — Less contribution of revenues from divested products— — —  — (245)— Less contribution of revenues from discontinued products— — —  — — — Total organic revenues1410,762 397,039 3.5% 1,521,563 1,541,328 (1.3)%          (1) Organic revenues have been adjusted to exclude foreign currency (current period), acquisitions and to account for divested and discontinued products. Items included in GAAP net income and from continuing operations and locations where each item is recorded are as follows: (In thousands) Three Months Ended December 31, 2024             ItemTotal AmountCOGS(a)SG&A(b)R&D(c)Amort.(d)OI&E(e)Tax(f)Acquisition, divestiture and integration-related charges2,264 513 315 1,034 — 402 — Structural Optimization charges9,083 4,238 4,261 583 — — — EU Medical Device Regulation charges9,461 1,054 3,933 4,474 — — — Boston Recall/Braintree Transition11,358 10,966 392 — — — — Intangible asset amortization expense26,557 22,842 — — 3,715 — — Estimated income tax impact from above adjustments and other items(4,902)— — — — — (4,902)Depreciation expense10,935 — — — — — —                a)COGS - Cost of goods sold b)SG&A - Selling, general and administrative c)R&D - Research & development d)Amort. - Intangible asset amortization e)OI&E - Other income & expense f)Tax - Income tax expense (benefit)    Three Months Ended December 31, 2023           ItemTotal AmountCOGS(a)SG&A(b)R&D(c)Amort.(d)OI&E(e)Tax(f)Acquisition, divestiture and integration-related charges7,117 73 8,040 (880)— (116)— Structural Optimization charges6,216 3,077 3,155 (16)— — — EU Medical Device Regulation charges12,387 2,227 4,653 5,507 — — — Boston Recall/Braintree Transition8,129 7,370 759 — — — — Intangible asset amortization expense20,687 17,653 — — 3,034 — — Estimated income tax impact from above adjustments and other items(5,272)— — — — — (5,272)Depreciation expense9,834 — — — — — —              (a)COGS - Cost of goods sold (b)SG&A - Selling, general and administrative (c)R&D - Research & development (d)Amort. - Intangible asset amortization (e)OI&E - Other income & expense (f)Tax - Income tax expense (benefit)    Items included in GAAP net income and location where each item is recorded are as follows: (In thousands) Twelve Months Ended December 31, 2024            ItemTotal AmountCOGS(a)SG&A(b)R&D(c)Amort.(d)OI&E(e)Tax(f)Acquisition, divestiture and integration-related charges33,626 9,071 25,793 (1,542)— 304 — Structural Optimization charges24,194 16,195 7,395 604 — — — EU Medical Device Regulation charges44,570 4,020 18,875 21,674 — — — Boston Recall45,034 43,175 1,859 — — — — Intangible asset amortization expense105,252 83,962 — — 21,290 — — Estimated income tax impact from above adjustments and other items(48,792)— — — — — (48,792)Depreciation expense41,449 — — — — — —   (a)COGS - Cost of goods sold (b)SG&A - Selling, general and administrative (c)R&D - Research & development (d)Amort. - Intangible asset amortization (e)OI&E - Other income & expense (f)Tax - Income tax expense (benefit)    Twelve Months Ended December 31, 2023           ItemTotal AmountCOGS(a)SG&A(b)R&D(c)Amort.(d)OI&E(e)Tax(f)Acquisition, divestiture and integration-related charges25,173 3,045 25,181 (2,188)— (865)— Structural Optimization charges16,084 8,208 7,943 (67)— — — EU Medical Device Regulation charges46,559 5,813 20,002 20,745 — — — Boston Recall46,970 46,116 853 — — — — Intangible asset amortization expense82,823 70,447 — — 12,376 — — Estimated income tax impact from above adjustments and other items(37,573)— — — — — (37,573)Depreciation expense39,704 — — — — — —   (a)COGS - Cost of goods sold (b)SG&A - Selling, general and administrative (c)R&D - Research & development (d)Amort. - Intangible asset amortization (e)OI&E - Other income & expense (f)Tax - Income tax expense (benefit)    INTEGRA LIFESCIENCES HOLDINGS CORPORATION RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME FROM CONTINUING OPERATIONS TO ADJUSTED EBITDA (UNAUDITED)    (In thousands)        Three Months Ended December 31, Twelve Months Ended December 31, 2024 2023 2024 2023        GAAP net income19,435  19,834  (6,944) 67,741 Non-GAAP adjustments:       Depreciation and intangible asset amortization expense37,491  30,522  146,701  122,528 Other (income), net(1,407) (1,897) (4,248) (2,853)Interest expense, net14,091  9,202  50,591  34,175 Income tax expense (benefit)3,106  9,024  (11,293) 13,328 Structural optimization charges9,083  6,216  24,194  16,084 EU Medical Device Regulation charges9,461  12,387  44,570  46,559 Boston Recall11,358  8,129  45,034  46,970 Acquisition, divestiture and integration-related charges2,264  7,117  33,626  25,173 Total of non-GAAP adjustments85,447  80,700  329,175  301,964 Adjusted EBITDA104,882  100,534  322,231  369,705              INTEGRA LIFESCIENCES HOLDINGS CORPORATION RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME FROM CONTINUING OPERATIONS TO MEASURES OF ADJUSTED NET INCOME AND ADJUSTED EARNINGS PER SHARE (UNAUDITED)    (In thousands, except per share amounts)        Three Months Ended December 31, Twelve Months Ended December 31, 2024 2023 2024 2023        GAAP net income 19,435  19,834   (6,944) 67,741 Non-GAAP adjustments:       Structural optimization charges 9,083  6,216   24,194  16,084 Acquisition, divestiture and integration-related charges 2,264  7,117   33,626  25,173 EU Medical Device Regulation charges 9,461  12,387   44,570  46,559 Boston Recall 11,358  8,129   45,034  46,970 Intangible asset amortization expense 26,557  20,687   105,252  82,823 Estimated income tax impact from adjustments and other items (4,902) (5,272)  (48,792) (37,573)Total of non-GAAP adjustments 53,821  49,264   203,884  180,036 Adjusted net income$73,256  69,098  $196,940  247,777         Adjusted diluted net income per share 0.97  0.89  $2.56  3.10 Weighted average common shares outstanding for diluted net income per share 76,419  77,959   77,079  80,337                INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED BALANCE SHEET DATA (UNAUDITED)    (In thousands)        December 31, December 31, 2024 2023    Cash and cash equivalents$246,375  $276,402 Accounts receivable, net 272,370   259,327 Inventory, net 429,090   389,608     Current and long-term borrowing under senior credit facility$1,121,823   840,094 Borrowings under securitization facility 108,100   89,200 Convertible securities 573,170   570,255     Stockholders' equity 1,545,280   1,587,884          INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED STATEMENT OF CASH FLOWS (UNAUDITED)   Twelve Months Ending December 31, 20242023Net cash provided by operating activities$129,382 $139,955 Net cash used in investing activities (390,808) (94,178)Net cash used in by financing activities 237,863  (229,925)Effect of exchange rate changes on cash and cash equivalents (6,464) 3,889    Net increase (decrease) in cash and cash equivalents (30,027) (180,259)    RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP OPERATING CASH FLOW TO MEASURES OF ADJUSTED FREE CASH FLOW AND ADJUSTED FREE CASH FLOW CONVERSION (UNAUDITED)  (In thousands)    Three Months Ended December 31, 20242023GAAP Net cash provided by operating activities$50,746 $58,746    Purchases of property and equipment (29,599) (24,563)Adj. Free Cash Flow$21,147 $34,183    Adjusted net income (1) $73,256  69,098 Adjusted Free Cash Flow Conversion 28.8% 49.5%       Twelve Months Ending December 31, 20242023GAAP Net cash provided by operating activities$129,382 $139,955    Purchases of property and equipment (104,418) (66,865)Adj. Free Cash Flow$24,964 $73,090    Adjusted net income (1) $196,940  247,777 Adjusted Free Cash Flow Conversion 12.7% 29.5%    (1) Adjusted net income for quarters and twelve months ended December 31, 2023 and 2024 are reconciled above. Adjusted net income for remaining quarters in the trailing twelve months calculation have been previously reconciled and are publicly available in the Quarterly Earnings Call Presentations on our website at investor.integralife.com. The Company calculates adjusted free cash flow conversion by dividing its free cash flow by adjusted net income. The Company believes this measure is a useful metric in evaluating the significance of the cash special charges in its adjusted earnings measures.   RECONCILIATION OF NON-GAAP ADJUSTMENTS - NET DEBT CALCULATION (UNAUDITED)  (In thousands)  December 31, 2024December 31, 2023Short-term borrowings under senior credit facility$33,906 $14,531 Long-term borrowings under senior credit facility 1,087,917  825,563 Borrowings under securitization facility 108,100  89,200 Convertible Securities 573,170  570,255 Deferred financing costs netted in the above 5,475  9,651 Short-term investments (27,192) (32,694)Cash & Cash Equivalents (246,375) (276,402)Net Debt$1,535,001 $1,200,104    

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