UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
 
FORM 10-Q
 
(Mark One)
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended June 30, 20212022
or
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from              to             
COMMISSION FILE NO. 0-26224
 
INTEGRA LIFESCIENCES HOLDINGS CORPORATION
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
 
Delaware 51-0317849
(STATE OR OTHER JURISDICTION OF
INCORPORATION OR ORGANIZATION)
 (I.R.S. EMPLOYER
IDENTIFICATION NO.)
1100 Campus Road 08540
Princeton,New Jersey(ZIP CODE)
(ADDRESS OF PRINCIPAL EXECUTIVE OFFICES) 
Registrant's Telephone Number, Including Area Code: (609) 275-0500
Former Name, Former Address and Former Fiscal Year, if Changed Since Last Report:
Securities registered pursuant to Section 12(b) of the Act:
TITLE OF EACH CLASSTRADING SYMBOLNAME OF EACH EXCHANGE ON WHICH REGISTERED
Common Stock, Par Value $.01 Per ShareIARTNasdaq Global Select Market
 
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes      No  

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).   Yes      No  

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of large accelerated filer, accelerated filer, smaller reporting company, and "emerging growth company" in Rule 12b-2 of the Exchange Act.





Large accelerated filerAccelerated filer
Non-accelerated filer
  
Smaller reporting company
Emerging growth company

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).    Yes      No  
Indicate by check mark whether the registrant has filed all documents and reports required to be filed by Section 12, 13 or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court.  Yes      No  
The number of shares of the registrant’s Common Stock, $0.01 par value, outstanding as of July 27, 202125, 2022 was 84,579,542.83,504,470.



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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
INDEX

 
 Page
Number
EX-101 INSTANCE DOCUMENT
EX-101 SCHEMA DOCUMENT
EX-101 CALCULATION LINKBASE DOCUMENT
EX-101 DEFINITION LINKBASE DOCUMENT
EX-101 LABELS LINKBASE DOCUMENT
EX-101 PRESENTATION LINKBASE DOCUMENT



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PART I. FINANCIAL INFORMATION

Item 1. Financial Statements

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
AND COMPREHENSIVE INCOME / (LOSS)
(UNAUDITED)
(Dollars in thousands, except per share amounts)
Three Months Ended June 30,Six Months Ended June 30, Three Months Ended June 30,Six Months Ended June 30,
2021202020212020 2022202120222021
Total revenue, netTotal revenue, net$389,992 $258,665 $750,063 $612,989 Total revenue, net$397,815 $389,992 $774,453 $750,063 
Costs and expenses:Costs and expenses:Costs and expenses:
Cost of goods soldCost of goods sold151,267 105,478 297,090 238,954 Cost of goods sold148,404 151,267 290,973 297,090 
Research and developmentResearch and development20,121 14,926 42,495 35,742 Research and development25,589 20,121 49,674 42,495 
Selling, general and administrativeSelling, general and administrative162,552 116,108 319,185 282,060 Selling, general and administrative160,651 162,552 320,577 319,185 
Intangible asset amortizationIntangible asset amortization4,198 8,073 8,725 15,050 Intangible asset amortization3,304 4,198 7,198 8,725 
Total costs and expensesTotal costs and expenses338,138 244,585 667,495 571,806 Total costs and expenses337,948 338,138 668,422 667,495 
Operating incomeOperating income51,854 14,080 82,568 41,183 Operating income59,867 51,854 106,031 82,568 
Interest incomeInterest income1,764 2,281 3,512 4,851 Interest income1,965 1,764 3,342 3,512 
Interest expenseInterest expense(13,149)(15,682)(26,078)(33,434)Interest expense(12,236)(13,149)(23,891)(26,078)
Gain (loss) from the sale of businessGain (loss) from the sale of business(679)42,197 Gain (loss) from the sale of business— (679)— 42,197 
Other income, netOther income, net5,034 972 9,903 493 Other income, net1,979 5,034 5,408 9,903 
Income before income taxesIncome before income taxes44,824 1,651 112,102 13,093 Income before income taxes51,575 44,824 90,890 112,102 
Provision for income taxesProvision for income taxes9,756 2,020 31,640 4,282 Provision for income taxes6,787 9,756 13,201 31,640 
Net income (loss)$35,068 $(369)$80,462 $8,811 
Net incomeNet income$44,788 $35,068 $77,689 $80,462 
Net income per shareNet income per shareNet income per share
Basic$0.41 $(0.00)$0.95 $0.10 
Diluted$0.41 $(0.00)$0.94 $0.10 
Weighted average common shares outstanding (See Note 13):
BasicBasic84,687 84,706 84,593 84,955 Basic$0.54 $0.41 $0.93 $0.95 
DilutedDiluted85,340 84,706 85,324 85,548 Diluted$0.54 $0.41 $0.93 $0.94 
Comprehensive income (loss) (See Note 14)28,7311,095 104,558 $(17,912)
Weighted average common shares outstanding (See Note 14):Weighted average common shares outstanding (See Note 14):
BasicBasic83,168 84,687 83,400 84,593 
DilutedDiluted83,622 85,340 83,979 85,324 
Comprehensive income (See Note 15)Comprehensive income (See Note 15)52,59828,731 109,630 $104,558 
The accompanying unaudited notes are an integral part of these condensed consolidated financial statements.
4

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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED)
(Dollars in thousands, except per share amounts)
June 30, 2021December 31, 2020June 30, 2022December 31, 2021
ASSETSASSETSASSETS
Current assets:Current assets:Current assets:
Cash and cash equivalentsCash and cash equivalents$397,414 $470,166 Cash and cash equivalents$447,152 $513,448 
Trade accounts receivable, net of allowances of $6,687 and $6,439229,823 225,532 
Trade accounts receivable, net of allowances of $3,995 and $4,735Trade accounts receivable, net of allowances of $3,995 and $4,735237,361 231,831 
Inventories, netInventories, net323,618 310,117 Inventories, net320,208 317,386 
Prepaid expenses and other current assetsPrepaid expenses and other current assets81,527 69,282 Prepaid expenses and other current assets102,168 91,051 
Assets held for saleAssets held for sale162,105 Assets held for sale30,525 — 
Total current assetsTotal current assets1,032,382 1,237,202 Total current assets1,137,414 1,153,716 
Property, plant and equipment, netProperty, plant and equipment, net295,759 287,529 Property, plant and equipment, net302,423 311,703 
Right of use asset - operating leasesRight of use asset - operating leases89,174 83,635 Right of use asset - operating leases145,135 84,543 
Intangible assets, netIntangible assets, net1,178,884 989,436 Intangible assets, net1,082,275 1,145,573 
GoodwillGoodwill1,015,638 932,367 Goodwill990,406 1,013,458 
Deferred tax assets, netDeferred tax assets, net80,086 73,690 Deferred tax assets, net46,982 56,950 
Other assetsOther assets20,864 11,277 Other assets48,227 16,440 
Total assetsTotal assets$3,712,787 $3,615,136 Total assets$3,752,862 $3,782,383 
LIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITYLIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:Current liabilities:Current liabilities:
Current portion of borrowings under senior credit facilityCurrent portion of borrowings under senior credit facility$45,000 $33,750 Current portion of borrowings under senior credit facility$50,625 $45,000 
Current portion of borrowings under securitization facility112,500 
Current portion of lease liability - operating leasesCurrent portion of lease liability - operating leases13,987 12,818 Current portion of lease liability - operating leases12,743 14,775 
Accounts payable, tradeAccounts payable, trade65,512 54,608 Accounts payable, trade69,498 61,837 
Income taxes payable17,112 
Contract liabilitiesContract liabilities5,890 5,275 Contract liabilities5,425 5,295 
Accrued compensationAccrued compensation72,047 76,117 Accrued compensation69,599 92,656 
Accrued expenses and other current liabilitiesAccrued expenses and other current liabilities99,208 94,194 Accrued expenses and other current liabilities85,403 120,458 
Liabilities held for saleLiabilities held for sale11,751 Liabilities held for sale2,303 — 
Total current liabilitiesTotal current liabilities318,756 401,013 Total current liabilities295,596 340,021 
Long-term borrowings under senior credit facilityLong-term borrowings under senior credit facility823,208 933,387 Long-term borrowings under senior credit facility819,654 824,257 
Long-term borrowings under securitization facilityLong-term borrowings under securitization facility112,500 Long-term borrowings under securitization facility112,500 112,500 
Long-term convertible securitiesLong-term convertible securities562,968 474,834 Long-term convertible securities565,883 564,426 
Lease liability - operating leasesLease liability - operating leases95,196 88,118 Lease liability - operating leases154,029 90,329 
Deferred tax liabilitiesDeferred tax liabilities63,447 16,190 Deferred tax liabilities61,287 45,788 
Other liabilitiesOther liabilities161,731 186,727 Other liabilities82,996 120,258 
Total liabilitiesTotal liabilities2,137,806 2,100,269 Total liabilities2,091,945 2,097,579 
Stockholders’ equity:Stockholders’ equity:Stockholders’ equity:
Preferred stock; 0 par value; 15,000 authorized shares; NaN outstanding
Common stock; $0.01 par value; 240,000 authorized shares; 89,474 and 89,251 issued at June 30, 2021 and December 31, 2020, respectively895 893 
Preferred stock; no par value; 15,000 authorized shares; none outstandingPreferred stock; no par value; 15,000 authorized shares; none outstanding— — 
Common stock; $0.01 par value; 240,000 authorized shares; 90,334 and 89,600 issued at June 30, 2022 and December 31, 2021, respectivelyCommon stock; $0.01 par value; 240,000 authorized shares; 90,334 and 89,600 issued at June 30, 2022 and December 31, 2021, respectively903 896 
Additional paid-in capitalAdditional paid-in capital1,248,555 1,290,909 Additional paid-in capital1,259,852 1,264,943 
Treasury stock, at cost; 4,899 shares and 4,914 shares at June 30, 2021 and December 31, 2020, respectively(234,461)(235,141)
Treasury stock, at cost; 6,823 shares and 4,899 shares at June 30, 2022 and December 31, 2021, respectivelyTreasury stock, at cost; 6,823 shares and 4,899 shares at June 30, 2022 and December 31, 2021, respectively(362,880)(234,448)
Accumulated other comprehensive lossAccumulated other comprehensive loss(49,963)(74,059)Accumulated other comprehensive loss(13,215)(45,155)
Retained earningsRetained earnings609,955 532,265 Retained earnings776,257 698,568 
Total stockholders’ equityTotal stockholders’ equity1,574,981 1,514,867 Total stockholders’ equity1,660,917 1,684,804 
Total liabilities and stockholders’ equityTotal liabilities and stockholders’ equity$3,712,787 $3,615,136 Total liabilities and stockholders’ equity$3,752,862 $3,782,383 
The accompanying unaudited notes are an integral part of these condensed consolidated financial statements.
5

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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(Dollars in thousands)
Six Months Ended June 30, Six Months Ended June 30,
20212020 20222021
OPERATING ACTIVITIES:OPERATING ACTIVITIES:OPERATING ACTIVITIES:
Net incomeNet income$80,462 $8,811 Net income$77,689 $80,462 
Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortizationDepreciation and amortization58,968 58,826 Depreciation and amortization59,336 58,968 
Non-cash impairment chargesNon-cash impairment charges2,754 Non-cash impairment charges— 2,754 
Deferred income tax (benefit) provision(4,907)(401)
Deferred income tax provision (benefit)Deferred income tax provision (benefit)7,542 (4,907)
Share-based compensationShare-based compensation22,033 8,922 Share-based compensation13,027 22,033 
Amortization of debt issuance costs and expenses associated with debt refinancingAmortization of debt issuance costs and expenses associated with debt refinancing3,569 5,551 Amortization of debt issuance costs and expenses associated with debt refinancing3,392 3,569 
Non-cash lease expenseNon-cash lease expense2,528 1,760 Non-cash lease expense1,393 2,528 
Accretion of bond issuance discount6,780 
Loss on disposal of property and equipmentLoss on disposal of property and equipment86 517 Loss on disposal of property and equipment732 86 
Gain from the sale of businessGain from the sale of business(42,197)Gain from the sale of business— (42,197)
Change in fair value of contingent consideration and othersChange in fair value of contingent consideration and others(385)(708)Change in fair value of contingent consideration and others(5,799)(385)
Changes in assets and liabilities:Changes in assets and liabilities:Changes in assets and liabilities:
Accounts receivableAccounts receivable10,802 95,293 Accounts receivable(9,632)10,802 
InventoriesInventories2,893 (47,041)Inventories(17,576)2,893 
Prepaid expenses and other current assetsPrepaid expenses and other current assets(8,061)2,191 Prepaid expenses and other current assets(4,120)(8,061)
Other non-current assetsOther non-current assets4,067 6,149 Other non-current assets6,738 4,067 
Accounts payable, accrued expenses and other current liabilitiesAccounts payable, accrued expenses and other current liabilities27,277 (88,671)Accounts payable, accrued expenses and other current liabilities(14,556)27,277 
Contract liabilitiesContract liabilities774 — 
Other non-current liabilitiesOther non-current liabilities482 (4,048)Other non-current liabilities(8,118)482 
Net cash provided by operating activitiesNet cash provided by operating activities160,371 53,931 Net cash provided by operating activities110,822 160,371 
INVESTING ACTIVITIES:INVESTING ACTIVITIES:INVESTING ACTIVITIES:
Purchases of property and equipmentPurchases of property and equipment(13,309)(23,736)Purchases of property and equipment(18,732)(13,309)
Proceeds from sale of Extremity Orthopedics businessProceeds from sale of Extremity Orthopedics business191,736 Proceeds from sale of Extremity Orthopedics business— 191,736 
Proceeds from sale of property and equipment3,302 
Cash (paid) provided for business acquisitions, net of cash acquired(303,910)
Acquired in-process research and development(5,000)
Acquired in-process research and development milestoneAcquired in-process research and development milestone(4,742)— 
Net proceeds from swaps designated as net investment hedgesNet proceeds from swaps designated as net investment hedges4,909 — 
Cash paid for business acquisitions, net of cash acquiredCash paid for business acquisitions, net of cash acquired— (303,910)
Net cash used in investing activitiesNet cash used in investing activities(125,483)(25,434)Net cash used in investing activities(18,565)(125,483)
FINANCING ACTIVITIES:FINANCING ACTIVITIES:FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtednessProceeds from borrowings of long-term indebtedness2,200 127,700 Proceeds from borrowings of long-term indebtedness23,000 2,200 
Payments on debtPayments on debt(102,200)(388,500)Payments on debt(23,000)(102,200)
Purchase of option hedge on convertible notes(104,248)
Proceeds from convertible notes issuance575,000 
Proceeds from sale of stock purchase warrants44,563 
Payment of debt issuance costsPayment of debt issuance costs(249)(20,264)Payment of debt issuance costs— (249)
Purchases of treasury stockPurchases of treasury stock(100,000)Purchases of treasury stock(125,000)— 
Proceeds from exercised stock optionsProceeds from exercised stock options3,603 3,598 Proceeds from exercised stock options1,592 3,603 
Cash taxes paid in net equity settlementCash taxes paid in net equity settlement(3,844)(4,397)Cash taxes paid in net equity settlement(23,204)(3,844)
Net cash (used) provided by financing activities(100,490)133,452 
Net cash used in financing activitiesNet cash used in financing activities(146,612)(100,490)
Effect of exchange rate changes on cash and cash equivalentsEffect of exchange rate changes on cash and cash equivalents(7,150)121 Effect of exchange rate changes on cash and cash equivalents(11,941)(7,150)
Net increase in cash and cash equivalents(72,752)162,070 
Net decrease in cash and cash equivalentsNet decrease in cash and cash equivalents(66,296)(72,752)
Cash and cash equivalents at beginning of periodCash and cash equivalents at beginning of period470,166 198,911 Cash and cash equivalents at beginning of period513,448 470,166 
Cash and cash equivalents at end of periodCash and cash equivalents at end of period$397,414 $360,981 Cash and cash equivalents at end of period$447,152 $397,414 
The accompanying unaudited notes are an integral part of these condensed consolidated financial statements.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'SSHAREHOLDERS' EQUITY
(UNAUDITED)
(Dollars in thousands, except per share amounts)thousands)
Six Months Ended June 30, 2021Six Months Ended June 30, 2022
Common StockTreasury StockAdditional Paid-In CapitalAccumulated Other Comprehensive LossRetained EarningsTotal EquityCommon StockTreasury StockAdditional Paid-In CapitalAccumulated Other Comprehensive LossRetained EarningsTotal Equity
SharesAmountSharesAmountSharesAmountSharesAmount
Balance, January 1, 202189,251 $893 (4,914)$(235,141)$1,290,909 $(74,059)$532,265 $1,514,867 
Balance, January 1, 2022Balance, January 1, 202289,600 $896 (4,899)$(234,448)$1,264,943 $(45,155)$698,568 $1,684,804 
Net incomeNet income— — — — — — 45,394 45,394 Net income— — — — — — 32,901 32,901 
Other comprehensive income, net of taxOther comprehensive income, net of tax— — — — — 30,432 — 30,432 Other comprehensive income, net of tax— — — — — 24,130 — 24,130 
Issuance of common stock through employee stock purchase planIssuance of common stock through employee stock purchase plan18 — — — 1,127 — — 1,127 Issuance of common stock through employee stock purchase plan17 — — — 1,078 — — 1,078 
Issuance of common stock for vesting of share based awards, net of shares withheld for taxesIssuance of common stock for vesting of share based awards, net of shares withheld for taxes137 15 680 (3,222)— — (2,541)Issuance of common stock for vesting of share based awards, net of shares withheld for taxes339 14 714 (9,758)— — (9,040)
Share-based compensationShare-based compensation— — — — 6,098 — — 6,098 Share-based compensation— — — — 6,324 — — 6,324 
Adoption of Update No. 2020-06— — — — (63,274)— (2,772)(66,046)
Balance, March 31, 202189,406 894 (4,899)(234,461)1,231,638 (43,627)574,887 1,529,331 
Accelerated shares repurchasedAccelerated shares repurchased— $— (1,938)$(129,152)$4,152 $— $— $(125,000)
Balance, March 31, 2022Balance, March 31, 202289,956 $900 (6,823)$(362,886)$1,266,739 $(21,025)$731,469 $1,615,197 
Net incomeNet income— — — — — — 35,068 35,068 Net income— — — — — — 44,788 44,788 
Other comprehensive loss, net of taxOther comprehensive loss, net of tax— — — — — (6,336)— (6,336)Other comprehensive loss, net of tax— — — — — 7,810 — 7,810 
Issuance of common stock for vesting of share based awards, net of shares withheld for taxesIssuance of common stock for vesting of share based awards, net of shares withheld for taxes68 — 1,175 — — 1,176 Issuance of common stock for vesting of share based awards, net of shares withheld for taxes378 — (13,655)— — (13,646)
Share-based compensationShare-based compensation— — — — 15,742 — — 15,742 Share-based compensation— — — — 6,768 — — 6,768 
Balance, June 30, 202189,474 $895 (4,899)$(234,461)$1,248,555 $(49,963)$609,955 $1,574,981 
Balance, June 30, 2022Balance, June 30, 202290,334 $903 (6,823)$(362,880)$1,259,852 $(13,215)$776,257 $1,660,917 
Six Months Ended June 30, 2020Six Months Ended June 30, 2021
Common StockTreasury StockAdditional Paid-In CapitalAccumulated Other Comprehensive LossRetained EarningsTotal EquityCommon StockTreasury StockAdditional Paid-In CapitalAccumulated Other Comprehensive LossRetained EarningsTotal Equity
SharesAmountSharesAmountSharesAmountSharesAmount
Balance, January 1, 202088,735 $887 (2,865)$(119,943)$1,213,620 $(76,401)$398,573 $1,416,736 
Balance, January 1, 2021Balance, January 1, 202189,251 $893 (4,914)$(235,141)$1,290,909 $(74,059)$532,265 $1,514,867 
Net incomeNet income— — — — — — 9,180 9,180 Net income— — — — — — 45,394 45,394 
Other comprehensive loss, net of tax— — — — — (28,187)— (28,187)
Other comprehensive income, net of taxOther comprehensive income, net of tax— — — — — 30,432 — 30,432 
Issuance of common stock through employee stock purchase planIssuance of common stock through employee stock purchase plan13 — — — 694 — — 694 Issuance of common stock through employee stock purchase plan18 — — — 1,127 — — 1,127 
Issuance of common stock for vesting of share based awards, net of shares withheld for taxesIssuance of common stock for vesting of share based awards, net of shares withheld for taxes357 10 476 (3,217)— — (2,739)Issuance of common stock for vesting of share based awards, net of shares withheld for taxes137 15 680 (3,222)— — (2,541)
Share-based compensationShare-based compensation— — — — 3,781 — — 3,781 Share-based compensation— — — — 6,098 — — 6,098 
Share repurchase and equity component of the convertible note issuance, net— — (135)(7,632)42,538 — — 34,906 
Accelerated shares repurchased— — (1,304)(75,407)(16,961)— — (92,368)
Adoption of Update No. 2016-13— — — — — — (200)(200)
Balance, March 31, 202089,105 $889 (4,294)$(202,506)$1,240,455 $(104,588)$407,553 $1,341,803 
Net loss— — — — — — (369)(369)
Other comprehensive income, net of tax— — — — — 1,464 — 1,464 
Adoption of Update No. 2020-06Adoption of Update No. 2020-06— — — — (63,274)— (2,772)(66,046)
Balance, March 31, 2021Balance, March 31, 202189,406 $894 (4,899)$(234,461)$1,231,638 $(43,627)$574,887 $1,529,331 
Net incomeNet income— — — — — — 35,068 35,068 
Other comprehensive loss, net of taxOther comprehensive loss, net of tax— — — — — (6,336)— (6,336)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxesIssuance of common stock for vesting of share based awards, net of shares withheld for taxes84 — (35)1,282 — — 1,250 Issuance of common stock for vesting of share based awards, net of shares withheld for taxes68 — — 1,175 — — 1,176 
Share-based compensationShare-based compensation— — — — 4,948 — — 4,948 Share-based compensation— — — — 15,742 — — 15,742 
Accelerated shares repurchased— — (621)(32,685)32,685 — — 
Balance, June 30, 202089,189 892 (4,915)(235,226)1,279,370 (103,124)407,184 1,349,096 
Balance, June 30, 2021Balance, June 30, 202189,474 $895 (4,899)$(234,461)$1,248,555 $(49,963)$609,955 $1,574,981 
The accompanying unaudited notes are an integral part of these condensed consolidated financial statements.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)

1. 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, 20212022 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, statement of changes in shareholder'sshareholders' equity, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 20202021 included in the Company’s Annual Report on Form 10-K. The December 31, 20202021 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three and six monthsix-month period ended June 30, 20212022 are not necessarily indicative of the results to be expected for the entire year.
The preparation of consolidated financial statements is in conformity with generally accepted accounting principles in the United States ("GAAP") which requires management to make estimates and assumptions that affect the reported amount of assets and liabilities, the disclosure of contingent liabilities, and the reported amounts of revenues and expenses. Significant estimates affecting amounts reported or disclosed in the consolidated financial statements include allowances for doubtful accounts receivable and sales returns and allowances, net realizable value of inventories, valuation of intangible assets including amortization periods for acquired intangible assets, discount rates and estimated projected cash flows used to value and test impairments of long-lived assets and goodwill, estimates of projected cash flows and depreciation and amortization periods for long-lived assets, computation of taxes, valuation allowances recorded against deferred tax assets, the valuation of stock-based compensation, valuation of derivative instruments, valuation of contingent liabilities, the fair value of debt instruments and loss contingencies. These estimates are based on historical experience and on various other assumptions that are believed to be reasonable under the current circumstances. Actual results could differ from these estimates.
Risks and Uncertainties
The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic. During the beginningpandemic, including reductions in capital and overall spending by our customers, increased freight costs, decreased availability of 2020, the Company's customers diverted resources to treat COVID-19 patientscertain raw materials used in certain of our products and deferred or canceled elective or non-emergent surgical procedures, all of which impacted hospitals' abilities to meet their obligations, including to the Company. Towards the end of 2020 and during the first half of 2021, procedural volumes relevant to the Company’s products steadily increased and, in some geographic areas, began to approach normalized levels. However, on-going uncertainty persists about the continuing sustainability of those procedural volumes as virus outbreaks constrain healthcare networks. Furthermore, capital markets and economies worldwide have also been negatively impacted by thelabor constraints. The COVID-19 pandemic and it is possible that it could cause a local and/or global economic recession. Such economic disruption has had, and may continue to have, an adverse effect on the Company'sCompany’s business, results of operations, financial condition, and cash flows, and its future impacts remain highly uncertain and unpredictable. Although there was not a material impact to the Company’s consolidated financial statements as customers curtailedof and reduced capitalfor the six months ended June 30, 2022, changes in the Company’s assessment about the length and overall spending. Policymakers aroundseverity of the globe have responded with fiscal policy actions to support the healthcare industry and the economypandemic, as a whole. The magnitude and overall effectiveness of these actions remains uncertain.well as other factors, could result in actual results differing from estimates. The severity of the impact of the COVID-19 pandemic on the Company's business will depend on a number of factors, including, but not limited to, duration of the pandemic, including resurgences, new variants or strains, impact of government regulations, the speed and effectiveness of vaccine distribution, vaccine adoption rates and the duration of direct and indirect economic effects of the pandemic, containment measures and containment measures. The Company's future results of operations and liquidityother macroeconomic factors which could be adversely impacted by delays in payments of outstanding receivable amounts beyond normal payment terms, supply chain disruptions and uncertain demand, and the impact of any initiatives cause a local/or programs that the Company may undertake to address financial and operations challenges faced by its customers. During the first half of 2021, the Company's revenues were still impacted due to COVID-19 resurgences and lower surgical procedural volumes, though not to the levels seen in early 2020. As a result, the Company has continued to manage its operating costs in this environment.global economic recession. Even after the COVID-19 pandemic and government responses thereto have subsided, residual economic and other effects may have an impact on the demand for post-pandemic surgery levels that are difficult to predict.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Employee Termination Benefits
The Company incurred restructuring costs related to employee terminations associated with a plant closure and future outsourcing plans for select transactional back office activities in the consolidated statement of operations for the six months ended June 30, 2022. The following table summarizes our restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the six months ended June 30, 2022. All balances are expected to be paid within the current fiscal year.
(Dollars in thousands)Amount
Balance at December 31,2021$10,226 
Charges:
Cost of Goods Sold$1,417 
Research and development133
Selling, general and administrative1,807
Payments and other adjustments$(6,885)
Balance at June 30,2022$6,698 
Recent Accounting Pronouncements
In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The ASU became effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020 is not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures.
The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the COVID-19 pandemic, and other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact due to customer and governmental responses to the COVID-19 pandemic.
In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans. This guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans. The ASU is effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption was permitted. The Company adopted this guidance during the year ended December 31, 2020. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures.
In August 2018, the FASB issued ASU 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under this guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a prospective transition method. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures.
In December 2019, the FASB issued ASU 2019-12, Income Taxes: Taxes: Simplifying the Accounting for Income Taxes, intended to simplify the accounting for income taxes by eliminating certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplifies aspects of the accounting for franchise taxes and enacted changes in tax laws or rates and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The standard is effective for annual periods beginning after December 15, 2020 and interim periods within, with early adoption permitted. The Company adopted ASU No. 2019-12 as of January 1, 2021. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The adoption of this guidance did not have a materialsignificant impact on the Company's results orconsolidated financial position.statements and related disclosures.
In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform, which provides optional guidance for a limited period of time to ease the potential burden in accounting for (or recognizing the effects of) reference rate reform on financial reporting. This amendment applies to all entities, subject to meeting certain criteria, that have contracts, hedging relationships, and other transactions that reference London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued because of reference rate reform. This ASU is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into or evaluated on or before December 31, 2022. In January 2021, the FASB also issued ASU 2021-01, Reference Rate Reform- Scope which clarified certain optional expedients and exceptions to entities that are affected because of the reference rate reform. The amendments in this ASU affect the guidance in ASU 2020-04 and are effective in the same timeframe as ASU 2020-04. The Company currently has contracts that are indexed to LIBOR and are continuing to evaluate the scope of impacted contracts and potential risk. The Company is currently assessingalso monitoring the developments regarding alternative rates and may amend certain contracts to accommodate those rates if the contract does not already specify a replacement rate. While the notional value of agreements potentially indexed to LIBOR is material, the Company does not expect a material impact that this ASU will have on itsto the consolidated financial statements and related disclosures.disclosures associated with this transition.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
In August 2020, the FASB issued ASU 2020-06, Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging ContractsHedging-Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting:Accounting for Convertible Instruments and Contracts in an Entity's Own Equity. The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will bewas effective for annual and interim periods beginning after December 15, 2021, and early adoption iswas permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years using either the modified retrospective or full retrospective method.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
As detailed in Note 6 –7, Debt, on February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes are subject to the guidance included in ASU 2020-06. The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts:
ADJUSTMENTAdjustmentCONSOLIDATED BALANCE SHEET CLASSIFICATIONConsolidated Balance Sheet ClassificationAMOUNTAmount
(in millions)
Deferred tax impact of cumulative-effect adjustmentDeferred tax liabilities$(20.6)
Debt discount reclassificationLong-term convertible securities89.1
Equity issuance costs reclassificationLong-term convertible securities(2.5)
Debt discount amortization and equity costs reclassification, net of taxRetained Earnings(2.8)
Net impact of cumulative-effect adjustmentAdditional paid-in capital(63.3)
Upon adoption of this ASU 2020-06, the Company’s Convertible Senior Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its convertible senior notes2025 Notes to be settled in cash and any excess in shares. Following the irrevocable notice, only the amounts settled in excess of the principal will be considered in diluted earnings per share under the “if-converted” method. Upon adoption of ASU 2020-06, the Company’s 2025 Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount, therefore the interest expense for the 2025 Notes, which is included in the interest expense on the consolidated statements of operations and comprehensive loss, is lower as compared to the fiscal year of 2020.discount.
In October 2020, the FASB issued ASU 2020-10, Codification Improvements, which updates various codification topics by clarifying or improving disclosure requirements to align with the SEC’s regulations.regulations of the U.S. Securities and Exchange Commission (the "SEC"). The ASU will behas been effective for the Company for annual and interim periods beginning after January 1, 2021. The Company adopted this standard on the January 1, 2021. The adoption of this guidance did not have a materialsignificant impact on the Company's results,consolidated financial position orstatements and related disclosures.
In May 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options which provides guidance to clarify and reduce diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options (for example, warrants) that remain equity classified after modification or exchange. The amendments in this ASU No. 2021-04 are effective for all entities for fiscal years beginning after December 15, 2021, and interim periods within those fiscal years, with early adoption permitted, including interim periods within those fiscal years. The amendment currently hashad no impact to the Company as the effect will largely depend on the terms of written call options or financings issued or modified in the future.
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.
2. ASSETS AND LIABILITIES HELD FOR SALE
On May 20 2022, the Company and certain of its subsidiaries, entered into an agreement to sell its non-core traditional wound care ("TWC") business to Gentell, LLC for $28.8 million, which consists of $27.8 million in cash plus $1.0 million in contingent consideration which may be received upon achieving certain revenue-based performance milestones. The transaction includes the sale of the Company's TWC products, such as sponges, gauze and conforming bandages, and certain advanced wound care dressings, such as supportive, calcium alginate, hydrogel, and foam dressings. This transaction is expected to close during the third quarter of 2022, subject to the satisfaction of customary conditions.
The Company considered the assets and liabilities associated with the TWC business to be accounted as held-for-sale as the six criteria under ASC 260 were met during the second quarter of 2022. Upon designation of the assets and liabilities as held for sale, the Company recorded the assets at the lower of their carrying value or their estimated fair value, less estimated costs to sell. Goodwill was allocated to the assets and liabilities held for sale using the relative fair value method of the TWC business to the Company's Tissue Technologies reporting unit. The fair value of the business less costs to sell exceeded the related carrying value.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
2.The TWC business was treated as a single disposal group and presented separately in the condensed consolidated balance sheet as assets and liabilities held for sale as of June 30, 2022. These balances are presented as current assets and liabilities as they are expected to be sold within twelve months. The sale of the TWC business does not represent a strategic shift that will have a major effect on the Company's operations and financial statements.
The major classes of assets and liabilities classified as a held for sale consisted of the following as of June 30, 2022 (dollar amounts in thousands):
Other assets$53 
Deferred tax assets178 
Prepaid expenses and other current assets338 
Right of use asset - operating leases1,316 
Property, plant, and equipment, net3,752 
Goodwill5,083 
Inventories, net9,275 
Intangible assets, net10,530 
Total assets held for sale$30,525 
Accrued expenses and other current liabilities$102 
Current portion of lease liability - operating leases584 
Lease liability - operating leases742 
Deferred tax liabilities875 
Total liabilities held for sale$2,303 
3. ACQUISITIONS AND DIVESTITURES
Sale of Extremity Orthopedics Business
On January 4, 2021, the Company completed its previously announcedthe sale of its Extremity Orthopedics business to Smith & Nephew USD Limited ("Smith & Nephew"). The transaction included the sale of the Company's upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. The Company received an aggregate purchase price of $240.0 million from Smith and& Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO") effectively terminating the licensing agreement between Integra and the CFO relating to the development of shoulder arthroplasty products.
Assets and liabilities divested consisted of the following as of December 31, 2020 (dollar amounts in thousands):
Prepaid expenses and other current assets$713 
Right of use asset-operating leases and Other assets3,186 
Deferred tax assets6,589 
Intangible assets, net13,332 
Property, plant and equipment, net37,893 
Goodwill47,546 
Inventories52,845 
Total assets held for sale$162,104 
Other liabilities336 
Current portion of lease liability - operating leases539 
Accrued compensation1,767 
Deferred tax liabilities3,440 
Lease liability - operating leases5,669 
Total liabilities held for sale$11,751 
The Divestiture doesdivestiture did not represent a strategic shift that will havehad a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method of the Extremity Orthopedics business to the Company's Tissue Technologies reporting unit.reportable business segment. In connection with the sale, the Company recognized a loss of $0.7$41.8 million associated with certain working capital adjustments and gain of $42.2 million that is presented inas Gain from the sale of business in the consolidated statement of operations for the three and six monthsyear ended June 30,December 31, 2021. The net proceeds are subject to adjustments based on changes inCompany finalized the actual closing net working capital. The purchase price is preliminary pending finalizationcapital and paid an additional $1.3 million to Smith & Nephew as of potential working capital adjustments.December 31, 2021.
The Company also entered into a transition services agreement ("TSA") with SmithSmith & Nephew which requires the Company to provide certain services on behalf of Smith & Nephew for the duration of the period subsequent to the sale of the business as defined in the agreement.TSA. The CompanyCompany recognized a payable due to Smith & Nephew of $10.9$6.5 million as of June 30, 2021,2022, which is included in the consolidated balance sheetsheets within accrued expenses and other current liabilities respectively.liabilities. The TSA includes services such as invoicing and cash collections from customers on behalf of Smith & Nephew. As of June 30, 2022, the Company has concluded the majority of the transition services agreement, pending final payment.
ACell, Inc. Acquisition
On January 20, 2021, the Company acquired ACell, Inc. (the "ACell Acquisition") for an acquisitiona total purchase price of $306.9 million plus contingent consideration of up to $100 million, thatwhich may be payable upon the Company achieving certain revenue-based performance milestones in 2022, 2023 and 2025. The final working capital adjustments of $1.3 million was finalized and paid as of June 30, 2021; however certain amounts relating2021. Prior to tax related matters have not been finalized. The finalization of these matters may result in changes to goodwill.the acquisition, ACell was a privately-held company that offered a portfolio of regenerative products for complex wound management, including developing and commercializing products based on MatriStem Urinary Bladder Matrix, ("UBM"), a technology platform derived from porcine urinary bladder extracellular matrix.
Assets Acquired and Liabilities Assumed at Fair Value
The ACell Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination are recognized at their fair values as of the acquisition date.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
The following table summarizes the preliminaryfinal fair values of the assets acquired and liabilities assumed at the acquisition date:
Dollars in thousandsPreliminaryFinal Valuation as of June 30, 2021Weighted Average Life
Current assets:
Cash$2,726 
Trade accounts receivable, net16,469 
Inventories, net18,299 
PrepaidsPrepaid expenses and other current assets1,498 
Total current assets$38,992 
Property, plant and equipment, net13,769 
Intangible assets245,000 13-14 years
Goodwill94,29894,147 
Right of use asset - operating leases9,259 
Deferred tax assets9,7687,465 
Other assets148 
Total assets acquired411,234$408,780 
Current liabilities:
Accounts payable$718 
Accrued expenses5,966 
Current portion of lease liability - operating leases1,673 
Total current liabilities$8,357 
Other long-term liability276
Lease liability - operating leases7,585 
Deferred tax liability64,17861,724 
Contingent consideration23,900 
Total liabilities assumed104,296$101,842 
Net assets acquired$306,938 
Intangible Assets
The estimated fair value of the developed technology acquired was determined using the multi-period excess earnings method of the income approach, which estimates value based on the present value of future economic benefits. Some of the more significant assumptions inherent in the development of those asset valuations include the estimated net cash flows for each year for each product including net revenues, cost of sales, R&D costs, selling and marketing costs, the appropriate discount rate to select in order to measure the risk inherent in each future cash flow stream, the assessment of each asset’s life cycle, and competitive trends impacting the asset and each cash flow stream.
The Company used a discount rate of 8.5% to arrive at the present value for the acquired intangible assets to reflect the rate of return a market participant would expect to earn and incremental commercial uncertainty in the cash flow projections. No assurances can be given that the underlying assumptions used to prepare the discounted cash flow analysis will not change. For these and other reasons, actual results may vary significantly from estimated results.
Goodwill
The Company allocated goodwill related to the ACell Acquisitionacquisition to the Tissue Technologies reportable business segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Contingent Consideration
As part of the acquisition,ACell Acquisition, the Company is required to paymake payments to the former shareholders of ACell up to $100 million based on the achievement by the Company of certain revenue-based performance milestones in 2022, 2023, and 2025. TheThe Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specific milestone. The Company estimated the fair value of the contingent consideration to be $23.9 million at the acquisition date. The estimated fair value as of June 30, 20212022 was $18.1 million. The Company recorded $18.1 million and $23.5 million. This amount is includedmillion in other liabilities at June 30, 2022 and June 30, 2021, respectively, in the consolidated balance sheets of the Company. The change in the fair value of the contingent obligation was primarily as a result of changes in estimates related to the timing of achieving these revenue-based performance milestones for each given year.
The Company determinesdetermined the acquisition date fair value of contingent consideration obligations using a Monte Carlo simulation, as well as significant unobservable inputs, reflecting the Company’s assessment of the assumptions market participants would use to value these liabilities. The fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined using the fair value concepts in ASC 820. The resultant most likely payouts are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligation will beobligations are revalued to estimated fair value and changes in fair value will be reflected as income or expense in our consolidated statement of operations. Changes in the fair value of the contingent considerations may result from changes in discount periods and rates and changes in the timing and amount of revenue estimates.
Deferred Tax Liabilities
Deferred tax liabilities result from identifiable intangible assets’ fair value adjustments. These adjustments create excess book basis over tax basis which is tax-effected by the statutory tax rates of applicable jurisdictions.
Pro Forma Results (unaudited)
Pro forma revenues for the three months ended June 30, 2021 and 2020 were $390.0 million and $269.6 million, respectively. Pro forma revenues for the six months ended June 30, 2021 and 2020 were $754.7 million and $646.9 million, respectively. Pro forma net income and earnings per share are not presented for this acquisition as they are not material.
3.4. REVENUES FROM CONTRACTS WITH CUSTOMERS
Summary of Accounting Policies on Revenue Recognition
Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services.
Performance Obligations
The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers.
Significant Judgments
Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company and the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant.
The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract.
The Company's return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days.
The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the goods or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Contract Asset and Liability
Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
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 summarizessummarized the changes in the contract asset and liability balances for the six months ended June 30, 2021:2022:
Dollars in thousandsTotal
Contract Asset
Contract asset, January 1, 20212022$7,43011,412 
Transferred to trade receivable of contract asset included in beginning of the year contract asset(7,430)(11,412)
Contract asset, net of transferred to trade receivables on contracts during the period7,95210,568 
Contract asset, June 30, 20212022$7,95210,568 
Contract Liability
Contract liability, January 1, 20212022$11,96111,946 
Recognition of revenue included in beginning of year contract liability(2,838)$(3,591)
Contract liability, net of revenue recognized on contracts during the period3,1024,347 
Foreign currency translation(125)(60)
Contract liability, June 30, 20212022$12,10012,642 
At June 30, 2021,2022, the short-term portion of the contract liability of $5.9$5.4 million and the long-term portion of $6.2$7.2 million wereis included in accrued expenses and other current liabilities and other liabilities, respectively, in the consolidated balance sheet.sheets.
As of June 30, 2021,2022, the Company is expected to recognize revenue of approximately 49%43% of unsatisfied (or partially unsatisfied) performance obligations as revenue within twelve 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.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Disaggregated Revenue
The following table presents revenues disaggregated by the major sources of revenues for the three and six months ended June 30, 20212022 and 20202021 (dollar amounts in thousands):
Three Months Ended June 30, 2021Three Months Ended June 30, 2020Six Months Ended June 30, 2021Six Months Ended June 30, 2020
Three Months Ended June 30, 2022Three Months Ended June 30, 2021Six Months Ended June 30, 2022Six Months Ended June 30, 2021
NeurosurgeryNeurosurgery$202,600 $141,430 $391,854 $326,373 Neurosurgery$200,295 $202,600 $394,970 $391,854 
InstrumentsInstruments54,237 28,348 106,224 74,845 Instruments57,568 54,237 110,201 106,224 
Total Codman Specialty SurgicalTotal Codman Specialty Surgical256,837 169,778 498,078 401,218 Total Codman Specialty Surgical257,863 256,837 505,171 498,078 
Wound Reconstruction and Care(2)
102,616 56,291 191,314 128,558 
Extremity Orthopedics(1)
11,162 32,634 
Wound Reconstruction and CareWound Reconstruction and Care104,894 102,616 199,524 191,314 
Private LabelPrivate Label30,539 21,434 60,671 50,579 Private Label35,058 30,539 69,758 60,671 
Total Tissue TechnologiesTotal Tissue Technologies133,155 88,887 251,985 211,771 Total Tissue Technologies139,952 133,155 269,282 251,985 
Total revenueTotal revenue$389,992 $258,665 $750,063 $612,989 Total revenue$397,815 $389,992 $774,453 $750,063 
(1)On January 4, 2021,May 20 2022, the Company completed its previously announced saleand certain of its Extremity Orthopedicssubsidiaries, entered into an agreement to sell its non-core traditional wound care ("TWC") business. In conjunction with the sale of this business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021. See Note 2. AcquisitionsAssets and Divestitures, Liabilities Held for details.
(2) See Note 2. Acquisitions and Divestitures, for details around the ACell Inc. Acquisition.Sale.
See Note 15,16, Segment and Geographical Information, for details of revenues based on the location of the customer.
4.5. INVENTORIES
Inventories, net consisted of the following:
Dollars in thousandsDollars in thousandsJune 30, 2021December 31, 2020Dollars in thousandsJune 30, 2022December 31, 2021
Finished goodsFinished goods$180,835 $180,301 Finished goods$164,277 $162,528 
Work in processWork in process61,987 53,336 Work in process72,779 65,323 
Raw materialsRaw materials80,796 76,480 Raw materials83,152 89,535 
Total inventories, netTotal inventories, net$323,618 $310,117 Total inventories, net$320,208 $317,386 
At December 31, 2020, $52.8June 30, 2022, $9.3 million of inventories, net waswere presented separately as "Assets"assets held for sale" in conjunction with the sale of the Extremity OrthopedicsTWC business.See Note 2. Assets and Liabilities Held for Sale.
5.6. GOODWILL AND OTHER INTANGIBLE ASSETS
Goodwill
Changes in the carrying amount of goodwill for the six-month period ended June 30, 20212022 were as follows:
Dollars in thousandsCodman Specialty
Surgical
Tissue TechnologiesTotal
Goodwill at December 31, 2020$671,975 $260,392 $932,367 
ACell Acquisition94,298 94,298 
Foreign currency translation(7,218)(3,809)(11,027)
Goodwill at June 30, 2021$664,757 $350,881 $1,015,638 
Dollars in thousandsCodman Specialty
Surgical
Tissue TechnologiesTotal
Goodwill at December 31, 2021$663,428 $350,030 $1,013,458 
Transfer to assets held for sale(1)
— (5,083)(5,083)
Foreign currency translation(11,822)(6,147)(17,969)
Goodwill at June 30, 2022$651,606 $338,800 $990,406 
(1) See Note 2. Assets and Liabilities Held for Sale
15

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Other Intangible Assets
The components of the Company’s identifiable intangible assets were as follows:
June 30, 2021 June 30, 2022
Dollars in thousandsDollars in thousandsWeighted
Average
Life
CostAccumulated
Amortization
NetDollars in thousandsWeighted
Average
Life
CostAccumulated
Amortization
Net
Completed technologyCompleted technology18 years$1,125,279 $(274,287)$850,992 Completed technology18 years$1,122,233 $(336,288)$785,945 
Customer relationshipsCustomer relationships12 years$212,572 $(137,897)$74,675 Customer relationships12 years$192,929 $(140,184)$52,745 
Trademarks/brand namesTrademarks/brand names28 years$99,319 $(29,866)$69,453 Trademarks/brand names28 years$96,745 $(32,847)$63,898 
Codman tradenameCodman tradenameIndefinite$166,651 $— $166,651 Codman tradenameIndefinite$164,150 $— $164,150 
Supplier relationshipsSupplier relationships30 years$30,211 $(15,691)$14,520 Supplier relationships30 years$30,211 $(16,681)$13,530 
All otherAll other11 years$6,473 $(3,880)$2,593 All other11 years$5,859 $(3,852)$2,007 
$1,612,127 $(529,852)$1,082,275 
$1,640,505 $(461,621)$1,178,884 
December 31, 2020 December 31, 2021
Dollars in thousandsDollars in thousandsWeighted
Average
Life
CostAccumulated
Amortization
NetDollars in thousandsWeighted
Average
Life
CostAccumulated
Amortization
Net
Completed technologyCompleted technology19 years$896,478 $(248,088)$648,390 Completed technology18 years$1,132,954 $(307,013)$825,941 
Customer relationshipsCustomer relationships12 years213,270 (132,838)80,432 Customer relationships12 years211,344 (142,755)68,589 
Trademarks/brand namesTrademarks/brand names28 years104,209 (31,767)72,442 Trademarks/brand names28 years98,367 (31,468)66,899 
Codman tradenameCodman tradenameIndefinite170,226 — 170,226 Codman tradenameIndefinite167,758 — 167,758 
Supplier relationshipsSupplier relationships27 years30,211 (15,203)15,008 Supplier relationships30 years30,211 (16,192)14,019 
All other (1)
All other (1)
4 years6,693 (3,755)2,938 
All other (1)
11 years6,258 (3,891)2,367 
$1,421,087 $(431,651)$989,436 $1,646,892 $(501,319)$1,145,573 
(1) Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.
The increase in the Company's identifiable intangible assets atAt June 30, 20212022, $10.5 million of customer relationships, net were presented separately as compared to the year ended December 31, 2020, was primarily driven from intangible assets acquired"assets held for sale" in conjunction with the ACell Inc. acquisition. sale of the TWC business. See Note 2, Acquisitions2. Assets and Divestitures,Liabilities Held for details.Sale.
Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of product revenues)goods sold) is expected to be approximately $40.6$38.4 million for the remainder of 2021, $79.1 million in 2022, $78.4$76.5 million in 2023, $77.7$75.8 million in 2024, $77.7$75.8 million in 2025, $77.5$75.7 million in 2026, $73.7 million in 2027 and $585.7$499.8 million thereafter.
6.7. DEBT
Amendment to the Sixth Amended and Restated Senior Credit Agreement
On February 3, 2020, the Company entered into the sixth amendment and restatement (the "February 2020 Amendment") of its Senior Credit Facility (the "Senior Credit Facility") with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The February 2020 Amendment extended the maturity date to February 3, 2025. The Company continues to have the aggregate principal amount of up to approximately $2.2 billion available to it through the following facilities: (i) a $877.5 million Term Loan facility, and (ii) a $1.3 billion revolving credit facility, which includes a $60 million sublimit for the issuance of standby letters of credit and a $60 million sublimit for swingline loans.
On July 14, 2020, the Company entered into an amendment (the "July 2020 Amendment") to the February 2020 Amendment of the Senior Credit Facility to increase financial flexibility in light of the unprecedented impact and uncertainty of the COVID-19 pandemic on the global economy. The July 2020 amendment does not increase the Company’s total indebtedness.
In connection with the July 2020 amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) was modified tois the following:
Fiscal QuarterMaximum Consolidated Total Leverage Ratio
Execution of July 2020 Amendment through June 30, 20215.50 to 1.00
September 30, 2021 through June 30, 20225.00 to 1.00
September 30, 2022 through June 30, 20234.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter4.00 to 1.00
16

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Borrowings under the Senior Credit Facility bear interest, at the Company’s option, at a rate equal to the following:
i.the Eurodollar Rate (as defined in the amendment and restatement) in effect from time to time plus the applicable rate (ranging from 1.00% to 2.25%), or
ii.the highest of:
1.the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50%
2.the prime lending rate of Bank of America, N.A. or
3.the one-month Eurodollar Rate plus 1.00%
The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness as of such date less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA, as defined by the July 2020 amendment, for the period of four consecutive fiscal quarters ending on such date).
The Company will pay an annual commitment fee (ranging from 0.15% to 0.30%), based on the Company's consolidated total leverage ratio, on the amount available for borrowing under the revolving credit facility.
The Senior Credit Facility is collateralized by substantially all of the assets of the Company’s U.S. subsidiaries, excluding intangible assets. The Senior Credit Facility is subject to various financial and negative covenants and at June 30, 2021,2022, the Company was in compliance with all such covenants. In connection with the February 2020 Amendment, the Company capitalized $4.6 million of financing costs in connection with modification of the Senior Credit Facility and wrote off $1.2 million of previously capitalized financing costs during the first quarter of 2020. In connection with the July 2020 amendment, the Company expensed $3.3 million of incremental financing costs in connection with the modification of the Senior Credit Facility during the third quarter of 2020.
At June 30, 20212022 and December 31, 2020,2021, there was $8.8$53.8 million and $97.5$31.3 million, respectively, outstanding under the revolving credit componentportion of the Senior Credit Facility at weighted average interest rates of 1.5%.3.0% and 1.4%, respectively. At June 30, 20212022 and December 31, 2020,2021, there was $866.3$821.3 million and $877.5$843.8 million, respectively, outstanding under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 1.5%.3.0% and 1.4%, respectively. At June 30, 2022 and December 31, 2021, there was $50.6 million and $45.0 million, respectively of the Term Loan component of the Senior Credit Facility is classified as current on the consolidated balance sheet.sheets.
The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at June 30, 20212022 were $8.6$52.5 million and $850.4$803.6 million, respectively. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly, and are other than active market observable inputs that reflect unadjusted quoted prices for identical assets or liabilities.
Letters of credit outstanding as of June 30, 20212022 and December 31, 20202021 totaled $1.6 million. There were 0no amounts drawn as of June 30, 2021.2022.
Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows:
Quarter Ended June 30, 2021Principal Repayment
Quarter Ended June 30, 2022Quarter Ended June 30, 2022Principal Repayment
Dollars in thousandsDollars in thousandsDollars in thousands
Remainder of 2021$22,500 
2022$45,000 
Remainder of 2022Remainder of 2022$22,500 
20232023$61,875 2023$61,875 
20242024$67,500 2024$67,500 
20252025$669,375 2025$669,375 
$821,250 
$866,250 
Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $12.2 million for remainder of 2022, $23.2 million in 2023, $21.1 million in 2024, and $1.9 million in 2025. Interest is calculated on the term loan portion of the Senior Credit Facility based on LIBOR plus the certain amounts set forth in the Sixth Amended and Restated Credit Agreement. As the revolving credit facility and Securitization Facility can be repaid at any time, no interest has been included in the calculation.
The outstanding balance of the revolving credit component of the Senior Credit Facility is due on February 3, 2025.



17

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Convertible Senior Notes
On February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes will mature on August 15, 2025 and bear interest at a rate of 0.5% per annum payable semi-annually in arrears, unless earlier converted, repurchased or redeemed in accordance with the terms of the 2025 Notes. The portion of debt proceeds that was classified as equity at the time of the offering was $104.5 million. The effective interest rate implicit in the liability component was 4.2%. In connection with this offering, the Company capitalized $13.2 million of financing fees.
The 2025 Notes are senior, unsecured obligations of the Company, and are convertible into cash and shares of its common stock based on initial conversion rate, subject to adjustment of 13.5739 shares per $1,000 principal amounts of the 2025 Notes (which represents an initial conversion price of $73.67 per share). The 2025 Notes convert only in the following circumstances: (1) if the closing price of the Company's common stock has been at least 130% of the conversion price during the period; (2) if the average trading price per $1,000 principal amount of the 2025 Notes is less than or equal to 98% of the average conversion value of the 2025 Notes during a period as defined in the indenture; (3) at any time on or after February 20, 2023; or (4) if specified corporate transactions occur. As of June 30, 2021,2022, none of these conditions existed with respect to the 2025 Notes and as a result the 2025 Notes are classified as long term.
On December 9, 2020, the Company entered into the First Supplemental Indenture to the original agreement dated as of February 4, 2020 between the Company and Citibank, N.A., as trustee, governing the Company’s outstanding 2025 Notes. The Company irrevocably elected (1) to eliminate the Company’s option to choose physical settlement on any conversion of the 2025 Notes that occurs on or after the date of the First Supplemental Indenture and (2) with respect to any Combination Settlement for a conversion of the 2025 Notes, the Specified Dollar Amount that will be settled in cash per $1,000 principal amount of the 2025 Notes shall be no lower than $1,000.
Holders of the Notes will have the right to require the Company to repurchase for cash all or a portion of their Notes at 100% of their principal amount, plus any accrued and unpaid interest, upon the occurrence of a fundamental change (as defined in the indenture relating to the Notes). The Company will also be required to increase the conversion rate for holders who convert their Notes in connection with certain fundamental changes occurring prior to the maturity date or following delivery by the Company of a notice of redemption.
In connection with the issuance of the 2025 Notes, the Company entered into call transactions and warrant transactions, primarily with affiliates of the initial purchasers of the 2025 Notes (the “hedge participants”). The cost of the call transactions was $104.2 million for the 2025 Notes. The Company received $44.5 million of proceeds from the warrant transactions for the 2025 Notes. The call transactions involved purchasing call options from the hedge participants, and the warrant transactions involved selling call options to the hedge participants with a higher strike price than the purchased call options. The initial strike price of the call transactions was $73.67, subject to anti-dilution adjustments substantially similar to those in the 2025 Notes. The initial strike price of the warrant transactions was $113.34 for the 2025 Notes, subject to customary anti-dilution adjustments.
At December 31, 2020, the carrying amount of the liability component was $485.9 million, the remaining unamortized discount was $89.1 million, and the principal amount outstanding was $575.0 million. On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. At June 30, 20212022, in conjunction with the adoption of the ASU, the carrying amount of the liability was $575.0 million. The fair value of the 2025 Notes at June 30, 20212022 was $630.7542.1 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quote. The level of the 2025 Notes is considered as Level 1.
On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. As a result of the adoption of the ASU 2020-06, the Company recognized only cash interest related to the contractual interest coupon of $1.4 million on the 2025 Notes for both the six months ended June 30, 2021. Prior to the adoption, during the six months ended2022 and June 30, 2020, the Company recognized cash interest of $1.2 million and amortization of the discount on the liability component of $6.8 million for a total interest charge of $8.0 million on the 2020 Notes.
18

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
2021.
Securitization Facility
During the fourth quarter of 2018, the Company entered into an accounts receivable securitization facility (the "Securitization Facility") under which accounts receivable of certain domestic subsidiaries are sold on a non-recourse basis to a special purpose entity (“SPE”), which is a bankruptcy-remote, consolidated subsidiary of the Company. Accordingly, the assets of the SPE are not available to satisfy the obligations of the Company or any of its subsidiaries. From time to time, the SPE may finance such accounts receivable with a revolving loan facility secured by a pledge of such accounts receivable. The amount of outstanding borrowings on the Securitization Facility at any one time is limited to $150.0 million. The Securitization Facility Agreement ("Securitization Agreement") 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, 2021,2022, the Company was in compliance with the covenants and none of the termination events had occurred.
18

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
On May 28, 2021, the Company entered into an amendment (the "May 2021 Amendment") of the Securitization Facility which extended the maturity date from December 21, 2021 to May 28, 2024. The May 2021 amendmentAmendment does not increase the Company’s total indebtedness.
At June 30, 20212022 and December 31, 2020,2021, the Company had $112.5 million respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 1.2%2.1% and 1.3%1.1%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at June 30, 20212022 was $110.3$110.0 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.
7.8. DERIVATIVE INSTRUMENTS
Interest Rate Hedging
The Company’s interest rate risk relates to U.S. dollar denominated variable interest rate borrowings. The Company uses interest rate swap derivative instruments to manage earnings and cash flow exposure resulting from changes in interest rates. These interest rate swaps apply a fixed interest rate on a portion of the Company's expected LIBOR-indexed floating-rate borrowings.
19

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
The Company held the following interest rate swaps as of June 30, 20212022 and December 31, 20202021 (dollar amounts in thousands):
June 30, 2021December 31, 2020June 30, 2021December 31, 2020June 30, 2022December 31, 2021June 30, 2022December 31, 2021
Hedged ItemHedged ItemNotional AmountDesignation DateEffective DateTermination DateFixed Interest RateEstimated Fair ValueHedged ItemNotional AmountDesignation DateEffective DateTermination DateFixed Interest RateEstimated Fair Value
Asset (Liability)
1-month USD LIBOR Loan$$100,000 March 27, 2017December 31, 2017June 30, 20211.971 %$$(929)
1-month USD LIBOR Loan300,000 300,000 December 13, 2017January 1, 2018December 31, 20222.201 %(9,122)(12,557)
1-month USD LIBOR Loan150,000 150,000 December 13, 2017July 1, 2019June 30, 20242.423 %(8,692)(11,502)
Asset (Liability)
1-month USD LIBOR Loan1-month USD LIBOR Loan200,000 200,000 December 13, 2017January 1, 2018December 31, 20242.313 %(11,856)(16,243)1-month USD LIBOR Loan300,000 300,000 December 13, 2017January 1, 2018December 31, 20222.201 %681 (5,268)
1-month USD LIBOR Loan1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.220 %(7,595)(9,836)1-month USD LIBOR Loan150,000 150,000 December 13, 2017July 1, 2019June 30, 20242.423 %1,937 (5,520)
1-month USD LIBOR Loan1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.199 %(7,553)(9,826)1-month USD LIBOR Loan200,000 200,000 December 13, 2017January 1, 2018December 31, 20242.313 %3,322 (7,421)
1-month USD LIBOR Loan1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.209 %(7,541)(9,783)1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.220 %(660)(5,512)
1-month USD LIBOR Loan1-month USD LIBOR Loan100,000 100,000 December 18, 2018December 30, 2022December 31, 20272.885 %(7,703)(10,407)1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.199 %(361)(5,464)
1-month USD LIBOR Loan1-month USD LIBOR Loan100,000 100,000 December 18, 2018December 30, 2022December 31, 20272.867 %(7,592)(10,431)1-month USD LIBOR Loan75,000 75,000 October 10, 2018July 1, 2020June 30, 20253.209 %(485)(5,494)
1-month USD LIBOR Loan1-month USD LIBOR Loan575,000 575,000 December 15, 2020July 31, 2025December 31, 20271.415 %3,931 (1,907)1-month USD LIBOR Loan100,000 100,000 December 18, 2018December 30, 2022December 31, 20272.885 %253 (6,886)
1-month USD LIBOR Loan1-month USD LIBOR Loan125,000 125,000 December 15, 2020July 1, 2025December 31, 20271.404 %987 (348)1-month USD LIBOR Loan100,000 100,000 December 18, 2018December 30, 2022December 31, 20272.867 %19 (6,764)
1-month USD LIBOR Loan1-month USD LIBOR Loan575,000 575,000 December 15, 2020July 31, 2025December 31, 20271.415 %17,938 3,552 
1-month USD LIBOR Loan1-month USD LIBOR Loan125,000 125,000 December 15, 2020July 1, 2025December 31, 20271.404 %4,295 821 
$1,775,000 $1,775,000 $26,939 $(43,957)
$1,775,000 $1,875,000 $(62,736)$(93,769)
The Company has designated these derivative instruments as cash flow hedges. The Company assesses the effectiveness of these derivative instruments and has recorded the changes in the fair value of the derivative instrument designated as a cash flow hedge as unrealized gains or losses in accumulated other comprehensive loss (“AOCL”), net of tax, until the hedged item affected earnings, at which point any gain or loss was reclassified to earnings. If the hedged cash flow does not occur, or if it becomes probable that it will not occur, the Company will reclassify the remaining amount of any gain or loss on the related cash flow hedge recorded in AOCL to interest expense at that time.
19

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Foreign Currency Hedging
From time to time, the Company enters into foreign currency hedge contracts intended to protect the U.S. dollar value of certain forecasted foreign currency denominated transactions. The Company assesses the effectiveness of the contracts that are designated as hedging instruments. The changes in fair value of foreign currency cash flow hedges are recorded in AOCL, net of tax. Those amounts are subsequently reclassified to earnings from AOCL as impacted by the hedged item when the hedged item affects earnings. If the hedged forecasted transaction does not occur or if it becomes probable that it will not occur, the Company will reclassify the amount of any gain or loss on the related cash flow hedge to earnings at that time. For contracts not designated as hedging instruments, the changes in fair value of the contracts are recognized in other income, net in the consolidated statements of operation, along with the offsetting foreign currency gain or loss on the underlying assets or liabilities.
During the fourth quarter of 2020, the Company entered into foreign currency forward contracts, with a notional amount of $9.7$4.2 million, to mitigate the foreign exchange risk related to certain intercompany loans denominated in Canadian Dollar ("CAD") and. During the second quarter of 2022, the Company entered into foreign currency forward contract, with a notional amount of $4.2 million, to mitigate the foreign exchange risk related to certain intercompany receivables denominated in Japanese Yen ("JPY"). The contracts are notnot designated as hedging instruments. The Company recognized a$0.1 million and $0.3 million losslosses from the change in fair value of thesuch contracts, which was included in other income, net in the consolidated statement of operations as of June 30, 2021. The Company subsequently settled its foreign currency forward contracts associated with the intercompany receivables denominated in JPY during the first quarter of 2021.2022 and June 30, 2021, respectively. The fair value of the foreign currency forward contracts denominated in CAD was $0.3less than $0.1 million and $0.2 million as of June 30, 2021.
20

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
2022 and December 31, 2021, respectively.
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 certain intercompany loan denominated in Japanese Yen ("JPY"). 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 $6.4 million. The change in fair value of the foreign currency swap was not material for the period.$1.6 million as of June 30, 2022.
The success of the Company’s hedging program depends, in part, on forecasts of certain activity denominated in foreign currency. The Company may experience unanticipated currency exchange gains or losses to the extent that there are differences between forecasted and actual activities during periods of currency volatility. In addition, changes in currency exchange rates related to any unhedged transactions may affect earnings and cash flows.
Cross-Currency Rate Swaps
On October 2, 2017, the Company entered into cross-currency swap agreements to convert a notional amount of $300.0 million equivalent to 291.2 million of Swiss Francs ("CHF") denominated intercompany loans into U.S. dollars. The CHF-denominated intercompany loans were the result of the purchase of intellectual property by a subsidiary in Switzerland as part of an acquisition.
On December 21, 2020, the Company entered into cross-currency swap agreements to convert a notional amount of $471.6 million equivalent to 420.1 million of a CHF-denominated intercompany loan into U.S. dollars. The CHF-denominated intercompany loan was the result of an intra-entity transfer of certain intellectual property rights to a subsidiary in Switzerland completed during the fourth quarter of 2020. The intercompany loan requires quarterly payments of CHF 5.8 million plus accrued interest. As a result, the aggregate notional amount of the related cross-currency swaps will decrease by a corresponding amount.
The objective of these cross-currency swaps is to reduce volatility of earnings and cash flows associated with changes in the foreign currency exchange rate. Under the terms of these contracts, which have been designated as cash flow hedges, the Company will make interest payments in Swiss Francs and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in Swiss Francs and receive U.S. dollars from the counterparties.
20

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
The Company held the following cross-currency rate swaps as of June 30, 20212022 and December 31, 20202021 (dollar amounts in thousands):
June 30, 2021December 31, 2020June 30, 2021December 31, 2020
Effective DateTermination DateFixed RateAggregate Notional AmountFair Value
Asset (Liability)
Pay CHFOctober 2, 2017October 2, 20211.85%CHF48,533 48,533 (2,228)(4,335)
Receive U.S.$4.46%$50,000 50,000 
June 30, 2022December 31, 2021June 30, 2022December 31, 2021
Effective DateTermination DateFixed RateAggregate Notional AmountFair Value
Asset (Liability)
Pay CHFPay CHFOctober 2, 2017October 2, 20221.95%CHF145,598 145,598 (4,641)(11,262)Pay CHFOctober 2, 2017October 2, 20221.95%CHF145,598 145,598 (2,557)(8,283)
Receive U.S.$Receive U.S.$4.52%$150,000 150,000 Receive U.S.$4.52%$150,000 150,000 
Pay CHFPay CHFDecember 21, 2020December 20, 20253.00%CHF408,637 420,137 10,124 (7,843)Pay CHFDecember 21, 2020December 22, 20253.00%CHF385,637 397,137 11,919 41 
Receive U.S.$Receive U.S.$3.98%$458,730 471,640 Receive U.S.$3.98%$432,911 445,821 
TotalTotal$3,255 $(23,441)Total$9,362 $(8,242)
On October 4, 2021 in accordance with the termination date, the Company settled a cross-currency swap designated as a cash flow hedge of an intercompany loan with an aggregate notional amount of $50.0 million. The gain recorded by the Company upon the settlement of the swap was not material for the period.
The cross-currency swaps are carried on the consolidated balance sheet at fair value, and changes in the fair values are recorded as unrealized gains or losses in AOCL. For the three and six months ended June 30, 2022, the Company recorded gains of $19.3 million and $25.8 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, 2021, the Company recorded a loss of $12.9 million and a gain of $30.0 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gainsgain or losses recognized on the intercompany loans.
For the three and six months ended June 30, 2020,2022, the Company recorded lossesgains of $3.4$21.1 million and $5.1$21.5 million respectively, in other income, netAOCL, respectively, related to change in fair value related toof the foreign currency rate translation to offset the gains recognized on the intercompany loans.
cross-currency swaps. For the three and six months ended June 30, 2021, the Company recorded a loss of $11.0 million and a gain of $29.2 million in AOCL, respectively, related to change in fair value of the cross-currency swaps.
For the three and six months ended June 30, 2020,2022, the Company recorded a lossgains of $2.3$2.0 million and a gain$3.8 million, respectively, in other income, net included in the consolidated statements of $3.6 million in AOCL, respectively,operations related to change in fair valuethe interest rate differential of the cross-currency swaps.
21

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
For the three and six months ended June 30, 2021, the Company recorded gains of $1.3 million and $2.5 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded gains of $1.5 million and $3.0 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.
The estimated gain that is expected to be reclassified to other income, (expense), net from AOCL as of June 30, 20212022 within the next twelve months is $7.0$3.6 million. As of June 30, 2021,2022, the Company does not expect any gains or losses will be reclassified into earnings as a result of the discontinuance of these cash flow hedges because the original forecasted transaction will not occur.
Net Investment Hedges
The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk from its international operations through foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business. On October 1, 2018, and December 16, 2020 and May 26, 2022, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries.
21

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 20212022 and December 31, 2020,2021, respectively (dollar amounts in thousands):
June 30, 2021December 31, 2020June 30, 2022December 31, 2021
Effective DateTermination DateFixed RateAggregate Notional AmountFair Value
Asset (Liability)
Effective DateTermination DateFixed RateAggregate Notional AmountFair Value
Asset (Liability)
Pay EURPay EUROctober 3, 2018September 30, 20210%EUR44,859 $(864)$(1,884)Pay EUROctober 3, 2018September 30, 2023—%EUR51,760 5,740 2,503 
Receive U.S.$Receive U.S.$3.01%$52,000 Receive U.S.$2.57%$60,000 
Pay EURPay EUROctober 3, 2018September 30, 20230%EUR51,760 901 (450)Pay EUROctober 3, 2018September 30, 2025—%EUR38,820 4,784 2,147 
Receive U.S.$Receive U.S.$2.57%$60,000 Receive U.S.$2.19%$45,000 
Pay EUROctober 3, 2018September 30, 20250%EUR38,820 849 92 
Pay CHF(1)
Pay CHF(1)
December 16, 2020December 16, 2027—%CHF222,300 — (792)
Receive U.S.$Receive U.S.$October 3, 2018September 30, 20252.19%$45,000 849 92 Receive U.S.$1.10%$250,000 
Pay CHFPay CHFDecember 16, 2020December 16, 20270%CHF222,300 3,292 (3,794)Pay CHFMay 26, 2022December 16, 2028—%CHF288,210 (1,824)— 
Receive U.S.$Receive U.S.$1.10%$250,000 Receive U.S.$1.94%$300,000 
TotalTotal$4,178 $(6,036)Total$8,700 $3,858 
(1) The following currency swaps designated as a net investment hedge were early settled during the three months ended June 30, 2022.
During the six months ended June 30, 2022, the Company early settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $250.0 million equivalent to 222.3 million Swiss Franc. The original settlement date was December 16, 2027. As a result of the settlement, the Company recorded a gain of $4.9 million in AOCL. On May 26, 2022, the Company entered into cross-currency swap agreements designated as net investment hedge to replace the following swaps of a notional amount of $300.0 million equivalent to 288.2 million Swiss Franc.
On September 30, 2021, in accordance with the termination date, the Company settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $52 million equivalent to 44.9 million Euros based on the termination date. As a result of the settlement, the Company recorded a gain of $0.1 million in AOCL.
The cross-currency swaps were carried on the consolidated balance sheet at fair value and changes in the fair values were recorded as unrealized gains or losses in AOCL. For the three and six months ended June 30, 2022, the Company recorded gains of $10.8 million and $12.1 million, respectively, in AOCL related to the change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2021, the Company recorded gains of $0.1 million and $13.7 million, respectively, in AOCL related to the change in fair value of the cross-currency swaps.
For the three and six months ended June 30, 2020,2022, the Company recorded a lossgains of $2.5$1.0 million and a gain$2.3 million in interest income included in the consolidated statements of $16.4 million, respectively, in AOCLoperations related to the change in fair valueinterest rate differential of the cross-currency swaps.
For the three and six months ended June 30, 2021, the Company recorded gains of $1.7 million and $3.4 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded gains of $2.2 million and $4.4 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.
The estimated gain that is expected to be reclassified to interest income from AOCL as of June 30, 20212022 within the next twelve months is $4.5$8.5 million.
Counterparty Credit Risk
The Company manages its concentration of counterparty credit risk on its derivative instruments by limiting acceptable counterparties to a group of major financial institutions with investment grade credit ratings, and by actively monitoring their credit ratings and outstanding positions on an ongoing basis. Therefore, the Company considers the credit risk of the counterparties to be low. Furthermore, none of the Company’s derivative transactions are subject to collateral or other security arrangements, and none contain provisions that depend upon the Company’s credit ratings from any credit rating agency.
22

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
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.
22

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
The following table summarizes the fair value for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of June 30, 20212022 and December 31, 2020:2021:
Fair Value as ofFair Value as of
Location on Balance Sheet (1):
Location on Balance Sheet (1):
June 30, 2021December 31, 2020
Location on Balance Sheet(1):
June 30, 2022December 31, 2021
Dollars in thousandsDollars in thousandsDollars in thousands
Derivatives designated as hedges — Assets:Derivatives designated as hedges — Assets:Derivatives designated as hedges — Assets:
Prepaid expenses and other current assetsPrepaid expenses and other current assetsPrepaid expenses and other current assets
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swap(2)
Interest rate swap(2)
4,369 $— 
Cross-currency swapCross-currency swap$9,206 $7,623 Cross-currency swap$6,122 $4,900 
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap5,345 5,297 Cross-currency swap8,472 5,120 
Other assetsOther assetsOther assets
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swap(2)
Interest rate swap(2)
4,918 
Interest rate swap(2)
24,619 4,373 
Cross-currency swapCross-currency swap4,605 Cross-currency swap5,797 — 
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap505 Cross-currency swap7,964 2,104 
Total derivatives designated as hedges — AssetsTotal derivatives designated as hedges — Assets$24,579 $12,920 Total derivatives designated as hedges — Assets$57,343 $16,497 
Derivatives designated as hedges — Liabilities:Derivatives designated as hedges — Liabilities:Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilitiesAccrued expenses and other current liabilitiesAccrued expenses and other current liabilities
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swap(2)
Interest rate swap(2)
$21,003 $22,033 
Interest rate swap(2)
$62 $18,187 
Cross-currency swapCross-currency swap2,228 4,335 Cross-currency swap$2,558 8,283 
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swap864 1,884 
Other liabilitiesOther liabilitiesOther liabilities
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swap(2)
Interest rate swap(2)
46,651 71,736 
Interest rate swap(2)
$1,987 30,143 
Cross-currency swapCross-currency swap8,328 26,728 Cross-currency swap$— 4,859 
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap808 9,449 Cross-currency swap$7,736 3,366 
Total derivatives designated as hedges — LiabilitiesTotal derivatives designated as hedges — Liabilities$79,882 $136,165 Total derivatives designated as hedges — Liabilities$12,343 $64,838 
(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, 20212022 and December 31, 2020,2021, the total notional amounts related to the Company’s interest rate swaps were both $1.8 billion and $1.9 billion, respectively.
23

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)

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, 20212022 and 2020:2021:
Dollars in thousandsDollars in thousandsBalance in AOCL
Beginning of
Quarter
Amount of
Gain (Loss)
Recognized in
AOCL
Amount of Gain (Loss)
Reclassified from
AOCL into
Earnings
Balance in AOCL
End of Quarter
Location in
Statements of
Operations
Dollars in thousandsBalance in AOCL
Beginning of
Quarter
Amount of
Gain (Loss)
Recognized in
AOCL
Amount of Gain (Loss)
Reclassified from
AOCL into
Earnings
Balance in AOCL
End of Quarter
Location in
Statements of
Operations
Three Months Ended June 30, 2021
Three Months Ended June 30, 2022Three Months Ended June 30, 2022
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swapInterest rate swap$(53,546)$(15,013)$(5,823)$(62,736)Interest expenseInterest rate swap$2,932 $20,116 $(3,891)$26,939 Interest expense
Cross-currency swapCross-currency swap(5,029)(10,969)(11,635)(4,363)Other income (expense),netCross-currency swap(17,703)21,136 21,268 (17,835)Other income, net
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap(429)88 1,737 (2,078)Interest incomeCross-currency swap(2,332)10,816 978 7,506 Interest income
$(59,004)$(25,894)$(15,721)$(69,177)$(17,103)$52,068 $18,355 $16,610 
Three Months Ended June 30, 2020
Three Months Ended June 30, 2021Three Months Ended June 30, 2021
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swapInterest rate swap$(95,753)$(9,988)$(3,614)$(102,127)Interest expenseInterest rate swap$(53,546)$(15,013)$(5,823)$(62,736)Interest expense
Cross-currency swapCross-currency swap6,266 (2,322)(1,899)5,843 Other income (expense),netCross-currency swap(5,029)(10,969)(11,635)(4,363)Other income, net
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap26,946 (2,543)2,179 22,224 Interest incomeCross-currency swap(429)88 1,737 (2,078)Interest income
$(62,541)$(14,853)$(3,334)$(74,060)$(59,004)$(25,894)$(15,721)$(69,177)
Dollars in thousandsDollars in thousandsBalance in AOCL
Beginning of
Year
Amount of
Gain (Loss)
Recognized in
AOCL
Amount of Gain (Loss)
Reclassified from
AOCL into
Earnings
Balance in AOCL
End of Quarter
Location in
Statements of
Operations
Dollars in thousandsBalance in AOCL
Beginning of
Year
Amount of
Gain (Loss)
Recognized in
AOCL
Amount of Gain (Loss)
Reclassified from
AOCL into
Earnings
Balance in AOCL
End of Quarter
Location in
Statements of
Operations
Six Months Ended June 30, 2022Six Months Ended June 30, 2022
Cash Flow HedgesCash Flow Hedges
Interest rate swapInterest rate swap$(43,956)$61,790 $(9,105)$26,939 Interest expense
Cross-currency swapCross-currency swap(9,688)21,452 29,599 (17,835)Other income, net
Net Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap(2,321)12,125 2,298 7,506 Interest income
$(55,965)$95,367 $22,792 $16,610 
Six Months Ended June 30, 2021Six Months Ended June 30, 2021Six Months Ended June 30, 2021
Cash Flow HedgesCash Flow HedgesCash Flow Hedges
Interest rate swapInterest rate swap$(93,769)$19,505 $(11,528)$(62,736)Interest expenseInterest rate swap$(93,769)$19,505 $(11,528)$(62,736)Interest expense
Cross-currency swapCross-currency swap(1,073)29,225 32,515 (4,363)Other income (expense),netCross-currency swap(1,073)29,225 32,515 (4,363)Other income, net
Net Investment HedgesNet Investment HedgesNet Investment Hedges
Cross-currency swapCross-currency swap(12,291)13,661 3,448 (2,078)Interest incomeCross-currency swap(12,291)13,661 3,448 (2,078)Interest income
$(107,133)$62,391 $24,435 $(69,177)$(107,133)$62,391 $24,435 $(69,177)
Six Months Ended June 30, 2020
Cash Flow Hedges
Interest rate swap$(45,146)$(61,637)$(4,656)$(102,127)Interest expense
Cross-currency swap177 3,585 (2,081)5,843 Other income (expense), net
Net Investment Hedges
Cross-currency swap10,229 16,357 4,362 22,224 Interest income
$(34,740)$(41,695)$(2,375)$(74,060)
8.9. STOCK-BASED COMPENSATION
As of June 30, 2021,2022, 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”). The 2000 and 2001 Equity Incentive Plans were terminated as of February 19, 2021, and no further awards may be issued under the plans.
Stock options issued under the 2003 Plan become exercisable over specified periods, generally within four years from the date of grant for officers and employees, 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 Plans2003 Plan vests over specified periods, generally three years after the date of grant. The vesting of performance stock issued under the Plans2003 Plan is subject to service and performance conditions.
24

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Stock Options
As of June 30, 2021,2022, there were approximately $4.6approximately $5.3 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately three years. There were 149,558145,565 stock options granted during the six months ended June 30, 2021.2022. For the six months ended June 30, 2021,2022, the weighted average grant date fair value for stock options was $22.59$23.15 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. AsAs of June 30, 2021,2022, there was approximately $32.9$40.2 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 242,464363,326 restricted stock awards and 176,147130,753 performance stock awards during the six months ended June 30, 2021.2022. For the six months ended June 30, 2021,2022, the weighted average grant date fair value for restricted stock awards and performance stock units was $68.21$64.65 and $68.10$65.11 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.
9.10. RETIREMENT PLANS
The Company maintains defined benefit pension plans that cover certain employees in France, Japan, Germany and Switzerland.
Net periodic benefit cost for the Company’s defined benefit pension plans for the three and six months ended June 30, 2022 were $0.3 million and $0.5 million. The components of the net periodic benefit costs other than the service cost component of $0.6 million and $1.3 million for the three and six months ended June 30, 2022 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 the six months ended June 30, 2021 were $0.6 million and $1.2 million.million . The components of the net periodic benefit costs other than the service cost component of $0.8 million and $1.7 million for the three and six months ended June 30, 2021 are included in other income, (expense), net in the consolidated statements of operations.
Net periodic benefit costs for the Company’s defined benefit pension plans for the three and six months ended June 30, 2020 were $1.0 million and $1.9 million, respectively. The components of the net periodic benefit costs other than the service cost component of $0.9 million and $1.9 million for the three and six months ended June 30, 2020, respectively, are included in other income (expense), net in the consolidated statements of operations.
The estimated fair values of plan assets were $33.8$34.4 million and $37.8$39.9 million as of June 30, 20212022 and December 31, 2020,2021, respectively. The net plan assets of the pension plans are invested in common trusts as of June 30, 20212022 and December 31, 2020.2021. Common trusts are classified as Level 2 in the fair value hierarchy. The fair value of common trusts is valued at the net asset value based on the fair values of the underlying investments of the trusts as determined by the sponsor of the trusts. The investment strategy of the Company's defined benefit plans is both to meet the liabilities of the plans as they fall due and to maximize the return on invested assets within an appropriate risk profile.
Deferred Compensation Plan
The Company maintains a Deferred Compensation Plan in which certain employees of the Company may defer the payment and taxation of up to 75% of their base salary and up to 100% of bonus amounts and other eligible cash compensation.
During the first quarter of 2020, employees participating in the Company's deferred compensation plan began to defer their compensation. This deferred compensation is invested in funds offered under this plan and is valued based on Level 1 measurements in the fair value hierarchy. Assets of the Company's deferred compensation plan are included in other current assets and recorded at fair value based on their quoted market prices. The fair value of these assets were $3.2$4.3 million and $2.0$3.8 million as of June 30, 20212022 and December 31, 2020, respectively.2021. Offsetting liabilities relating to the deferred compensation plan are included in Other liabilities.
10.11. 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, 2021.2022. 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.
25

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Most facility leases include 1 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, 20212022 and June 30, 20202021 was $10.6$10.2 million and $9.7$10.6 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 rateDollars in thousands, except lease term and discount rateJune 30, 2021December 31, 2020Dollars in thousands, except lease term and discount rateJune 30, 2022December 31, 2021
ROU assetsROU assets$89,174 $83,635 ROU assets$145,135 $84,543 
Current lease liabilitiesCurrent lease liabilities13,987 12,818 Current lease liabilities12,743 14,775 
Non-current lease liabilitiesNon-current lease liabilities95,196 88,118 Non-current lease liabilities154,029 90,329 
Total lease liabilitiesTotal lease liabilities$109,183 $100,936 Total lease liabilities$166,772 $105,104 
Weighted average remaining lease term (in years):Weighted average remaining lease term (in years):Weighted average remaining lease term (in years):
Leased facilitiesLeased facilities11.3 years11.6 yearsLeased facilities17.9 years10.4 years
Leased vehiclesLeased vehicles2.3 years2.3 yearsLeased vehicles2.1 years2.1 years
Weighted average discount rate:Weighted average discount rate:Weighted average discount rate:
Leased facilitiesLeased facilities5.0 %4.6 %Leased facilities5.2 %5.1 %
Leased vehiclesLeased vehicles2.7 %2.3 %Leased vehicles2.7 %2.6 %
Supplemental cash flow information related to leases for the six months ended June 30, 20212022 and 20202021 were as follows:
Dollars in thousandsDollars in thousandsJune 30, 2021June 30, 2020Dollars in thousandsJune 30, 2022June 30, 2021
Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leasesOperating cash flows from operating leases$7,019 $6,728 Operating cash flows from operating leases$8,798 $7,019 
ROU assets obtained in exchange for lease liabilities:ROU assets obtained in exchange for lease liabilities:ROU assets obtained in exchange for lease liabilities:
Operating leasesOperating leases$10,528 $6,007 Operating leases$69,489 $10,528 
Future minimum lease payments under operating leases at June 30, 20212022 were as follows:
Dollars in thousandsDollars in thousandsRelated PartiesThird PartiesTotalDollars in thousandsRelated PartiesThird PartiesTotal
2021$148 $7,973 $8,121 
2022296 16,833 17,129 
Remainder of 2022Remainder of 2022$148 $7,824 $7,972 
20232023296 13,945 14,241 2023296 18,022 18,318 
20242024296 11,461 11,757 2024296 18,008 18,304 
20252025296 10,835 11,131 2025296 16,505 16,801 
20262026296 9,553 9,849 2026296 14,981 15,277 
20272027296 14,580 14,876 
ThereafterThereafter837 72,887 73,724 Thereafter246 164,917 165,163 
Total minimum lease paymentsTotal minimum lease payments$2,465 $143,487 $145,952 Total minimum lease payments$1,874 $254,837 $256,711 
Less: Imputed interestLess: Imputed interest36,769 Less: Imputed interest89,939 
Total lease liabilitiesTotal lease liabilities109,183 Total lease liabilities166,772 
Less: Current lease liabilitiesLess: Current lease liabilities13,987 Less: Current lease liabilities12,743 
Long-term lease liabilitiesLong-term lease liabilities95,196 Long-term lease liabilities154,029 
26

INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Related Party Leases
The Company leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a corporation whose shareholdersstockholders are trusts, whose beneficiaries include family members of the Company’s principal stockholder and former director. The term of the current lease agreement is through October 31, 2029 at an annual rate of approximately $0.3 million per year. The current lease agreement also provides (i) a 5-year renewal option for the Company to extend the lease from November 1, 2029 through October 31, 2034 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2034 through October 31, 2039 at the fair market rental rate of the premises.
11.12. TREASURY STOCK
As of June 30, 2021 and December 31, 2020, there were 4.9 million shares of treasury stock outstanding with a cost of $234.5 million and $235.1 million, respectively, at a weighted average cost per share of $47.86.
On December 7, 2020,April 26 2022, the Board of Directors of the Company authorized the Company to repurchase up to $225.0 million of the Company’s common stock. The program allows the Company to repurchase its shares opportunistically from time to time. The repurchase authorization expires in December 2022. The Company has $225.02024. This stock repurchase authorization replaces the previous $225 million remaining understock repurchase authorization, of which $100 million remained authorized at the share repurchasetime of its Common Stock. The pricereplacement, and timing of any future purchases under the share repurchase program will dependwhich was otherwise set to expire on factors such as levels of cash generation from operations, the volume of stock option exercises by employees, cash requirements for acquisitions, dividends, economic and market conditions and stock price.
During the twelve months ended December 31, 2020,2022. Purchases may be affected through one or more open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, or a combination of the Company repurchased 2.1foregoing.
As of June 30, 2022 and December 31, 2021, there were 6.8 million and 4.9 million shares of Integra’s commontreasury stock as partoutstanding with a cost of the previous$362.9 million and $234.4 million, at a weighted average cost per share repurchase authorization. The Company utilized $100.0 million of net proceeds from the offering of the Convertible Senior Notes to execute the share repurchase transactions. This included $7.6 million from certain purchasers of the convertible notes in conjunction with the closing of the offering. $53.18 and $47.86, respectively.
On February 5, 2020,January 12, 2022, the Company entered into a $92.4$125.0 million accelerated share repurchase ("2022 ASR") to complete the remaining $100.0 million of share repurchase. The Companyand received 1.31.48 million shares of Company common stock at inception, of the ASR, which represented approximately 80% of the expected total shares.shares under the 2022 ASR. On March 24, 2022, the early exercise provision was exercised by 2022 ASR counterparty. Upon settlement of the ASR in June 2020,on March 24, 2022, the Company received an additional 0.60.46 million shares determined using the volume-weighted average price of the Company's common stock during the term of the transaction.2022 ASR.
12.13. 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,
 2021202020212020
Reported tax rate21.8 %122.4 %28.2 %32.7 %
 Three Months Ended June 30,Six Months Ended June 30,
 2022202120222021
Reported tax rate13.2 %21.8 %14.5 %28.2 %
The Company’s effective income tax rates for the three months ended June 30, 2022 and 2021 were 13.2% and 2020 were 21.8% and 122.4%, respectively. For the three months ended June 30, 2021,2022, the primary driver of the lower tax rate is duea $4.8 million benefit related to mix of income impacted by the COVID-19 pandemic. For the three months ended June 30, 2020, the primary drivers of the higherexcess tax rate was lower income impacted by the COVID-19 pandemic and a $3.4 million valuation allowance on certain foreign deferred tax assets.benefits from stock compensation.
The Company'sCompany’s effective income tax rates for the six months ended June 30, 2022 and 2021 were 14.5% and 2020 were 28.2% and 32.7%, respectively. For the six months ended June 30, 2022, the primary driver of the tax rate is a $5.7 million benefit related to excess tax benefits from stock compensation. For the six months ended June 30, 2021, the primary driversdriver of the lowerhigher tax rate were mix of income in lower-taxes jurisdictions, offset bywas the tax impact of the gain on the sale of the Extremity and Orthopedics business which was completed during the first quarter of 2021. For the six months ended June 30, 2020, the primary drivers
Changes to income tax laws and regulations, in any of the higher tax rate were lower book incomejurisdictions in lower-taxed jurisdictions and a $3.4 million valuation allowance on certain foreign deferred tax assets aswhich the Company determined that it was no longer more likely than not that theseoperates, 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. The current U.S. administration has proposed tax reform which, if enacted, may increase the Company’s U.S. federal income tax liability. Further, legislation in foreign deferred tax assets wouldjurisdictions may be realized dueenacted, in response to the adverse impactbase erosion and profit-sharing project begun by the Organization for Economic Cooperation and Development ("OECD"). The OECD recently finalized major reform of the COVID-19 pandemicinternational tax system with respect to a global minimum tax rate. Such changes in certain jurisdictions.U.S. and non-U.S. jurisdictions could have an adverse effect on the Company’s effective tax rate.
As of June 30, 2021,2022, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed to be indefinitely reinvested. Suchreinvested unless there is a manner under which to remit the earnings with no material tax cost. Material taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. The Company will repatriate foreign earnings when there is no need for reinvestment overseas and there is no material cost to bring the earnings back to the United States. Reinvestment considerations would include future acquisitions, transactions, and capital expenditure plans. As such, the Company has determined the tax impact of repatriating these foreign earnings would not be material as of June 30, 2021. The Company does not anticipate the need to repatriate earnings from foreign subsidiaries as a result of the impact of the COVID-19 pandemic.2022.
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NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
13.14. NET INCOME PER SHARE
Basic and diluted net income per share was as follows:
Three Months Ended June 30,Six Months Ended June 30, Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousands, except per share amounts Dollars in thousands, except per share amounts2021202020212020 Dollars in thousands, except per share amounts2022202120222021
Basic net income per share:Basic net income per share:Basic net income per share:
Net income (loss)$35,068 $(369)$80,462 $8,811 
Net incomeNet income$44,788 $35,068 $77,689 $80,462 
Weighted average common shares outstandingWeighted average common shares outstanding84,687 84,706 84,593 84,955 Weighted average common shares outstanding83,168 84,687 83,400 84,593 
Basic net income per common shareBasic net income per common share$0.41 $(0.00)$0.95 $0.10 Basic net income per common share$0.54 $0.41 $0.93 $0.95 
Diluted net income per share:Diluted net income per share:Diluted net income per share:
Net income (loss)$35,068 $(369)$80,462 $8,811 
Net incomeNet income$44,788 $35,068 $77,689 $80,462 
Weighted average common shares outstanding — BasicWeighted average common shares outstanding — Basic84,687 84,706 84,593 84,955 Weighted average common shares outstanding — Basic83,168 84,687 83,400 84,593 
Effect of dilutive securities:Effect of dilutive securities:Effect of dilutive securities:
Stock options and restricted stockStock options and restricted stock653 731 593 Stock options and restricted stock454 653 579 731 
Weighted average common shares for diluted earnings per shareWeighted average common shares for diluted earnings per share85,340 84,706 85,324 85,548 Weighted average common shares for diluted earnings per share83,622 85,340 83,979 85,324 
Diluted net income per common shareDiluted net income per common share$0.41 $0.00 $0.94 $0.10 Diluted net income per common share$0.54 $0.41 $0.93 $0.94 
Common stock of approximately 0.10.2 million and 0.5and 0.1 million shares at June 30, 2022, and 2021, and 2020, respectivelyrespectively that are issuable through exercise of dilutive securities were not included in the computation of diluted net income per share because their effect would have been anti-dilutive.
Performance Shares and Restricted Units that entitle the holders to approximately 0.5 million shares of common stock are included in the basic and diluted weighted average shares outstanding calculation from their date of issuance because no further consideration is due related to the issuance of the underlying common shares.
Based on the adoption of ASU 2020-06, as the principal amount of the 2025 Notes will be paid in cash and only the conversion spread is settled in shares, the Company will be utilizing the if-converted method and only includes the net number of incremental shares that would be issued upon conversion.

14.15. ACCUMULATED OTHER COMPREHENSIVE LOSS
Comprehensive income (loss) for the six months ended June 30, 20212022 and 20202021 was as follows:
Three Months Ended June 30,Six Months Ended June 30, Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
Net income (loss)$35,068 $(369)$80,462 $8,811 
Net incomeNet income$44,788 $35,068 $77,689 $80,462 
Foreign currency translation adjustmentForeign currency translation adjustment1,558 10,433 (5,243)3,620 Foreign currency translation adjustment(18,067)1,558 (23,749)(5,243)
Change in unrealized loss on derivatives, net of tax(7,804)(8,830)29,111 (30,136)
Change in unrealized gain (loss) on derivatives, net of taxChange in unrealized gain (loss) on derivatives, net of tax25,922 (7,804)55,744 29,111 
Pension liability adjustment, net of taxPension liability adjustment, net of tax(91)(139)228 (207)Pension liability adjustment, net of tax(45)(91)(54)228 
Comprehensive income (loss), net$28,731 $1,095 $104,558 $(17,912)
Comprehensive income, netComprehensive income, net$52,598 $28,731 $109,630 $104,558 
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Changes in accumulated other comprehensive loss by component between December 31, 20202021 and June 30, 20212022 are presented in the table below, net of tax:
Dollars in thousandsGains and Losses on DerivativesDefined Benefit Pension ItemsForeign Currency ItemsTotal
Balance at January 1, 2021$(82,249)$(5,105)$13,295 $(74,059)
Other comprehensive income (loss)47,885 228 (5,243)42,870 
Less: Amounts reclassified from accumulated other comprehensive loss18,774 18,774 
Net current-period other comprehensive income (loss)29,111 228 (5,243)24,096 
Balance at June 30, 2021$(53,138)$(4,877)$8,052 $(49,963)
Dollars in thousandsGains and Losses on DerivativesDefined Benefit Pension ItemsForeign Currency ItemsTotal
Balance at January 1, 2022$(42,981)$1,893 $(4,067)$(45,155)
Other comprehensive gain (loss)72,499 (54)(23,750)48,695 
Less: Amounts reclassified from accumulated other comprehensive income, net16,755 — — 16,755 
Net current-period other comprehensive gain (loss)55,744 (54)(23,750)31,940 
Balance at June 30, 2022$12,763 $1,839 $(27,817)$(13,215)
For the six months ended June 30, 2021,2022, the Company reclassified a gain of $25.0$22.8 million and a loss of $6.2$5.2 million from accumulated other comprehensive loss to other income, (expense), net and interest income.income, respectively.
15.16. SEGMENT AND GEOGRAPHIC INFORMATION
The Company internally manages 2 global reportable segments and reports the results of its businesses to its chief operating decision maker. The 2 reportable segments and their activities are described below.
The Codman Specialty Surgical segment includes (i) the Neurosurgery business, which sells a full line of products for neurosurgery and neuro critical care such as tissue ablation equipment, dural repair products, cerebral spinal fluid management devices, intracranial monitoring equipment, and cranial stabilization equipment, and solutions for use in minimally invasive neurosurgery and in the management of intracerebral hemorrhages, and (ii) the instrumentsInstruments business, which sells more than 40,000 instrument patterns and surgical and lighting products to hospitals, surgery centers, dental, podiatry, and veterinary offices.
The Tissue Technologies segment includes a large, complementary portfolio of products to address plastic and surgical reconstructive procedures such offerings as skincomplex and woundtraumatic wounds, hernia and abdominal wall repair, bone grafts,breast reconstruction, and peripheral nerve and tendon repair products. In conjunction with the sale of the Extremity Orthopedics business, the Company rebranded the Orthopedics andrepair. The Tissue Technologies segment as Tissue Technologies in the first quarter of 2021.has four unique technology platforms, including bovine engineered collagen matrix, bovine dermal matrix, amniotic technology and porcine bladder matrix technology, to address regenerative soft tissue reconstruction procedures.
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, 20212022 and 20202021 are as follows :follows:
Three Months Ended June 30,Six Months Ended June 30,Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
Segment Net SalesSegment Net SalesSegment Net Sales
Codman Specialty SurgicalCodman Specialty Surgical$256,837 $169,778 $498,078 $401,218 Codman Specialty Surgical$257,863 $256,837 $505,171 $498,078 
Tissue Technologies
Tissue Technologies
133,155 88,887 251,985 211,771 
Tissue Technologies
139,952 133,155 269,282 251,985 
Total revenuesTotal revenues$389,992 $258,665 $750,063 $612,989 Total revenues$397,815 $389,992 $774,453 $750,063 
Segment ProfitSegment ProfitSegment Profit
Codman Specialty SurgicalCodman Specialty Surgical$113,996 $65,256 $220,774 $152,491 Codman Specialty Surgical$92,196 $113,996 $202,356 $220,774 
Tissue Technologies
Tissue Technologies
64,413 28,688 114,42459,958 
Tissue Technologies
61,626 64,413 115,519114,424 
Segment profitSegment profit178,409 93,944 335,198 212,449 Segment profit153,822 178,409 317,875 335,198 
AmortizationAmortization(4,198)(8,073)(8,725)(15,050)Amortization(3,304)(4,198)(7,198)(8,725)
Corporate and otherCorporate and other(122,357)(71,791)(243,905)(156,216)Corporate and other(90,651)(122,357)(204,646)(243,905)
Operating incomeOperating income$51,854 $14,080 $82,568 $41,183 Operating income$59,867 $51,854 $106,031 $82,568 
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
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.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
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, Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
United StatesUnited States$278,186 $181,850 $525,979 $428,702 United States$287,347 $278,186 $550,698 $525,979 
EuropeEurope48,437 32,026 94,256 77,922 Europe46,862 48,437 90,606 94,256 
Asia PacificAsia Pacific44,306 33,501 91,601 73,461 Asia Pacific43,365 44,306 91,082 91,601 
Rest of WorldRest of World19,063 11,288 38,227 32,904 Rest of World20,241 19,063 42,067 38,227 
Total RevenuesTotal Revenues$389,992 $258,665 $750,063 $612,989 Total Revenues$397,815 $389,992 $774,453 $750,063 
16.17. COMMITMENTS AND CONTINGENCIES
In consideration for certain technology, manufacturing, distribution, and selling rights and licenses granted to the Company, the Company has agreed to pay royalties on sales of certain products that it sells. The royalty payments that the Company made under these agreements were not significant for any of the periods presented.
The Company is subject to various claims, lawsuits and proceedings in the ordinary course of the Company's business, including claims by current or former employees, distributors and competitors and with respect to its products and product liability claims, lawsuits and proceedings, some of which have been settled by the Company. In the opinion of management, such claims are either adequately covered by insurance or otherwise indemnified, or are not expected, individually or in the aggregate, to result in a material, adverse effect on the Company's financial condition. However, it is possible that the Company's results of operations, financial position and cash flows in a particular period could be materially affected by these contingencies.
The Company accrues for loss contingencies when it is deemed probable that a loss has been incurred and that loss is estimable. The amounts accrued are based on the full amount of the estimated loss before considering insurance proceeds and do not include an estimate for legal fees expected to be incurred in connection with the loss contingency. The Company consistently accrues legal fees expected to be incurred in connection with loss contingencies as those fees are incurred by outside counsel as a period cost.
Contingent Consideration
The Company determined the fair value of contingent consideration during the six month period ended June 30, 20212022 and June 30, 20202021 to reflect the change in estimates,estimate, additions, payments, transfers and the time value of money during the period.
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the six months ended June 30, 20212022 and June 30, 20202021 is as follows (in thousands):
Six Months Ended June 30, 2021Contingent Consideration Liability Related to Acquisition of:
ArkisLocation in Financial StatementsDerma SciencesACell Inc.
 (See Note 2)
Location in Financial Statements
Short-termLong-termLong-termLong-term
Balance as of January 1, 2021$3,415 $11,746 $230 $
Additions from acquisition of ACell— — — 23,900 
Transfers(3,432)3,432 — — 
Gain (loss) from change in fair value of contingent consideration liabilities17 $(402)Research and development— (400)Selling, general and administrative
Balance as of June 30, 2021$$14,776 $230 $23,500 
Six Months Ended June 30, 2022Contingent Consideration Liability Related to Acquisition of:
ArkisLocation in Financial StatementsDerma SciencesACell Inc.
 (See Note 3)
Location in Financial Statements
Short-termLong-termLong-termShort-termLong-term
Balance as of January 1, 2022$3,691 $11,408 $230 $— $21,800 
Transfers00— 4,885 (4,885)
Change in fair value of contingent consideration liabilities(155)$(1,978)Research and development— (4,885)1,219 Selling, general and administrative
Balance as of June 30, 2022$3,536 $9,430 $230 $— $18,134 
Six Months Ended June 30, 2020Contingent Consideration Liability Related to Acquisition of:
ArkisDerma SciencesLocation in Financial Statements
Long-termLong-term
Balance as of January 1, 2020$14,210 $230 
Loss from change in fair value of contingent consideration liabilities(708)Research and development
Balance as of June 30, 2020$13,502 $230 
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INTEGRA LIFESCIENCES HOLDINGS CORPORATION
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) (continued)
Six Months Ended June 30, 2021Contingent Consideration Liability Related to Acquisition of:
ArkisLocation in Financial StatementsDerma SciencesACell Inc.
 (See Note 3)
Location in Financial Statements
Short-termLong-termLong-termLong-term
Balance as of January 1, 2021$3,415 $11,746 $230 $— 
Additions from acquisition of ACell— — — 23,900 
Transfers(3,432)3,432 — — 
Change in fair value of contingent consideration liabilities17 (402)Research and development— (400)Selling, general and administrative
Balance as of June 30, 2021$— $14,776 $230 $23,500 
Arkis BioSciences Inc.
On July 29, 2019, the Company acquired Arkis BioSciences Inc. ("Arkis") for an acquisition purchase price of $30.6 million (the "Arkis Acquisition") plus contingent consideration of up to $25.5 million, that may be payable based on the successful completion of certain development and commercial milestones. Arkis was a privately-held company that marketed the CerebroFlo®CerebroFlo® external ventricular drainage (EVD) catheter with Endexo®Endexo® technology, a permanent additive designed to reduce the potential for catheter obstruction due to thrombus formation.
As part of the acquisition, the Company is required to pay the former shareholders of Arkis up to $25.5 million based on the timing of certain development milestones of $10.0 million and commercial sales milestones of $15.5 million, respectively. The Company used a probability weighted income approach to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specified milestone. The Company estimated the fair value of the contingent consideration to be $13.1 million at the acquisition date. The estimated fair value as of June 30, 20212022 and June 30, 20202021 was $14.8$13.0 million and $13.5$14.8 million, respectively. The Company recorded $14.8$9.4 million and $13.5$14.8 million in other liabilities at June 30, 20212022 and June 30, 2020,2021, respectively, and $3.5 million in accrued expenses and other current liabilities at June 30, 2022, in the consolidated balance sheet of the Company.
Derma Sciences
The Company assumed contingent consideration incurred by Derma Sciences, Inc. ("Derma Sciences") related to its acquisitions of BioD and the intellectual property related to Medihoney products. The Company accounted for the contingent liabilities by recording their fair value on the date of the acquisition based on a probability weighted income approach. The Company has already paid $33.3 million related to the aforementioned contingent liabilities. NaN contingent liabilitymilestone remains which relates to net sales of MedihoneyMedihoney™ products exceeding certain amounts defined in the agreement between the Company and Derma Sciences. The potential maximum undiscounted payment amounts to $3.0 million. The estimated fair value as of June 30, 20212022 and June 30, 20202021 was $0.2 million.
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ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis of the Company's financial condition and results of operations should be read in conjunction with our condensed consolidated financial statements and the related notes thereto appearing elsewhere in this report and our consolidated financial statements for the year ended December 31, 20202021 included in our Annual Report on Form 10-K.
We have made statements in this report which constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended and Section 21E of the Securities Exchange Act of 1934 (the “Exchange Act”). These forward-looking statements are subject to a number of risks, uncertainties and assumptions about the Company and other matters. These forward-looking statements include, but are not limited to, statements related to the Company's expectations regarding the potential impacts of the COVID-19 pandemic on our business, financial condition, and results of operations. These statements should, therefore, be considered in light of various important factors, including, but not limited to, the following: the Company's ability to recover to normalized procedure volume in the midstrisk of the COVID-19 pandemic; the risk that the COVID-19 pandemic could lead to further material delays and cancellations of, or reduced demand for, procedures; curtailed or delayed capital spending by the Company's customers; disruption and/or higher costs to the Company'sCompany’s supply chain; closures ofstaffing shortages in hospitals; labor impacts in our facilities; delays in gathering clinical evidence; diversion of management and other resources to respond to the COVID-19 outbreak; the impact of global and regional economic and credit market conditions on healthcare spending; the risk that the COVID-19 virus disrupts local economies and causes economies in our key markets to enter prolonged recessions. The Company's actual results could differ materially from those anticipated in these forward-looking statements as a result of many factors, including but not limited to those set forth under the heading “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2020, and2021, under the heading "Risk Factors" in this report.report, and in other filings with the SEC. We undertake no obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events or otherwise.otherwise, except to the extent required by applicable law.
You can identify these forward-looking statements by forward-looking words such as “believe,” “may,” “might,” “could,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “seek,” “plan,” “expect,” “should,” “would” and similar expressions in this report.
GENERAL
Integra, headquartered in Princeton, New Jersey, is a world leader in medical technology. The Company was founded in 1989 with the acquisition of an engineered collagen technology platform used to repair and regenerate tissue. Since then, Integra has developed numerous product lines from this technology for applications ranging from burn and deep tissue wounds to the repair of dura mater in the brain, as well as peripheral nerves and tendons. The Company has expanded its base regenerative technology business to include surgical instruments, neurosurgical products and advanced wound care through a combination of several global acquisitions and product development of products internally to further meet the evolving needs of its customers and impactenhance patient care.
Integra manufactures and sells medical technologies and products in two reportable business segments: Codman Specialty Surgical and Tissue Technologies. In conjunction with the sale of the Extremity and Orthopedics business, the Company rebranded the Orthopedics("CSS") and Tissue Technologies ("TT"). The CSS segment, as Tissue Technologies in the first quarterwhich represents two-thirds of 2021. See Note 2. Acquisitions and Divestitures, for details. Our Codman Specialty Surgical products compriseour total revenue, consists of specialty surgical implantsmarket-leading technologies and instrumentation used for a broadwide range of specialties. This segment includes productsspecialties, such as neurosurgery, neurocritical care and solutions for dural accessotolaryngology. We are the world leader in neurosurgery and repair,one of the top three providers in instruments advanced energy, cerebral spinal fluid ("CSF") management and neuro monitoring including market leading product portfolios used in neurosurgery operation suitesprecision, specialty, and critical care units. Codman Specialty Surgical products are sold through a combination of directly employed sales representatives, distributors and wholesalers, depending on the customer call point.general surgical procedures. Our Tissue Technologies product portfolios consist of differentiated regenerative technology products for soft tissue repair and tissue regeneration products, and surgical reconstruction. This business also includes private label sales of a broad setTT segment generates about one-third of our regenerativeoverall revenue and focuses on three main areas: complex wound care medicine technologies. Tissue Technologies products are sold through directly employed sales representativessurgery, surgical reconstruction, and distributors focused on their respective surgical specialties, and strategic partners.peripheral nerve repair.
We have key manufacturing and research facilities located in California, Indiana, Maryland, Massachusetts, New Jersey, Ohio, Puerto Rico, Tennessee, Utah, Canada, China, France, Germany, Ireland Puerto Rico and Switzerland. We also source most of our handheld surgical instruments and dural sealant products through specialized third-party vendors.
Integra is committed to delivering high quality products that positively impact the lives of millions of patients and their families. We focus on four key pillars of our strategy: 1) enabling an execution-focused culture, 2) optimizing relevant scale, 3) advancing innovation and agility, and 4) leading in customer experience. We believe that by sharpening our focus on these areas through improved planning and communication, optimization of our infrastructure, and strategically aligned tuck-in acquisitions, we can build scale, increase competitiveness, and achieve our long-term goals.
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To this end, the executive leadership team has established the following key priorities aligned to the following areas of focus:
Strategic Acquisitions. An important part of the Company's strategy is pursuing strategic transactions and licensing agreements that increase relevant scale in the clinical areas in which Integra competes. In December 2020, Integra entered into a merger agreement to acquireDuring 2021, the Company acquired ACell Inc. ("ACell"), an innovative regenerative medicine company specializing in the manufacturemanufacturing of porcine urinary bladder extracellular matrices. This acquisition which closed on January 20, 2021, expands ournot only expanded the Company’s product offering of regenerative technology andtechnologies, but it is complementaryalso expected to Integra’s existing tissue technologies portfolio. The acquisition also supports oursupport the Company’s long-term growth and profitability strategy withas this product line has a financial profile similar to Integra’s other regenerative tissue products. In 2021, we are focused on the integrationAll critical components of ACell Inc.,have been integrated into our Tissue Technologies business segment, while also continuing the development of regenerative tissue products for complex wound management that will benefit the expanded portfolio.Company’s TT segment. See Note 2,3, Acquisitions and Divestitures, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for additional details. In 2022, we continued to advance the development of pioneering neurosurgical technologies from our 2019 acquisitions, Arkis Biosciences, Inc. and Rebound Therapeutics Corporation
Portfolio Optimization and New Product Introductions. We are investing in innovative product development to drive a multi-generational pipeline for our key product franchises. Our product development efforts span across our key global franchises focused on potential for significant returns on investment. We continue to advance the development of pioneering technologies from our 2019 acquisitions, Arkis Biosciences, Inc. and Rebound Therapeutics Corporation. In addition to new product development, we are funding studies to gather clinical evidence to support launches, ensure market access and improve reimbursement for existing products. We continueIn addition to identify ways of optimizingacquisitions and organic reinvestment, we continually look to optimize our portfolio including identifying low-growth, low-margintowards higher growth and higher margin businesses. As such, we may opportunistically divest businesses or discontinue products where we see limited runway for future value creation in line with our aspirations due in part to changes in the market, business fundamentals or the regulatory environment.
On May 20, 2022, we entered into an agreement to sell our non-core traditional wound care ("TWC") business to Gentell, LLC for approximately $28.8 million, which consists of $27.8 million in cash plus $1.0 million in contingent consideration which may be received upon achieving certain revenue-based performance milestones. The transaction is expected to close at or around August 31, 2022, subject to the satisfaction of customary conditions. Revenues for the TWC business were approximately $27 million in 2021. See Note 2, Assets and product franchisesLiabilities Held for discontinuation.Sale, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details. Our portfolio optimization actions over the past two years have allowed us to increase our focus on Integra’s core portfolio of market-leading products in neurosurgery, surgical instrumentation and regenerative tissue and moves us closer to achieving our long-term organic growth and profitability targets.
In January 2021, we completed the sale of our Extremity Orthopedics business to Smith & Nephew USD Limited ("Smith & Nephew"), a subsidiary of Smith & Nephew plc, for approximately $240 million in cash subject to finalization of working capital adjustments.cash. This transaction enables us to increase our investments in our core Neurosurgeryneurosurgery and Tissue Technologytissue technologies businesses which willand fund pipeline opportunities to expand our addressable markets to strengthen our existing leadership positions in both areas, fund pipeline opportunities tothese segments and drive future growth and expand our addressable markets.growth. See Note 2,3, Acquisitions and Divestitures, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details.
Commercial Channel Investments.With acquisitions, new product introductions and a broad portfolio of products, investing Investing in our sales channels is a core part of our strategy to create specialization and greater focus on reaching new and existing customers and addressing their needs. To support our commercial efforts in Tissue Technologies, we expanded ourutilize a two-tier specialist model to increase our presence in focused segments. We createdsegments by creating a virtual selling organization to help serve the evolving needs of our customers. In addition, we continue to build upon our leadership brands across our product franchises in both CSS and TT to engage customers through enterprise-wide contracts with leading hospitals, integrated delivery networks and global purchasing organizations in the United States. Internationally, we have increased our commercial resources significantly in key emerging markets and are making investments to support our sales organization and maximize our commercial opportunities. Domestically, we have also increased our TT sales force in the United States to support the expanded regenerative tissue product portfolio that included ACell products. These strong investments in our international and domestic sales channel position us well for expansion and long-term growth. In addition, we continue to build upon our leadership brands across our product franchises to enable us to engage customers through enterprise-wide contracts.
Customer Experience.We aspire to be ranked as a best-in-class provider and are committed to strengthen our relationships with all customers. We continue to invest in technologies, systems and processes to enhance the customer experience. Additionally, weWe also launched new digital tools and programs, resources and virtual product training to drive continued customer familiarity with our growing portfolio of medical technologies globally. In addition, we announced plans to outsource certain transactional back-office finance and customer service activities to enhance customer quality, build scale for future growth, and capture cost efficiencies.
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Clinical and Product Development Activities
We continue to invest in collecting clinical evidence to support the Company's existing products and new product launches, and to ensure that we obtain market access for broader and more cost-effective solutions. In each area,2021, we continue to benefit from products launched overour CereLink™ ICP Monitor System in the past several years.
Within our Codman Specialty Surgical segment, the Company received FDA clearance in 2020 to treat malignantU.S. and benign tumors, butEurope direct markets. CereLink provides enhanced accuracy, usability and advanced data presentation that provides clinicians with uncompromised, advanced continuous ICP monitoring that until now, has not limited to meningiomas and gliomas, for its CUSA® Clarity Ultrasonic Surgical Aspirator System,been available when treating patients with traumatic brain injuries. Through the first and only ultrasonic tissue ablation systemhalf of 2022, we have continued the global rollout of Cerelink with this specific indication. The FDA clearance is based on a wealth of peer-reviewed clinical publications and 40 years of surgical cases involving resection of brain and spinal tumors.
Additionally, the Company continued to reap the benefits of our product launches from the prior year from the Codman Specialty Surgical segment, including our new electrosurgery generatorin Australia and irrigator system, an innovative customer-centric toolkit for our Certas™ Plus Programmable Valve along with additional shunt configurations. In Japan, we are experiencing strong growthCanada, as a result of the successful launch of DuraGen®well as several other indirect markets in mid-2019, which is the first and only collagen xenograft approved for use as a dural substitute in the country.EMEA. We are focused on the development of core clinical applications in our electromechanical technologies portfolio. In June 2022, we launched the Neutus® EVD system, our first external ventricular drain (“EVD") in China. The Neutus EVD system is manufactured in China by Shanghai Haoju Medical Technology Co., Ltd. under an exclusive distribution arrangement. The device is used in the management of cerebrospinal fluid and is highly complementary to our Bactiseal® catheter and advanced intercranial pressure monitoring products. Also, we updatedcontinue to update our CUSA Clarity platform to incorporate aby incorporating new ultrasonic handpiece, surgical tips and integrated electrosurgical capabilities. We continue to work with several instrument partners to bring new surgical instrument platforms to the market. This enables us
In 2022, we continued to add new instruments with minimal expense and invest in ongoing development, such as our next generation of LED technology with our DUO LED Surgical Headlight System.
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We advancedadvance the two early-stage technology platforms we acquired duringin 2019. Through the acquisition of Arkis Biosciences, acquisition, we added a platform technology, CerebroFlo® external ventricular drainage (EVD)CerebroFlo® EVD, catheter with Endexo®Endexo® technology, a permanent additive designed to reduce the potential for catheter obstruction due to thrombus formation. The CerebroFlo®CerebroFlo EVD Catheter has demonstrated an average of 99% less thrombus accumulation onto its surface, in vitro, compared to a market leading EVD catheter. WeIn 2019, we also acquired Rebound Therapeutics a company thatCorporation which specialized in a single-use medical devices that enabledevice, known as Aurora Surgiscope, which is the only tubular retractor system designed for cranial surgery with an integrated access channel, camera and lighting. In 2021, we began and continued to conduct a limited clinical launch of the Aurora Surgiscope for use in minimally invasive access with enhanced lighting and visualization to the neurosurgery suite and launched theas well as initiated a registry called MIRROR registry to collect data on early surgical intervention using this new device. These new platforms provide ussame technology platform for the treatment of intracerebral hemorrhages ("ICH"). In the second quarter of 2022, we have continued to execute on our growth initiatives. We launched the Aurora® Evacuator with Coagulation device in the opportunityU.S., designed to expand into new, faster growth therapeutic areas such as intracerebral hemorrhagebe used in conjunction with our Aurora Surgiscope to safely address and minimally invasive neurosurgery.evacuate blood in the brain caused by hemorrhagic stroke. 
Within our Tissue TechnologiesTT segment, in the first half of 2022, we recentlylaunched NeuraGen® 3D Nerve Guide Matrix, a resorbable implant for repair of peripheral nerve discontinuities and designed to optimize the environment for nerve regeneration to allow for more complete functional recovery. During 2021, we completed one of the largest diabetic foot ulcers (DFU)("DFU"), randomized controlled trials (RCTs) of PriMatrix®the PriMatrix® Dermal Repair Scaffold for the management of DFU. This multi-center study enrolled more than 225 patients with chronic DFU's over the course of 12-week treatments and 4-week follow-up phases. The results of this study, which was published in the Journal of Wound Care, demonstrated that PriMatrix®PriMatrix plus standard of care (SOC)("SOC") consisting of sharp debridement, infection elimination, use of dressings and offloading was significantly more likely to achieve complete wound closure compared with SOC alone, with a median number of one application of the product. In 2020, we announced positive clinical and economic data on Integra® Bilayer Wound Matrix ("IBWM") in complex lower extremity reconstruction based on two retrospective studies recently published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons. As surgeons look for ways to efficiently and effectively repair and close wounds during these challenging times, IBWM helps address the efficiency needed in operating rooms by reducing both the operating time and costs to hospitals and patients.
COVID-19 Pandemic and the Economic Recession
During this global crisis, the Company's focus remained on supporting patients, providing customers with life-saving products, and protecting the well-being of our employees. The rapid and evolving spread of the virus hasand subsequent variants have resulted in an unprecedented challengechallenges to the global healthcare industry, as medical resources were reallocated to fight COVID-19. During the first half of 2020, inindustry. In response to the pandemic, we acted swiftly by implementing protocols to ensure continuity of our manufacturing and distribution sites around the world and to provide for the safety of our employees. During the second half of 2020, the Company's revenues were still impacted due to COVID-19 resurgences, though not to the levels seen in the first half of 2020.
During the first half of 2021, our business segments were well positioned to capitalize on the improving demand driven by the ongoing global market recovery. We saw particularly healthy order activity in products used in neurosurgery, instruments, burn, trauma and surgical reconstruction as markets gradually recovered. Areas such as capital equipment and our international indirect markets are still early in their recovery, but are reporting encouraging trends. We remain confident that the underlying markets in which the Company competes remain attractive over the long term. We alsoand we remain focused on managing the business for the long-term, including preserving full time jobs needed to support the rebound in surgical procedure volumes. The Company's adaptability and resiliency in the face of this unprecedented crisis is made possible in part by prior investments in technology infrastructure and operations, as well as our talented and committed global workforce.long-term.
Capital markets and worldwide economies have also been significantly impacted by the COVID-19 pandemic, and it is possible that it could cause a local and/or global economic recession. Any such economic recession could have a material adverse effect on the Company's long-term business as hospitals curtail and reduce capital as well as overall spending. The COVID-19 pandemic and local actions taken by governmental authorities, private businesses and individuals, such as “shelter-in-place” orders and restrictions on travel and access to our customers or temporary closures of our facilities or the facilities ofof our suppliers, disruption and/or higher costs to the Company’s supply chain, staffing shortages in hospitals and their contract manufacturers,labor constraints in our facilities, could further significantly impact our sales margins and our ability to ship our products and supply our customers.
While COVID variants continue to contribute to an uncertain business environment, effects resulting from the pandemic such as inflationary pressures and global central bank actions to contain high inflation levels could cause a local and/or global economic recession. Capital markets and worldwide economies have also been significantly impacted and such economic recession could have a material adverse effect on the Company’s long-term business as hospitals reduce capital, as well as overall spending.
Any of these events could negatively impact the number of surgical and medical intervention procedures performed and have a material adverse effect on our business, financial condition, results of operations, or cash flows.
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FDA Matters
We manufacture and distribute products derived from human tissue for which FDA has specific regulations governing human cells, tissues and cellular and tissue-based products or ("HCT/Ps.Ps"). An HCT/P is a product containing or consisting of human cells or tissue intended for transplantation into a human patient. Refer to Item 1. Business and Item 1A. Risk Factors in our 2021 10-K report for further details around these FDA regulations and their potential effect on the Company's portfolio of morselized amniotic material-based products as well as the impact on consolidated revenues.
On June 22, 2015, the FDA issued an Untitled Letter (the "Untitled Letter") alleging that BioD'sBioD LLC's morselized amniotic membrane tissue-based products do not meet the criteria for regulation as HCT/Ps solely under Section 361 of the Public Health Services Act ("Section 361") and that, as a result, BioD LLC ("BioD") would need a biologics license to lawfully market those morselized products. Since the issuance of the Untitled Letter, BioD and the Company have made known to the FDA their disagreement with the FDA’s assertion that certain products are more than minimally manipulated. The FDA has not changed its position that certain of the BioD acquired products are not eligible for marketing solely under Section 361. In July 2020, the FDA issued the final guidance document related to human tissue titled, “Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use” (the “HCT/“2020 HCT/P Final Guidance”). ThisThe 2020 HCT/P Final Guidance document supersedes the November 2017 guidance by the same title.
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The HCT/P Final Guidance maintains the FDA’s position that products such as the Company’s morselized amniotic membrane tissue-based products do not meet the criteria for regulation solely as HCT/Ps. In addition, in the November 2017 guidance, the FDA articulated a risk-based approach to enforcement and, while some uses for amniotic membrane tissue-based products would have as much as thirty-six months of enforcement discretion, other high risk uses could be subject to immediate enforcement action. The revised final guidance of July 2020 HCT/P Final Guidance maintained this approach and extended the discretionary enforcement period to May 31, 2021.
Rather thanConsidering the risk of enforcement action, the Company discontinued the manufacturing of all morselized amniotic membrane tissue-based products prior to May 31, 2021. We no longer distribute these products. As of June 30, 2021,2022, the Company has not received any further notice of enforcement action from the FDA regarding its morselized amniotic membrane tissue-based products.
Revenues from the now discontinued BioD morselized amniotic membrane-based products for the six months ended June 30, 2021 were less than 1.0% of consolidated revenues.
On March 7, 2019, TEI Biosciences, Inc. ("TEI"), a wholly-owned subsidiary of the Company received a Warning Letter (the “Warning Letter”), dated March 6, 2019, from the FDA. The warning letter relatesrelated to quality systems issues at ourTEI's manufacturing facility located in Boston, Massachusetts. The letter resulted from an inspection held at that facility in October and November 2018 and did not identify any new observations that were not already provided in the Form 483 that followed the inspection. The Company submitted its initial response to the FDA Warning Letter on March 28, 2019 and provides regular progress reports to the FDA as to its corrective actions and, since the conclusion of the inspection, has undertaken significant efforts to remediate the observations and continues to do so. On October 28, 2021 the FDA initiated an inspection of the facility and at the conclusion of the inspection issued a FDA Form 483 on November 12, 2021 (the "2021 Form 483"). The warning letter doesCompany provided an initial response to the inspection observations and will continue to provide responses to FDA. The Warning Letter and the 2021 FDA Form 483 do not restrict the Company’s ability to manufacture or ship products or require the recall of any products. Nor does itproducts, nor do they restrict our ability to seek FDA 510(k) clearance of products. The letter states that requests for Certificates to Foreign Governments would not be granted. However, due to our progress reports, the FDA agreed to resume issuing Certificates to Foreign Governments to TEI due to substantial progress and the length of time it takes to resolve the Warning Letter. Additionally, premarket approval applications for Class III devices to which the Quality System regulation violations are reasonably related will not be approved until the violations have been corrected. The TEI Boston facility manufactures extracellular bovine matrix (EBM) products. The Company does not expect to incur material incremental expense for remediation activities. We cannot however, give any assurances that the FDA will be satisfied with our response to the Warning Letter or as to the expected date of the resolution of the matters included in the letter. Until the issues cited in the letter are resolved to the FDA’s satisfaction, the FDA may initiate additional regulatory action without further notice. Any adverse regulatory action, depending on its magnitude, may restrict us from effectively manufacturing, marketing and selling our products and could have a material adverse effect on our business, financial condition and results of operations.
Revenues of products manufactured in the TEI Boston facility for the six months ended June 30, 20212022 were approximately 4.5%6.0% of consolidated revenues.
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ACQUISITIONS & DIVESTITURES
Divestiture
On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business to Smith & Nephew USD Limited.Nephew. The transaction included the sale of the Company's upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. The Company received an aggregate purchase price of $240.0 million from Smith and& Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO"), effectively terminating the licensing agreement between Integra and CFO relating to the development of shoulder arthroplasty products. The Company recognized a gain of $42.2 million inIn connection with the sale, that is presented inthe Company recognized a $41.8 million as Gain from the sale of business in the consolidated statement of operations for the year ended June 30,December 31, 2021.The Company finalized the net working capital and paid an additional $1.3 million to Smith & Nephew as of December 31, 2021. See Note 2-3, Acquisitions and Divestitures, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details.
Acquisition
Our growth strategy includes the acquisition of businesses, assets or products lines to increase the breadth of our offerings and the reach of our product portfolios and drive relevant scale to our customers.
On January 20, 2021, the Company acquired ACell, Inc. for an acquisition purchase price of $306.9 million plus contingent consideration obligations of up to $100 million, that may be payable upon achieving certain revenue-based performance milestones in 2022, 2023 and 2025. ACell was a privately-held company that offered a portfolio of regenerative products for complex wound management, including developing and commercializing products based on MatriStem Urinary Bladder Matrix ("UBM"), a technology platform derived from porcine urinary bladder extracellular matrix. See Note 2-3, Acquisitions and Divestitures, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details.
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OPTIMIZATION AND INTEGRATION ACTIVITIES
As a result of our ongoing acquisition strategy and significant growth in recent years, we have undertaken cost-saving initiatives to consolidate manufacturing operations, distribution facilities and transfer activities, implement a common ERP system, eliminate duplicative positions, realign various sales and marketing activities, and expand and upgrade production capacitycapacity for our regenerative technology products. These efforts are expected to continue and while we expect a positive impact from ongoing restructuring, integration, and manufacturing transfer and expansion activities, such results remain uncertain. In support of our continued focus on product margins during 2022, we closed a manufacturing facility located in France and began the transfer of production to the Company’s existing Switzerland facility. In addition, we announced plans to outsource certain transactional back-office finance and customer service activities to enhance customer quality, build scale for future growth, and capture cost efficiencies. We expect this transition to be completed by the fourth quarter of 2022.
RESULTS OF OPERATIONS
Executive Summary
Net income for the three months ended June 30, 20212022 was $35.1$44.8 million, or $0.41$0.54 per diluted share, as compared to $(0.4)$35.1 million or $(0.00)$0.41 per diluted share for the three months ended June 30, 2020.2021. The increase in net income for the three months ended June 30, 2021,2022, was primarily driven by increase inhigher revenues due to procedure recovery experienced in the current year as compared to the height of the COVID-19 pandemic in the first half of 2020.across most franchises.
Net income for the six months ended June 30, 20212022 was $80.5$77.7 million, or $0.94$0.93 per diluted share, as compared to $8.8$80.5 million or $0.10$0.94 per diluted share for the six months ended June 30, 2020. 2021. The decrease in net income for the six months ended June 30, 20212022, was primarily driven by higher revenue relating to surgical procedure recovery for the first half of 2021 and increase in non-operating income in the prior period due to the gain of $42.2 million recognized in the first quarter of 2021 as a result of the sale of the Extremity Orthopedics business. Excluding the impact of the gain, net income increased for the six months ended June 30, 2022, driven by higher revenues across most franchises.
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Special Charges
Income before taxes includes the following special charges:
Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousands2021202020212020
Acquisition, divestiture and integration-related charges(1)
$10,776 $6,542 $(16,225)$12,708 
Structural optimization charges4,409 1,230 8,355 4,471 
EU medical device regulation3,415 884 9,163 3,071 
Discontinued product lines charges303 1,302 336 4,487 
Convertible debt non-cash interest expense— 4,250 — 6,780 
Expenses related to debt refinancing— — — 2,740 
COVID-19 pandemic related charges(2)
— (869)— 3,836 
Total$18,903 $13,339 $1,629 $38,093 
Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousands2022202120222021
Acquisition, divestiture and integration-related charges(1)
$(6,284)$10,776 $(5,710)$(16,225)
Structural optimization charges8,172 4,712 14,492 8,691 
EU medical device regulation ("EU MDR")10,249 3,415 19,762 9,163 
Total$12,137 $18,903 $28,544 $1,629 
(1) The Company completed its sale of its Extremity Orthopedics business and recognized a gain of $42.2 million for the six months ended June 30, 2021 which was partially offset by other acquisition, divestiture and integration-related charges. See Note 2. 3, Acquisitions and Divestitures for details.
(2)Charges relate to business interruptions and costs associated with the COVID-19 pandemic which impacted the Company's operations globally, partially offset by Coronavirus government relief programs in the prior year.
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The items reported above are reflected in the condensed consolidated statements of operations as follows:
Three Months Ended June 30,Six Months Ended June 30,Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
Cost of goods soldCost of goods sold$10,724 $6,300 $20,903 $15,607 Cost of goods sold$5,131 $10,724 $9,661 $20,903 
Research and developmentResearch and development2,108 624 7,623 (427)Research and development5,538 2,108 9,805 7,623 
Selling, general and administrativeSelling, general and administrative6,563 2,164 18,057 13,394 Selling, general and administrative2,661 6,563 11,563 18,057 
Interest expense(1)
— 4,251 — 9,519 
Gain from the sale of business679 — (42,197)— 
Gain from the sale of business(1)
Gain from the sale of business(1)
— 679 — (42,197)
Other incomeOther income(1,171)— (2,757)$— Other income(1,193)(1,171)(2,485)$(2,757)
Total Total$18,903 $13,339 $1,629 $38,093  Total$12,137 $18,903 $28,544 $1,629 
(1)(1 Upon adoption of ASU No. 2020-06, the Company will no longer incur non-cash interest expense for the amortization of debt discount. ) See Note 1. Basis of Presentation,3, Acquisitions and Divestitures for details.
We typically define special charges as items for which the amounts and/or timing of such expenses may vary significantly from period to period, depending upon our acquisition, divestiture, integration and restructuring activities, and for which the amounts are non-cash in nature, or for which the amounts are not expected to recur at the same magnitude. We believe that given our ongoing strategy of seeking acquisitions and divestitures and efforts to optimize our continuing focus on rationalizing our existing manufacturing, distribution, commercial and distributionadministration infrastructure, and our continuing review of various product lines in relation to our current business strategy, some of the special charges discussed above could recur with similar materiality in the future.
We believe that the separate identification of these special charges provides important supplemental information to investors regarding financial and business trends relating to our financial condition and results of operations. Investors may find this information useful in assessing comparability of our operating performance from period to period, against the business model objectives that management has established, and against other companies in our industry. We provide this information to investors so that they can analyze our operating results in the same way that management does and to use this information in their assessment of our core business and valuation of Integra.
Revenues and Gross Margin
The Company's revenues and gross margin on product revenues were as follows:
Three Months Ended June 30,Six Months Ended June 30, Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
Segment Net SalesSegment Net SalesSegment Net Sales
Codman Specialty SurgicalCodman Specialty Surgical$256,837$169,778$498,078$401,218Codman Specialty Surgical$257,863$256,837$505,171$498,078
Tissue TechnologiesTissue Technologies133,15588,887251,985211,771Tissue Technologies139,952133,155269,282251,985
Total revenuesTotal revenues$389,992$258,665$750,063612,989Total revenues$397,815$389,992$774,453750,063
Cost of goods soldCost of goods sold151,267105,478297,090238,954Cost of goods sold148,404151,267290,973297,090
Gross margin on total revenuesGross margin on total revenues$238,725$153,187$452,973$374,035Gross margin on total revenues$249,411$238,725$483,480$452,973
Gross margin as a percentage of total revenuesGross margin as a percentage of total revenues61.2 %59.2 %60.4 %61.0 %Gross margin as a percentage of total revenues62.7 %61.2 %62.4 %60.4 %
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Three Months Ended June 30, 20212022 as Compared to Three Months Ended June 30, 20202021
Revenues
For the three months ended June 30, 2021,2022, total revenues increased by $131.3$7.8 million to $390.0$397.8 million from $258.7$390.0 million for the same period in 2020.2021, inclusive of a unfavorable foreign currency impact of $10.3 million on revenues. Domestic revenues increased by $96.3$9.2 million, or 53.0%3.3%, to $278.2$287.3 million and were 71.3%72.2% of total revenues for the three months ended June 30, 20212022 compared to $181.9$278.2 million during the same period in the prior year. International revenues increaseddecreased by $35.0$1.4 million or 45.6%1.2% to $111.8$110.5 million for the three months ended June 30, 20212022 compared to $76.8$111.8 million during the same period in the prior year. The increase in revenues globally were primarily asyear, which is inclusive of a result of the recovery experienced from the COVID-19 pandemic across all franchises compared to the prior year due to rebound in surgical procedure volumes. Foreign exchange fluctuations had a favorable unfavorable foreign currency impact of $6.0 million on revenues for the quarter.$10.3 million.
In the Codman Specialty SurgicalCSS segment, ("CSS"), revenues were $256.8$257.9 million which was an increase of $87.1$1.0 million, or 51.3%0.4% as compared to the prior-year period.period, inclusive of a $9.2 million unfavorable foreign currency impact on revenue. The Neurosurgery and Instrument portfolios increased high-double digitsincrease was as a result of the continued broad demand recovery experienced fromwe have seen across many CSS franchises as well as our ability to maintain pace with customer deliveries. Excluding the COVID-19 pandemic.impact of foreign currency, Neurosurgery portfolio grew low single digits primarily driven by sales in advanced energy and CSF management. Sales in our instruments portfolio increased mid single digits as compared to the same period in the prior year.
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In the Tissue Technologies ("TT")TT segment, revenues were $133.2$140.0 million which was an increase of $44.3$6.8 million, or 49.8%5.1% from the prior-year period. Theperiod, inclusive of a $1.1 million unfavorable foreign currency impact on revenue. Sales in our Wound Reconstruction business, increased low single digits, led by Integra® Dermal Matrices and SurgiMend®. Sales in our Private Label portfoliosbusiness increased high-doublelow double digits as a result of the recovery experienced from the COVID-19 pandemic. Additionally, our TT segment revenue reflect the acquisition of ACell Inc. which was completed on January 20, 2021driven by higher customer demand and the sale of the Company's Extremity Orthopedics product portfolio which occurred on January 4, 2021.
We continue to closely monitor local, regional, and global COVID-19 surges as well as new variants of the virus for an impact on procedures during Q2 2021 and beyond. The reallocation of hospital resources to treat COVID-19 may continue to cause a financial strain on healthcare systems and reduce procedural volumes. Additionally, the Company does not expect all markets and product lines to improve at the same rate based on the level of recurrence of COVID-19 and its associated impact on the pace of procedure recovery and economic normalization.favorable order timing.
Gross Margin
Gross margin increased to $238.7was $249.4 million for the three months ended June 30, 2021,2022, an increase of $85.5$10.7 million from $153.2$238.7 million for the samesame period in 2020.2021. Gross margin as a percentage of revenues increased to 61.2%was 62.7% for the second quarter of 2021 from 59.2% in the same period last year. This increase was mainly attributable to our strong revenue recovery from the disruption caused by the COVID-19 pandemic duringthree months ended June 30, 2022 and 61.2% or the same period in 2021. This increase in gross margin was due to higher revenues and a decrease in amortization associated with reduction of inventory step-up amortization in connection with the acquisition of ACell in the prior year, as well as due to favorable U.S. product mix and improved manufacturing utilization.year.
Operating Expenses
The following is a summary of operating expenses as a percent of total revenues: 
Three Months Ended June 30, Three Months Ended June 30,
20212020 20222021
Research and developmentResearch and development5.2 %5.8 %Research and development6.4 %5.2 %
Selling, general and administrativeSelling, general and administrative41.7 %44.9 %Selling, general and administrative40.4 %41.7 %
Intangible asset amortizationIntangible asset amortization1.1 %3.1 %Intangible asset amortization0.8 %1.1 %
Total operating expensesTotal operating expenses48.0 %53.8 %Total operating expenses47.6 %48.0 %
Total operating expenses, which consist of research and development, selling, general and administrative, and amortization expenses, increased by $47.8$2.7 million, or 34.4%1.4% to $186.9$189.5 million in the three months ended June 30, 2021,2022, compared to $139.1$186.9 million in the same period in 2020.2021. The increase in operating expenses compared to the prior year was primarily due to an increasereflects increased selling costs associated with higher revenue as well as higher spending for key growth initiatives in research and development, selling, general and administrative costs partially offset by a decrease in amortization expense. development.
The Company continues to manage and prioritize itits operating costs closely givento increase organic investments that will drive long-term growth including the continued uncertaintysupport of COVID-19. We also benefited from cost synergies as a result of the ACell Inc. acquisition the sale of the Extremity Orthopedic business.new product development and introductions, clinical studies, geographic expansion and targeted U.S. sales channel expansion.
Research and Development
Research and development expenses for the three months ended June 30, 20212022 increased by $5.2$5.5 million as compared to the same period in the prior year. This increase in spending resulted from additional spending on new product development, clinical studies and spending related to the EU MDR compliance activities.
Selling, General and Administrative
Selling, general and administrative costs increasedfor the three months ended June 30, 2022 decreased by $46.4$1.9 million as compared to the same period in the prior year driven primarily due to costs associated with higher employee related costs, higherby lower incentive and stock-based compensation increased variable selling costs, as well as increased outsidelower acquisition related expenses partially offset by normalization of spending as revenue recovered.in selling and marketing.
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Intangible Asset Amortization
AAmortization expense (exclumortization expense (excludinding amounts reported in cost of product revenues for technology-based intangible assets) for the three months ended June 30, 20212022 was $4.2$3.3 million compared to $8.1$4.2 million for the same period in prior year primarily due to a reduction in amortization expense associated with intangible assets sold in conjunction with the sale of the Extremity and Orthopedics business during the current year.
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Non-Operating Income and Expenses
The following is a summary of non-operating income and expenses:
Three Months Ended June 30, Three Months Ended June 30,
Dollars in thousandsDollars in thousands20212020Dollars in thousands20222021
Interest incomeInterest income$1,764 $2,281 Interest income$1,965 $1,764 
Interest expenseInterest expense(13,149)(15,682)Interest expense(12,236)(13,149)
Other income, netOther income, net1,979 5,034 
Gain (loss) from the sale of businessGain (loss) from the sale of business(679)— Gain (loss) from the sale of business— (679)
Other income, net5,034 972 
Total non-operating income and expenseTotal non-operating income and expense$(7,030)$(12,429)Total non-operating income and expense$(8,292)$(7,030)
Interest Income and Interest Expense
Interest income for the three months ended June 30, 2021 decreased2022 increased by $0.5$0.2 million as compared to the same period last year.
Interest Expense
Interest expense for the three months ended June 30, 20212022 decreased by $2.5$0.9 million as compared to the same period last year primarily from a lower outstanding borrowing on the Senior Secured Credit Facility.
Other income, net for the three months ended June 30, 2022 decreased by $3.1 million compared to the same period in the prior year primarily due to the elimination of the non-cash interest expense as the result of the adoption ASU 2020-06 and the expenses associated with Amended and Restated Senior Credit Agreement which occurred in the prior period. See Note 1. Basis of Presentation for details in relation to the adoption of ASU 2020-06.
Other Income, net
Other income, net for the three months ended June 30, 2021 increased by $4.1 million compared to the same period in the prior year primarily due tolower income associated with the transition services agreement from the divestiture of the Extremity Orthopedics business and and higher income from additional cross currency swaps that were entered into during Q4 2020.business.
Income Taxes
Three Months Ended June 30, Three Months Ended June 30,
Dollars in thousandsDollars in thousands20212020Dollars in thousands20222021
Income before income taxesIncome before income taxes$44,824 $1,651 Income before income taxes$51,575 $44,824 
Income tax (benefit) expenseIncome tax (benefit) expense9,756 2,020 Income tax (benefit) expense6,787 9,756 
Effective tax rateEffective tax rate21.8 %122.4 %Effective tax rate13.2 %21.8 %
The Company’s effective income tax rates for the three months ended June 30, 2022 and 2021 were 13.2% and 2020 were 21.8% and 122.4%, respectively.
For the three months ended June 30, 2021,2022, the primary driver of the lower tax rate is duea $4.8 million benefit related to mix of income impacted by the COVID-19 pandemic.
For the three months ended June 30, 2020, the primary drivers of the higherexcess tax rate were lower income impacted by the COVID-19 pandemic, in addition to a $3.4 million valuation allowance on certain foreign deferred tax assets.benefit from stock compensation.
The effective tax rate may vary from period to period depending on, among other factors, the geographic and business mix of taxable earnings and losses, tax planning and settlements with various taxing authorities. We consider these factors and others, including the Company's history of generating taxable earnings, in assessing our ability to realize tax assets on a quarterly basis.
Six Months Ended June 30, 2022 as Compared to Six Months Ended June 30, 2021
Revenues and Gross Margin
For the six months ended June 30, 2022, total revenues increased by $24.4 million to $774.5 million from $750.1 million for the same period in 2021, inclusive of an unfavorableforeign currency impact of $14.9 million on revenues. Domestic revenues increased by $24.7 million, or 4.7%, to $550.7 million and were 71.1% of total revenues for the six months ended June 30, 2022. International revenues decreased by $0.3 million, or 0.1% to $223.8 million for the six months ended June 30, 2022 compared to $224.1 million during the same period in the prior year.
In the CSS segment, revenues were $505.2 million, which was an increase of $7.1 million, or 1.4% from the prior-year period, inclusive of a $13.4 million unfavorable foreign currency impact on revenue. The Neurosurgery portfolio grew low single digits primarily due to sales in neuromonitoring and CSF management. Sales in our instruments portfolio increased low single digits as compared to the same period in the prior year.
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In the TT segment, revenues were $269.3 million, which was a increase of $17.3 million, or 6.9% from the prior-year period, inclusive of a $1.5 million unfavorable foreign currency impact on revenue. Sales in our Wound Reconstruction business increased low single digits, led by Integra® Dermal Matrices and SurgiMend®. Sales in our Private Label business increased low double digits driven by higher customer demand and favorable order timing.
Gross Margin
Gross margin was $483.5 million for the six months ended June 30, 2022, an increase of $30.5 million from $453.0 million for the same period last year. Gross margin as a percentage of total revenue increased to 62.4% for the six months ended June 30, 2022 from 60.4% in the same period last year. The increase in gross margin percentage was due to higher revenues and a reduction of inventory step-up amortization in connection with the acquisition of ACell in the prior year.
Operating Expenses
The following is a summary of operating expenses as a percent of total revenues:
 Six Months Ended June 30,
 20222021
Research and development6.4 %5.7 %
Selling, general and administrative41.4 %42.6 %
Intangible asset amortization0.9 %1.2 %
Total operating expenses48.7 %49.5 %
Total operating expenses, which consist of selling, general and administrative expenses, research and development expenses, and amortization expenses, increased by $7.0 million, or 1.9% to $377.4 million in the six months ended June 30, 2022, compared to $370.4 million in the same period in 2021.
The Company continues to prioritize its operating costs to increase organic investments that will drive long-term growth including the support of new product development and introductions, clinical studies, geographic expansion and targeted U.S. sales channel expansion.
Research and Development
Research and development expenses for the six months ended June 30, 2022 increased by $7.2 million as compared to the same period in the prior year. This increase in spending resulted from additional spending on new product development, clinical studies and additional spending due to the EU MDR compliance.
Selling, General and Administrative
Selling, general and administrative costs increased by $1.4 million as compared to the same period in the prior year driven primarily due to higher spending, including selling costs on commissions, investment in sales force expansion, and higher spend for key growth initiatives, offset by lower employee related costs, stock-based compensation and acquisition related costs.
Intangible Asset Amortization
Amortization expense (excluding amounts reported in cost of product revenues for technology-based intangible assets) for the six months ended June 30, 2022 was $7.2 million compared to $8.7 million for the same period in prior year.
We expect total annual amortization expense to be approximately $38.4 million for the remainder of 2022, $76.5 million in 2023, $75.8 million in 2024, $75.8 million in 2025, $75.7 million in 2026, $73.7 million in 2027 and $499.8 million thereafter.
Non-Operating Income and Expenses
The following is a summary of non-operating income and expenses:
 Six Months Ended June 30,
Dollars in thousands20222021
Interest income$3,342 $3,512 
Interest expense(23,891)(26,078)
Gain from the sale of business— 42,197 
Other income, net5,408 9,903 
Total non-operating income and expense$(15,141)$29,534 
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Interest Income
Interest income for the six months ended June 30, 2022 decreased by $0.2 million as compared to the same period last year.
Interest Expense
Interest expense for the six months ended June 30, 2022 decreased by $2.2 million as compared to the same period last year primarily from a lower outstanding borrowing on the Senior Secured Credit Facility.
Gain from the sale of business
On January 4, 2021, the Company completed its sale of its Extremity Orthopedics business and recognized a gain of $42.2 million for the six months ended June 30, 2021.
Other Income, net
Other income, net for the six months ended June 30, 2022, increased by $4.5 million compared to the same period in the prior year primarily due to lower income associated with the transition services agreement from the divestiture of the Extremity Orthopedics business.
Income Taxes
 Six Months Ended June 30,
Dollars in thousands20222021
Income before income taxes$90,890 $112,102 
Income tax (benefit) expense13,201 31,640 
Effective tax rate14.5 %28.2 %
The Company’s effective income tax rates for the six months ended June 30, 2022 and 2021 were 14.5% and 28.2%, respectively.
For the six months ended June 30, 2022, the primary driver of the tax rate is a $5.7 million benefit related to excess tax benefits from stock compensation. For the six months ended June 30, 2021, the primary driver of the higher tax rate is the tax impact of the gain on sale of the Extremity Orthopedics business,which closed during the first quarter of 2021.
The effective tax rate may vary from period to period depending on, among other factors, the geographic and business mix of taxable earnings and losses, tax planning and settlements with various taxing authorities. We consider these factors and others, including the Company's history of generating taxable earnings, in assessing our ability to realize tax assets on a quarterly basis.
Additionally, 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. The current U.S. administration has proposed tax reform which, if enacted, would increase the Company’s U.S. federal income tax liability. Further, legislation in foreign jurisdictions may be enacted, in response to the BEPS project begun by the OECD. The OECD recently finalized major reform of the international tax system with respect to a minimum tax rate. Such changes in U.S. and Non-U.S. jurisdictions could have an adverse effect on the Company’s effective tax rate.
While it is often difficult to predict the outcome or the timing of the resolution of a particular matter with the various federal, state, and foreign tax authorities, we believe that our reserves reflect the most probable outcome of known tax contingencies. Settlement of a particular issue would usually require the use of cash. A favorable resolution would be recognized as a reduction to our annual effective tax rate in the year of resolution. The Company's tax reserves are presented in the balance sheet within other liabilities, except for amounts relating to items that we expect to pay in the coming year, which would be classified as current income taxes payable.
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Six Months Ended June 30, 2021 as Compared to Six Months Ended June 30, 2020
Revenues and Gross Margin
For the six months ended June 30, 2021, total revenues increased by $137.1 million to $750.1 million from $613.0 million for the same period in 2020. Domestic revenues increased by $97.3 million, or 23%, to $526.0 million and were 70% of total revenues for the six months ended June 30, 2021. International revenues increased by $39.8 million, or 22% to $224.1 million for the six months ended June 30, 2021 compared to $184.3 million during the same period in the prior year. The net increase of $137.1 million was a result of the recovery experienced from the COVID-19 pandemic across all franchises compared to the prior year due to rebound in surgical procedure volumes. Foreign exchange fluctuations had a favorable impact of $11.9 million on revenues for the year.
Codman Specialty Surgical revenues were $498.1 million, an increase of $96.9 million, or 24.1% from the prior-year period. The Neurosurgery and Instrument portfolios increased high-double digits as a result of the recovery experienced from the COVID-19 pandemic.
Tissue Technologies revenues were $252.0 million, an increase of $40.2 million, or 19.0% from the prior-year period. The Wound Reconstruction and Private Label portfolios increased high-double digits as a result of the recovery experienced from the COVID-19 pandemic. Additionally, our TT segment revenue reflect the acquisition of ACell Inc. which was completed on January 20, 2021 and the sale of the Company's Extremity Orthopedics product portfolio which occurred on January 4, 2021.
Gross Margin
Gross margin was $453.0 million for the six-month period ended June 30, 2021, an increase of $78.9 million from $374.0 million for the same period last year. Gross margin as a percentage of total revenue decreased to 60.4% for the six months ended June 30, 2021 from 61.0% in the same period last year. The decrease in gross margin percentage was due to increased amortization associated with technology-based intangible assets and inventory step-up amortization in connection with the ACell Inc. acquisition.
Operating Expenses
The following is a summary of operating expenses as a percent of total revenues:
 Six Months Ended June 30,
 20212020
Research and development5.7 %5.8 %
Selling, general and administrative42.6 %46.0 %
Intangible asset amortization1.2 %2.5 %
Total operating expenses49.5 %54.3 %
Total operating expenses, which consist of selling, general and administrative expenses, research and development expenses, IPR&D expense and amortization expenses, increased by $37.6 million, or 11.3% to $370.4 million in the six months ended June 30, 2021, compared to $332.9 million in the same period in 2020.
Selling, General and Administrative
Selling, general and administrative costs increased by $37.1 million as compared to the same period in the prior year driven primarily due to costs associated with higher employee related costs, higher incentive and stock-based compensation, increased variable selling costs, as well as increased outside spending as revenue recovered.
Intangible Asset Amortization
Amortization expense (excluding amounts reported in cost of product revenues for technology-based intangible assets) for the six months ended June 30, 2021 was $8.7 million compared to $15.1 million for the same period in prior year primarily due to a reduction in amortization expense associated with intangible assets sold in conjunction with the sale of the Extremity and Orthopedics business during the current year and accelerated amortization expense associated with an intangible asset recorded in the prior year.
We expect total annual amortization expense to be approximately $40.6 million for the remainder of 2021, $79.1 million in 2022, $78.4 million in 2023, $77.7 million in 2024, $77.7 million in 2025, $77.5 million in 2026 and $585.7 million thereafter.
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Non-Operating Income and Expenses
The following is a summary of non-operating income and expenses:
 Six Months Ended June 30,
Dollars in thousands20212020
Interest income$3,512 $4,851 
Interest expense(26,078)(33,434)
Gain from the sale of business42,197 — 
Other income, net9,903 493 
Total non-operating income and expense$29,534 $(28,090)
Interest Income
Interest income for the six months ended June 30, 2021 decreased by $1.3 million as compared to the same period last year primarily due to the settlement of cross-currency swaps designated as net investment hedges during Q4 2020.
Interest Expense
Interest expense for the six months ended June 30, 2021 decreased by $7.4 million as compared to the same period last year primarily due to the elimination of the non-cash interest expense as the result of the adoption ASU 2020-06 and the expenses associated with Amended and Restated Senior Credit Agreement which occurred in the prior period. See Note 1. Basis of Presentation for details in relation to the adoption of ASU 2020-06.
Gain from the sale of business
On January 4, 2021, the Company completed its sale of its Extremity Orthopedics business and recognized a gain of $42.2 million in the first quarter of the current year.
Other Income, net
Other income, net for the six months ended June 30, 2021, increased by $9.4 million primarily due to income associated with the transition services agreement with Smith and Nephew and higher income from additional cross currency swaps that were entered into during Q4 2020.
Income Taxes
 Six Months Ended June 30,
Dollars in thousands20212020
Income before income taxes$112,102 $13,093 
Income tax (benefit) expense31,640 4,282 
Effective tax rate28.2 %32.7 %
The Company’s effective income tax rates for the six months ended June 30, 2021 and 2020 were 28.2% and 32.7%, respectively.
For the six months ended June 30, 2021, the primary drivers of the lower tax rate was mix of income in lower-taxed jurisdictions, offset by the tax impact of the gain on sale of its Extremity Orthopedics business which was completed during the first quarter of 2021. For the six months ended June 30, 2020, the primary drivers of the higher tax rate were lower book income in lower-taxed jurisdictions and a $3.4 million valuation allowance on certain foreign deferred tax assets, as the Company determined that it is no longer more likely than not that these foreign deferred tax assets would be realized due to the adverse impact of the COVID-19 pandemic in certain jurisdictions.
The Company expects its effective income tax rate for the full year to be approximately 24.8%, driven primarily by the jurisdictional mix of income and the tax impact of the gain from the sale of its Extremity Orthopedic business, which closed during the first quarter.
The effective tax rate may vary from period to period depending on, among other factors, the geographic and business mix of taxable earnings and losses, tax planning and settlements with various taxing authorities. We consider these factors and others, including the Company's history of generating taxable earnings, in assessing our ability to realize tax assets on a quarterly basis.
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While it is often difficult to predict the outcome or the timing of the resolution of a particular matter with the various federal, state, and foreign tax authorities, we believe that our reserves reflect the most probable outcome of known tax contingencies. Settlement of a particular issue would usually require the use of cash. Favorable resolution would be recognized as a reduction to our annual effective tax rate in the year of resolution. The tax reserves are presented in the balance sheet within other liabilities, except for amounts relating to items we expect to pay in the coming year, which would be classified as current income taxes payable.
GEOGRAPHIC PRODUCT REVENUES AND OPERATIONS
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,Three Months Ended June 30,Six Months Ended June 30,
Dollars in thousandsDollars in thousands2021202020212020Dollars in thousands2022202120222021
United StatesUnited States$278,186 $181,850 $525,979 $428,702 United States$287,347 $278,186 $550,698 $525,979 
EuropeEurope48,437 32,026 94,256 77,922 Europe46,862 48,437 90,606 94,256 
Asia PacificAsia Pacific44,306 33,501 91,601 73,461 Asia Pacific43,365 44,306 91,082 91,601 
Rest of WorldRest of World19,063 11,288 38,227 32,904 Rest of World20,241 19,063 42,067 38,227 
Total RevenuesTotal Revenues$389,992 $258,665 $750,063 $612,989 Total Revenues$397,815 $389,992 $774,453 $750,063 
The Company generates significant revenues outside the U.S., a portion of which are U.S. dollar-denominated transactions conducted with customers that generate revenue in currencies other than the U.S. dollar. As a result, currency fluctuations between the U.S. dollar and the currencies in which those customers do business could have an impact on the demand for the Company's products in foreign countries. Local economic conditions, regulatory compliance or political considerations, the effectiveness of our sales representatives and distributors, local competition and changes in local medical practice all may combine to affect our sales into markets outside the U.S.
Domestic revenues increased by $96.3$9.2 million for the three months ended June 30, 20212022 compared to the same period last year. European sales increaseddecreased by $16.4$1.6 million for the three months ended June 30, 20212022 compared to the same period last year. Sales to customers in Asia Pacific increaseddecreased by $10.8$0.9 million for the three months ended June 30, 2021.2022. The Rest of the World for the three months ended June 30, 20212022 increased by $7.8$1.2 million compared to the same period last year. The increaseinternational revenues were impacted by a $10.3 million unfavorable foreign exchange impact. Sales in revenues globally were primarily as a result of the recovery experienced from the COVID-19 pandemic across all franchises comparedJapan, China, Canada and Europe continue to the prior year due to rebound in surgical procedure volumes.drive international growth.
Domestic revenues increased by $97.3$24.7 million for the six months ended June 30, 20212022 compared to the same period last year. European sales increaseddecreased by $16.3$3.7 million for the six months ended June 30, 20212022 compared to the same period last year. Sales to customers in Asia Pacific increaseddecreased by $18.1$0.5 million for the six months ended June 30, 2021.2022. The Rest of the World for the six months ended June 30, 20212022 increased by $5.3$3.8 million compared to the same period last year. The increaseinternational revenues were impacted by a $14.9 million unfavorable foreign exchange impact. Sales in revenues globally were primarily as a result of the recovery experienced from the COVID-19 pandemic across all franchises comparedJapan, China, Canada and Europe continue to the prior year due to rebound in surgical procedure volumes.drive international growth.
LIQUIDITY AND CAPITAL RESOURCES
Working Capital
The Company's working capital as of June 30, 20212022 and December 31, 20202021 was $713.6$841.8 million and $836.2$813.7 million, respectively. Working capital consists of total current assets less total current liabilities as presented in the consolidated balance sheets.
Cash and Marketable Securities
The Company had cash and cash equivalents totaling approximately $397.4$447.2 million and $470.2$513.4 million at June 30, 20212022 and December 31, 20202021 respectively, which are valued based on Level 1 measurements in the fair value hierarchy. At June 30, 2021,2022, our non-U.S. subsidiaries held approximately $290.8$302.6 million of cash and cash equivalents that are available for use outside the U.S. The Company asserts that it has the ability and intends to indefinitely reinvest the undistributed earnings from its foreign operations unless there is no material tax cost to remit the earnings into the U.S. The Company does not anticipate the need to repatriate earnings from foreign subsidiaries as a result of the impact of the COVID-19 pandemic.
Cash Flows
 Six Months Ended June 30,
Dollars in thousands20222021
Net cash provided by operating activities$110,822 $160,371 
Net cash used in investing activities(18,565)(125,483)
Net cash used in financing activities(146,612)(100,490)
Effect of exchange rate fluctuations on cash(11,941)(7,150)
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Cash Flows
 Six Months Ended June 30,
Dollars in thousands20212020
Net cash provided by operating activities$160,371 $53,931 
Net cash used in investing activities(125,483)(25,434)
Net cash (used) provided by financing activities(100,490)133,452 
Effect of exchange rate fluctuations on cash(7,150)121 
Cash Flows Provided by Operating Activities
Operating cash flows for the six months ended June 30, 2022 decreased by $49.5 million compared to the same period in 2021. Net income after removing the impact of the gain on sale of business and non-cash adjustments increased for the six months ended June 30, 2022 by approximately $34.4 million as compared to the same period in 2021 primarily due to earnings from higher revenues. The changes in assets and liabilities, net of business acquisitions, decreased cash flows by $46.5 million in 2022 as compared to the increase of $37.5 million for the same period in 2021. The change in 2022 is mainly attributable to increases in inventory and accounts receivable due to higher revenues and decrease in accrued expenses and other current liabilities due to increased payments processed in the quarter. The changes in 2021 were primarily attributable to a reduction in inventories mainly driven by higher revenues in the first half of 2021, an increase in accounts payables, accrued expenses and other current liabilities partially offset by an increase in accounts receivable due to continued collection efforts.
Operating cash flows for the six months ended June 30, 2021 increased by $106.4 million compared to the same period in 2020. Net income after removing the impact of the gain on sale of business and non-cash adjustments increased for the six months ended June 30, 2021 by approximately $32.9 million as compared to the same period in 2020 primarily due to the revenue recovery in the current year as compared to the height of the COVID-19 pandemic in the first half of the 2020.2020. The changes in assets and liabilities, net of business acquisitions, increased cash flows by $37.5 million in 2021 as compared to the decrease of $36.1 million for the same period in 2020. The increase
Cash Flows Used in 2021 is attributable to a reduction in inventories mainly driven by higher revenues in the first half of 2021, an increase in accounts payables, accrued expenses and other current liabilities partially offset by an increase in accounts receivable due to continued collection efforts.Investing Activities
Operating cash flows forDuring the six months ended June 30, 2020 decreased compared2022, the Company paid $18.7 million for capital expenditures to support operations improvement initiatives at a number of our manufacturing facilities and other information technology investments as well as the final $4.7 million payment related to the same period in 2019. Net income after non-cash adjustments decreasedfinal developmental milestone for the six months ended June 30, 2020 by approximately $37.7 million compared to the same period in 2019 primarily due to adverse effects of the COVID-19 pandemic. The changes in assets and liabilities, net of business acquisitions, decreased cash flows from operating activities by $36.1 million for the six months ended June 30, 2020 compared to a decrease of $49.8 million for the same period in 2019. The decrease in 2020 is attributable to an increase in inventory to ensure an adequate safety stock of select products as surgical procedures continue to recover from levels experienced in the second quarter. In addition, decreases were also driven by reduced payablesRebound Therapeutics Corporation. This was partially offset by decreases in accounts receivable due to lower revenue and continued collection efforts.
Cash Flows Used in Investing Activities$4.9 million proceeds on cross-currency swaps designated as net investment hedge.
During the six months ended June 30, 2021, we paid a net cash amount of $303.9 million in relation to the acquisition of ACell Inc. and received net proceeds of $191.7 million for the sale of the Extremity Orthopedics business. The Company also paid for $13.3 million capital expenditures to support operations improvement initiatives at a number of our manufacturing facilities and other information technology investments.
DuringCash Flows Used in Financing Activities
Uses of cash from financing activities in the six months ended June 30, 2020,2022 related to the repurchase of treasury stock of $125.0 million under the 2022 accelerated share repurchase agreement. In addition, the Company had $23.2 million in cash taxes paid $23.7 million for capital expenditures, mostnet equity settlements as a result of which were directed to our facilities located in Mansfield, MA, Boston, MA, Memphis, TN, and Princeton, NJ.
Cash Flows Used in Financing Activitiesthe departure of the former chief executive officer of the Company.
Uses of cash from financing activities in the six months ended June 30, 2021 were repayments of $102.2 million under our Senior Credit Facility and Securitization Facility. In addition, the Company had $3.8 million in cash taxes paid in net equity settlement. These uses were offset by $3.6 million proceeds from the exercise of stock options and $2.2 million borrowings under our Securitization Facility.
Sources of cash from financing activities in the six months ended June 30, 2020 were $515.3 million proceeds from the issuance of Convertible Senior Notes including the call and warrant transactions, $127.7 million borrowing under our Senior Credit Facility and Securitization Facility. These were offset by repayments of $388.5 million on the revolving portion of our Senior Credit Facility and Securitization Facility, $20.3 million debt issuance costs related to the Amended and Restated Senior Credit Agreement and the issuance of Convertible Senior Notes and $100.0 million purchases of treasury stock.
Amended and Restated Senior Credit Agreement, Convertible Senior Notes, Securitization and Related Hedging Activities
See Note 6,7, Debt, to the current period’s condensed consolidated financial statementsNotes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for a discussion of our Amended and Restated Senior Credit Agreement, Convertible Seniorthe 2025 Notes and Securitization Facility and Note 7,8, Derivative Instruments, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for discussion of our hedging activities. We are forecasting that sales and earnings for the next twelve months sales and earnings will be sufficient to remain in compliance with our financial covenants under the terms of the February 2020 Amendment and July 2020 Amendment to the Senior Credit Facility.
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Share Repurchase Plan
On December 7, 2020,April 26, 2022, the Board of Directors authorized the Company to repurchase up to $225$225.0 million of the Company’s common stock. The program allows the Company to repurchase its shares opportunistically from time to time. The repurchase authorization expires in December 2022. The Company has2024. This stock repurchase authorization replaces the previous $225 million remaining understock repurchase authorization, of which $100 million remained authorized at the share repurchasetime of its Common Stock. The pricereplacement, and timing of any future purchases under the share repurchase program will dependwhich was otherwise set to expire on factors such as levels of cash generation from operations, the volume of stock option exercises by employees, cash requirements for acquisitions, dividends, economic and market conditions and stock price.
During the year ended December 31, 2020, the Company repurchased 2.1 million shares of Integra’s common stock as2022. Purchases may be affected through one or more open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, or a part of our previous share repurchase authorization. The Company utilized $100.0 million of net proceeds from the offeringcombination of the Convertible Senior Notes to execute the share repurchase transactions. This included $7.6 million from certain purchasers of the convertible notes in conjunction with the closing of the offering. foregoing
On February 5, 2020,January 12, 2022, the Company entered into a $92.4$125.0 million accelerated share repurchase ("2022 ASR") to completeand received 1.48 million shares of the remaining $100.0 million of share repurchase. The Company received 1.3 million shares through the ASR,common stock at inception, which represented approximately 80% of the expected total shares. On March 24, 2022, the early exercise provision was exercised by 2022 ASR counterparty. Upon settlement of the ASR in June 2020,on March 24, 2022, the Company received an additional 0.60.46 million shares determined using the volume-weighted average price of the Company's common stock during the term of the transaction.2022 ASR.
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See Note 12, Treasury Stock of the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for further details.
Dividend Policy
The Company hasWe have not paid any cash dividends on our common stock since our formation. Our Senior Credit Facility limits the amount of dividends that we may pay. Any future determinations to pay cash dividends on our common stock will be at the discretion of the Board and will depend upon our financial condition, results of operations, cash flows and other factors deemed relevant by the Board.
Capital Resources
We believe that our cash and available borrowings under the Senior Credit Facility are sufficient to finance our operations and capital expenditures for the foreseeable future. Our future capital requirements will depend on many factors, including the growth of our business, the timing and introduction of new products and investments, strategic plans and acquisitions, among others. Additional sources of liquidity available to us include short term borrowings and the issuance of long term debt and equity securities.
Off-Balance Sheet Arrangements
We do not have any off–balance sheet financing arrangements during the six months ended June 30, 20212022 that have or are reasonably likely to have, a current or future effect on our financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures or capital resources that are material to our interests.
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Contractual Obligations and Commitments
As of June 30, 2021, the Company is obligatedWe will continue to have cash requirements to support seasonal working capital needs and capital expenditures, to pay the following amounts under various agreements:
Payments Due by Calendar Year
Dollars in millionsTotalRemaining 20212022-20232024-2025Thereafter
Revolving Credit Facility (1)$8.8 $— $— $8.8 $— 
Term Loan866.3 22.5 106.9 736.9 — 
Securitization Facility (1)112.5 — — 112.5 — 
Convertible Debt (4)575.0 — — 575.0 — 
Interest (2)40.8 6.3 23.3 11.2 — 
Employment Agreements (3)0.5 0.5 — — — 
Operating Leases146.0 8.1 31.4 22.9 83.6 
Purchase Obligations4.4 1.1 3.3 — — 
Other3.6 0.4 1.1 2.1 — 
Total$1,757.9 $38.9 $166.0 $1,469.4 $83.6 
interest, to service debt, and to fund acquisitions. As part of our ongoing operations, we enter into contractual arrangements that obligate us to make future cash payments.
(1)Our primary obligations include principal and interest payments on revolving portion and The Company may borrow and make payments against the revolving credit portion of its Senior Credit Facility and Securitization Facility from time to time and considers all of the outstanding amounts to be long term based on its current intent and ability to repay the borrowing outside of the next twelve-month period.
(2) Interest is calculated on the term loan portionTerm Loan component of the Senior Credit Facility, based on LIBOR plus the spread paid by the Company. As the revolving credit facility and Securitization Facility can be repaid at any time, no interest has been included in the calculation.
(3) Amounts shown under Employment Agreements do not include compensation resulting from a change in control.
(4) On February 4, 2020, the Company issued $575.0 million aggregate principal amount of its of 0.5%and Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes will mature on August 15, 2025 and bear interest at a rate of 0.5% per annum payable semi-annually in arrears, unless earlier converted, repurchased or redeemed in accordance with the terms of the Notes.Securities. See Note 6,7, Debt, to the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details. The Company also leases some of our manufacturing facilities and office buildings which have future minimum lease payments associated. See Note 11, Leases and Related Party Leasesto the details onNotes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for a schedule of our future minimum lease payments. Amounts related to the 2025 Notes.Company's other obligations, including employment agreements and purchase obligations were not material.
The Company has excluded its contingent consideration obligation related to prior and current year acquisitions from the contractual obligations table above; this liability had a total estimated fair value of $38.5 million at June 30, 2021. This liability has been excluded because the amount to be paid or the potential payment date is not fixed.
The Company has excluded itsand future pension contribution obligations fromobligations. See Note 10, Defined Benefit Plans and Note 17, Commitments and Contingenciesto the table above. This has been excluded because the future amountsNotes to be paid and the potential payment datesConsolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details. The associated obligations are not fixed.
The Company also has excluded thea liability for uncertain tax benefits fromincluding interest and penalties. See Note 13, Income Taxesto the contractual obligations table above, including iNotes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for details. nterest and penalties, totaling $0.8 million at June 30, 2021. This liability for uncertain tax benefits has been excluded because weThe Company cannot make a reliable estimate of the period in which the uncertain tax benefits may be realized.
Employee Termination Benefits
The Company incurred restructuring costs related to employee terminations associated with a plant closure and with future outsourcing plans for select transactional back office activities in the consolidated statement of operations for the six months ended June 30, 2022. Restructuring costs were included in accrued expenses and other current liabilities in the consolidated balance sheet for the six months ended June 30, 2022 and year ended December 31, 2021. See Note 1, Basis of Presentation of the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for additional details.
OTHER MATTERS
Critical Accounting Estimates
The critical accounting estimates included in the Company's Annual Report on Form 10-K for the fiscal year ended December 31, 20202021 have not materially changed.
Recently Issued Accounting Standards
Information regarding new accounting pronouncements is included in Note 1, - Basis of Presentation to the current period’s condensed consolidated financial statements.
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ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
We are exposed to various market risks, including changes in foreign currency exchange rates and interest rates that could adversely affect our results of operations and financial condition. To manage the volatility relating to these typical business exposures, we may enter into various derivative transactions when appropriate. We do not hold or issue derivative instruments for trading or other speculative purposes.
Foreign Currency Exchange and Other Rate Risks
We operate on a global basis and are exposed to the risk that changes in foreign currency exchange rates could adversely affect our financial condition, results of operations and cash flows. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and net assets denominated in Euros, ("EUR"), British pounds, ("GBP"), Swiss francs, ("CHF"), Canadian dollars, Japanese yen, Mexican pesos, Brazilian reais, Australian dollars and Chinese yuan. We manage the foreign currency exposure centrally, on a combined basis, which allows us to net exposures and to take advantage of any natural offsets. To mitigate the impact of currency fluctuations on transactions denominated in nonfunctional currencies, we periodically enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. We temporarily record realized and unrealized gains and losses on these contracts that qualify as cash flow hedges in other comprehensive income, and then recognize them in other income or expense when the hedged item affects net earnings.
From time to time, we enter into foreign currency forward exchange contracts to manage currency exposures for transactions denominated in a currency other than an entity’s functional currency. As a result, the impact of foreign currency gains/losses recognized in earnings are partially offset by gains/losses on the related foreign currency forward exchange contracts in the same reporting period. Refer to Note 7,8, Derivative Instrumentsof the Notes to Consolidated Financial Statements (Part I, Item 1 of this Form 10-Q) for further information.
We maintain written policies and procedures governing our risk management activities. With respect to derivatives, changes in hedged items are generally expected to be completely offset by changes in the fair value of hedge instruments. Consequently, foreign currency exchange contracts would not subject us to material risk due to exchange rate movements, because gains and losses on these contracts offset gains and losses on the assets, liabilities or transactions being hedged.
The results of operations discussed herein have not been materially affected by inflation.
Interest Rate Risk
Cash and Cash Equivalents - We are exposed to the risk of interest rate fluctuations on the interest income earned on our cash and cash equivalents. A hypothetical 100 basis points movement in interest rates applicable to our cash and cash equivalents outstanding at June 30, 20212022 would increase interest income by approximately $4.0$4.5 million on an annual basis. No significant decrease in interest income would be expected as our cash balances are earning interest at rates of approximately one basis point. We are subject to foreign currency exchange risk with respect to cash balances maintained in foreign currencies.
Debt - Our interest rate risk relates primarily to U.S. dollar LIBOR-indexed borrowings. We use interest rate swap derivative instruments to manage our earnings and cash flow exposure to changes in interest rates. These interest rate swaps fix the interest rate on a portion of our expected LIBOR-indexed floating-rate borrowings. These interest rate swaps were designated as cash flow hedges as of March 31, 2021.June 30, 2022. The total notional amounts related to the Company’s interest rate swaps were $1.8 billion with $875.0 million effective as of June 30, 2021.2022. Based on our outstanding borrowings at June 30, 2021,2022, a 100 basis points change in interest rates would have impacted interest expense on the unhedged portion of the debt by $1.1 million on an annualized basis.Seebasis. See Note 7,8, Derivative Instruments, for the details of interest rate swaps.
ITEM 4. CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
The Company maintains disclosure controls and procedures that are designed to provide reasonable assurance that information required to be disclosed in our Exchange Act report is recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commission’sSEC’s rules and forms and that such information is accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate, to allow timely decisions regarding required disclosure. Disclosure controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, and management is required to apply its judgment in evaluating the cost-benefit relationship of possible controls and procedures. Management has designed our disclosure controls and procedures to provide reasonable assurance of achieving the desired control objectives.
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As required by Exchange Act Rule 13a-15(b), the Company has carried out an evaluation, under the supervision and with the participation of our management, including our principal executive officer and principal financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures as of June 30, 2021.2022. Based upon this evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective as of June 30, 20212022 to provide such reasonable assurance.
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Changes in Internal Control Over Financial Reporting
There were no changes in our internal control over financial reporting (as defined in Rule 13a-15(f) under the Exchange Act) that occurred during the quarter ended June 30, 20212022 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
In response to business integration activities, the Company has and will continue to further align and streamline the design and operation of the financial control environment to be responsive to the changing business model.
PART II. OTHER INFORMATION
ITEM 1. LEGAL PROCEEDINGS
Information pertaining to legal proceedings can be found in Note 16.17, Commitment and Contingencies.
ITEM 1A. RISK FACTORS
There have been no material changes in the Company's risk factors included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2020 2021and subsequent periodic reports filed with the Securities and Exchange Commission pursuant to the Securities Exchange Act of 1934, as amended.amended (the "Exchange Act").
ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS
Information pertaining to our common stock under the repurchase program can be found in Note 11. Treasury Stock.Not applicable.
ITEM 4. MINE SAFETY DISCLOSURES
Not applicable.
ITEM 5. OTHER INFORMATION
Not applicable.
ITEM 6. EXHIBITS
Reference is hereby made to the Exhibit Index on page 49.


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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
INTEGRA LIFESCIENCES HOLDINGS CORPORATION
Date:July 29, 2021/s/ Peter J. Arduini
Peter J. Arduini
President and Chief Executive Officer
(Principal Executive Officer)
Date:July 29, 2021/s/ Carrie L. Anderson
Carrie L. Anderson
Executive Vice President, Chief Financial Officer, and Treasurer
(Principal Financial Officer)
Date:July 29, 2021/s/ Jeffrey A. Mosebrook
Jeffrey A. Mosebrook
Senior Vice President, Finance
(Principal Accounting Officer)

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Exhibits
*10.1
Amendment No. 3 to Receivables Financing Agreement and Reaffirmation of Performance Guaranty, dated as of May 28, 2021, by and among, Integra Receivables LLC, Integra LifeSciences Sales LLC, as Servicer, PNC Bank, National Associations, as Administrative Agent, PNC Capital Markets LLC, as Structuring Agent, Committed Lender and Group Agent, and certain lenders and group agents that are parties thereto from time to time; Amendment No. 2 to Receivables Financing Agreement and Reaffirmation of Performance Guaranty, dated as of July 17, 2020, and Amendment No. 1 to Receivables Financing Agreement and Reaffirmation of Performance Guaranty, dated as of March 29, 2019, in each case by and among, Integra Receivables LLC, Integra LifeSciences Sales LLC, as Servicer, PNC Bank, National Associations, as Administrative Agent, Committed Lender and Group Agent, Mizuho Bank, Ltd., as Committed Lender and Group Agent and PNC Capital Markets LLC, as Structuring Agent, and certain lenders and group agents that are parties thereto from time to time.
*31.1 
*31.2 
*32.1 
*32.2 
*†101.INS XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
*†101.SCH XBRL Taxonomy Extension Schema Document
*†101.CAL XBRL Taxonomy Extension Calculation Linkbase Document
*†101.DEF XBRL Definition Linkbase Document
*†101.LAB XBRL Taxonomy Extension Labels Linkbase Document
*†101.PRE XBRL Taxonomy Extension Presentation Linkbase Document
104Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)
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*Filed herewith
#Indicates a management contract or compensatory plan or arrangement.
The financial information of Integra LifeSciences Holdings Corporation Quarterly Report on Form 10-Q for the quarter ended June 30, 2022 filed on July 27, 2022 formatted in XBRL (Extensible Business Reporting Language): (i) the Condensed Consolidated Statements of Operations and Comprehensive Income, (ii) the Condensed Consolidated Balance Sheets, (iii) Parenthetical Data to the Condensed Consolidated Balance Sheets, (iv) the Condensed Consolidated Statements of Cash Flows, and (v) Notes to Condensed Consolidated Financial Statements, is furnished electronically herewith.
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
INTEGRA LIFESCIENCES HOLDINGS CORPORATION
Date:July 27, 2022/s/ Jan De Witte
Jan De Witte
President and Chief Executive Officer
(Principal Executive Officer)
Date:July 27, 2022/s/ Carrie L. Anderson
Carrie L. Anderson
Executive Vice President and Chief Financial Officer
(Principal Financial Officer)
Date:July 27, 2022/s/ Jeffrey A. Mosebrook
Jeffrey A. Mosebrook
Senior Vice President, Finance
(Principal Accounting Officer)

† The financial information of Integra LifeSciences Holdings Corporation Quarterly Report on Form 10-Q for the quarter ended June 30, 2021 filed on July 29, 2021 formatted in XBRL (Extensible Business Reporting Language): (i) the Condensed Consolidated Statements of Operations and Comprehensive Income, (ii) the Condensed Consolidated Balance Sheets, (iii) Parenthetical Data to the Condensed Consolidated Balance Sheets, (iv) the Condensed Consolidated Statements of Cash Flows, and (v) Notes to Condensed Consolidated Financial Statements, is furnished electronically herewith.




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