Tissue Technologies, Inc.

Revolutionary Solution for Smoother Healing and Significantly Reduced Scar Visibility MARIETTA, Ga., Sept. 27, 2024 /PRNewswire/ -- BRIJ Medical is excited to announce the launch of Brijjit® Scar Therapy, a game-changing solution that allows surgeons to grow their practice and helps patients take proactive control over scar prevention – from the second the incision is closed throughout all of the key stages of wound healing. Tissue Bridge Technology Continue Reading BRIJ Medical Launches Brijjit Scar Therapy - Help Prevent Bad Scars Before They Start Powered by Brijjit® Force Modulating Tissue Bridges, this groundbreaking approach tackles scar formation from the outset, unlike traditional treatments that focus on scars after they form. Brijjit addresses the issue right at the source by relieving tension on the incision immediately after surgery. Proven in a randomized clinical trial with UT Southwestern Medical Center and a study led by Dr. Holly Wall, published in the Aesthetic Surgery Journal, Brijjit has been shown to reduce scar area by 38% and decrease wound breakdown by 90%. By eliminating up to 100% of tension on the incision, Brijjit empowers patients with greater control over their recovery and scar outcomes. "Scarring is a major concern for surgical patients, something I encountered firsthand as a plastic surgeon. It's what inspired the creation of Brijjit," said Dr. Monte Eaves, Founder and Chief Medical Officer of BRIJ Medical. "Brijjit Scar Therapy is a true game changer—helping surgeons achieve better scar outcomes while empowering patients to take an active role in their recovery." As featured in the recent New York Times article, "The Power of a Smaller Breast," there is a growing trend of patients opting for breast reduction surgery, even if it means accepting the potential for scars. Now, surgeons can offer a comprehensive solution that addresses both wound breakdown and scar therapy—all in a single device. Dr. Killeen, the surgeon featured in the article, uses Brijjit devices to Relieve the Tension® on her breast surgeries, including with Cheyenne, the patient featured in the article. Program Details By offering Brijjit Scar Therapy direct to patients, surgeons can improve patient outcomes, grow their practice, and empower patients to take control of their scar healing through every stage of post-surgical recovery. BRIJ Medical now offers a detailed guide with best practices and a step-by-step implementation guide to streamline the integration of Brijjit Scar Therapy into their practice. For more information, visit BRIJmedical.com and discover how the Brijjit Scar Therapy Program is transforming post-surgical care and patient healing. About BRIJ Medical Our flagship product, the Brijjit® Force Modulating Tissue Bridge, is clinically proven in multiple studies, including a randomized clinical trial, to reduce wound breakdown by 90% and reduce scar area by 38%. It eliminates up to 100% of tension on incisions and healing wounds, while also saving surgeons time (up to 9x faster than sutures), and is a cost-effective solution for practices, ASCs and hospitals alike. At BRIJ, we provide enhanced control and confidence at every step of the healing journey. For more information, visit BRIJmedical.com. SOURCE BRIJ Medical WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

PRINCETON, N.J., Oct. 26, 2022 (GLOBE NEWSWIRE) -- Integra LifeSciences Holdings Corporation (NASDAQ: IART), a leading global medical technology company, today reported financial results for the third quarter ending September 30, 2022. Third Quarter 2022 Highlights Third quarter revenues of $385 million decreased 0.4% on a reported basis and increased 3.5% on an organic basis compared to the prior year. Third quarter GAAP earnings per diluted share of $0.60, compared to $0.51 in the prior year; adjusted earnings per diluted share of $0.86, compared to $0.86 in the prior year. The Company completed the sale of its non-core traditional wound care (“TWC”) business at the end of August 2022. The Company is raising its earnings per share outlook to a range of $3.29 to $3.33 and reaffirming its full-year 2022 revenue guidance at the midpoint of its prior guidance with a tightened range of $1,551 million to $1,563 million. The revenue range represents reported growth of 0.5% to 1.3%, inclusive of the divestiture of the TWC business and an updated foreign currency outlook, with organic growth of 3.7% to 4.5%. “We are pleased with our sales performance in the third quarter. Our diverse portfolio continues to deliver solid, profitable growth for our shareholders,” said Jan De Witte, Integra’s president and chief executive officer. “We continue to see strong demand for our products globally and are focused on our execution in achieving our short- and long-term targets.” Third Quarter 2022 Consolidated Performance Total reported revenues of $385.2 million decreased 0.4% on a reported basis and increased 3.5% on an organic basis compared to the prior year. The Company reported GAAP gross margin of 61.5%, compared to 62.7% in the third quarter of 2021. Adjusted gross margin was 66.7%, compared to 68.3% in the prior year. Adjusted EBITDA for the third quarter of 2022 was $105.3 million, or 27.3% of revenue, compared to $104.3 million, or 27.0% of revenue, in the prior year. The Company reported GAAP net income of $49.9 million, or $0.60 per diluted share, in the third quarter of 2022, compared to a GAAP net income of $43.2 million, or $0.51 per diluted share, in the prior year. Adjusted net income for the third quarter of 2022 was $71.7 million, or $0.86 per diluted share, compared to $73.1 million, or $0.86 per diluted share, in the prior year. Third Quarter 2022 Segment Performance Codman Specialty Surgical (~65% of Revenues) Total revenues were $249.8 million, representing reported decline of 2.6% and organic growth of 1.6% compared to the third quarter of 2021, driven by strength in both advanced energy and CSF management partially offset by the impact of the CereLink® recall in neuro monitoring. Tissue Technologies (~35% of Revenues) Total revenues were $135.4 million, representing reported growth of 3.9% and organic growth of 7.2% compared to the third quarter of 2021, driven by sales of Integra skin, amniotics and ACell MicroMatrix®. Key Products and Business Highlights Advancing Key Products Return-to-market plans for the CereLink ICP monitor are progressing, targeting first half of 2023. Third quarter results include a $1.5 million recall returns provision and a $0.8 million rework accrual in cost of goods sold, both of which impacted gross margin. Expanded the CUSA® Clarity portfolio CUSA Clarity extended laparoscopic tip launched in the U.S., bringing the benefits of ultrasonic ablation technology to minimally invasive laparoscopic liver procedures. CUSA single-sided bone tip received 510(k) approval. Commercial launch is expected in the first quarter of 2023. Advanced the science for the Aurora® Surgiscope® with the publication, in Operative Neurosurgery, of the first peer-reviewed journal article. The Aurora Surgiscope is intended for use in neurosurgery and endoscopic neurosurgery and pure neuroendoscopy (i.e., ventriculoscopy) for visualization, diagnostic and/or therapeutic procedures such as ventriculostomies, biopsies and removal of cysts, tumors and other obstructions. Business Highlights Completed the previously announced sale of the non-core 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 included 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. Issued our inaugural Environmental, Social and Governance (ESG) report. The report highlights 2021 performance in key areas such as employee health and safety, diversity and inclusion, community impact, ethics and compliance, and environmental responsibility. The report also includes the company’s ESG strategy and roadmap to long-term sustainability. Appointed two new key executives Harvinder Singh, EVP & President, International, based in Singapore with a focus on setting and executing product-market strategies and building out Integra’s local commercial capabilities in international markets. Mark Jesser, CVP & Chief Digital Officer, based in our Princeton, N.J. headquarters with a focus on partnering with our commercial, strategic marketing and business development teams to define and execute digital proposition strategies that enhance Integra’s device portfolio and its positioning within the digital health ecosystem. Balance Sheet, Cash Flow and Capital Allocation The Company generated cash flow from operations of $68 million in the quarter. Net debt at the end of the quarter was $1.04 billion, and the consolidated total leverage ratio was 2.4x. As of quarter end, the Company had total liquidity of approximately $1.75 billion, including approximately $512 million in cash and the remainder available under the revolving credit facility. 2022 Outlook For the full year 2022, the Company is reaffirming its revenue expectations at the midpoint of its August 2022 guidance with a tightened range of $1,551 million to $1,563 million. The revenue range represents reported growth of 0.5% to 1.3%, inclusive of the divestiture of the TWC business and an updated foreign currency outlook, with organic growth of 3.7% to 4.5%. Our guidance reflects our solid revenue performance through the first 9 months while considering the macro environment, continuing supply constraints, and potential adjustments to the CereLink reserve. Full-year 2022 reported revenue guidance reflects an additional 25 basis points of unfavorable foreign currency impact relative to guidance provided in August 2022. Foreign currency is now expected to unfavorably impact full year reported growth by approximately 250 basis points compared to the prior year due to the continuing strength of the US Dollar. Full year 2022 adjusted EPS guidance is being raised to a range of $3.29 to $3.33, an increase of $0.15 at the mid-point compared to the Company’s August guidance. For the fourth quarter 2022, the Company expects reported revenues in the range of $391 million to $403 million, representing reported growth of -3.5% to -0.6% and organic growth of 1.3% to 4.3%. Adjusted earnings per diluted share is expected to be in a range of $0.87 to $0.91. The Company’s guidance for fourth quarter and full-year organic sales growth excludes acquisitions and divestitures, the effects of foreign currency and the year-over-year change in revenue from discontinued products. Organic growth includes ACell as of January 20, 2022 and excludes sales from the TWC divestiture as of September 1, 2022. Adjusted earnings per share guidance reflects the impact of the divestiture of the TWC business as well as an updated foreign currency outlook. Conference Call and Presentation Available Online Integra has scheduled a conference call for 8:30 a.m. ET on Wednesday, October 26, 2022, to discuss third quarter 2022 financial results, and forward-looking financial guidance. The conference call will be hosted by Integra's senior management team and will be open to all listeners. Additional forward-looking information may be discussed in a question-and-answer session following the call. Integra's management team will reference a presentation during the conference call, which can be found on the Investor section of the website at investor.integralife.com. Access to the live call is available by dialing 866-571-0905 and using the passcode 1121226#. A simultaneous webcast of the call will be available via the Company’s website at >.integralife.com. A webcast replay of the call can be accessed through the Investor Relations homepage of Integra's website at . A replay of the call will be available until November 7, 2022 by dialing 866-583-1035 and using the passcode 1121226#. About Integra Integra LifeSciences is a global leader in regenerative tissue technologies and neurosurgical solutions dedicated to limiting uncertainty for clinicians so they can focus on providing the best patient care. Integra offers a comprehensive portfolio of high quality, leadership brands that include AmnioExcel®, Aurora®, Bactiseal®, BioD™, CerebroFlo®, CereLink® Certas® Plus, Codman®, CUSA®, Cytal®, DuraGen®, DuraSeal®, Gentrix®, ICP Express®, Integra®, Licox® , MAYFIELD®, MediHoney®, MicroFrance®, MicroMatrix®, NeuraGen® , NeuraWrap™ , PriMatrix®, SurgiMend®, TCC-EZ® and VersaTru®. For the latest news and information about Integra and its products, please visit . Forward-Looking Statements This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that involve risks and uncertainties and reflect the Company's judgment as of the date of this release. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements. Some of these forward-looking statements may contain words like “will,” “believe,” “may,” “could,” “would,” “might,” “possible,” “should,” “expect,” “intend,” "forecast," "guidance," “plan,” “anticipate,” "target," or “continue,” the negative of these words, other terms of similar meaning or they may use future dates. Forward-looking statements contained in this news release include, but are not limited to, statements concerning future financial performance, including projections for revenues, expected revenue growth (both reported and organic), GAAP and adjusted net income, GAAP and adjusted earnings per diluted share, non-GAAP adjustments such as divestiture, acquisition and integration-related charges, intangible asset amortization, structural optimization charges, EU Medical Device Regulation-related charges, and income tax expense (benefit) related to non-GAAP adjustments and other items, capital return plans and expectations and plans with respect to strategic initiatives and product development. It is important to note that the Company’s goals and expectations are not predictions of actual performance. Such forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from predicted or expected results. Such risks and uncertainties include, but are not limited, to the following: the impact of COVID-19 (and any subsequent variants) and its effects on our employees, customers, patients, suppliers and distributors, including the economic impacts of the various recommendations, orders and protocols issued by governmental agencies and other regulatory bodies (including any periodic reimplementation of preventative measures in various global locations) in response to the continual evolution of the pandemic; macroeconomic conditions, including inflation, disruptions to the global supply chain, fluctuations in currency exchange rates, weakness in general economic conditions and recessions; the Company's ability to execute its operating plan effectively; the Company’s ability to successfully integrate acquired businesses; the Company’s ability to achieve sales growth in a timely fashion and execute on its channel reorganization in its Tissue Technologies segment; the Company's ability to manufacture and ship sufficient quantities of its products to meet its customers' demands; the ability of third-party suppliers to supply us with raw materials and finished products; global macroeconomic and political conditions; the Company's ability to manage its direct sales channels effectively; the sales performance of third-party distributors on whom the Company relies to generate revenue for certain products and geographic regions; the Company's ability to access and maintain relationships with customers of acquired entities and businesses; physicians' willingness to adopt and third-party payors' willingness to provide or maintain reimbursement for the Company's recently launched, planned and existing products; initiatives launched by the Company's competitors; downward pricing pressures from customers; the Company's ability to secure regulatory approval for products in development; the Company's ability to remediate quality systems violations; fluctuations in hospitals' spending for capital equipment; the Company's ability to comply with and obtain approvals for products of human origin and comply with regulations regarding products containing materials derived from animal sources; difficulties in controlling expenses, including costs to procure and manufacture our products; the impact of changes in management or staff levels; the impact of goodwill and intangible asset impairment charges if future operating results of acquired businesses are significantly less than the results anticipated at the time of the acquisitions, the Company's ability to leverage its existing selling organizations and administrative infrastructure; the Company's ability to increase product sales and gross margins, and control non-product costs; the Company’s ability to achieve anticipated growth rates, margins and scale and execute its strategy generally; the amount and timing of divestiture, acquisition and integration-related costs; the geographic distribution of where the Company generates its taxable income; new U.S. and foreign government laws and regulations, and changes in existing laws, regulations and enforcement guidance, which affect areas of our operations including, but not limited to, those affecting the health care industry, including the EU Medical Devices Regulation; fluctuations in foreign currency exchange rates; the amount of our bank borrowings outstanding and other factors influencing liquidity; and the economic, competitive, governmental, technological, and other risk factors and uncertainties identified under the heading “Risk Factors” included in Item 1A of Integra's Annual Report on Form 10-K for the year ended December 31, 2021 and information contained in subsequent filings with the Securities and Exchange Commission. These forward-looking statements are made only as of the date hereof, and the Company undertakes no obligation to update or revise the forward-looking statements, whether as a result of new information, future events, or otherwise. Discussion of Adjusted Financial Measures In addition to our GAAP results, we provide certain non-GAAP measures, including organic revenues, adjusted earnings before interest, taxes, depreciation and amortization ("EBITDA"), adjusted net income, adjusted earnings per diluted share, free cash flow and adjusted free cash flow conversion. Organic revenues consist of total revenues excluding the effects of currency exchange rates, revenues from current-period acquisitions and product divestitures and discontinuances. Adjusted EBITDA consists of GAAP net income excluding: (i) depreciation and amortization; (ii) other income (expense); (iii) interest income and expense; (iv) income tax expense (benefit); and (v) those operating expenses also excluded from adjusted net income. The measure of adjusted net income consists of GAAP net income, excluding: (i) structural optimization charges; (ii) divestiture, acquisition and integration-related charges; (iii) EU Medical Device Regulation-related charges; (iv) intangible asset amortization expense; and (v) income tax impact from adjustments. The adjusted earnings per diluted share measure is calculated by dividing adjusted net income attributable to diluted shares by diluted weighted average shares outstanding. The measure of free cash flow consists of GAAP net cash provided by operating activities less purchases of property and equipment. Reconciliations of GAAP revenues to organic revenues and GAAP adjusted net income to adjusted EBITDA, and adjusted net income, and GAAP earnings per diluted share to adjusted earnings per diluted share all for the quarters and nine months ended September 30, 2022 and 2021, and the free cash flow and adjusted free cash flow conversion for the quarters and twelve months ended September 30, 2022 and 2021, appear in the financial tables in this release. The Company believes that the presentation of organic revenues and the other non-GAAP measures provide important supplemental information to management and investors regarding financial and business trends relating to the Company's financial condition and results of operations. For further information regarding why Integra believes that these non-GAAP financial measures provide useful information to investors, the specific manner in which management uses these measures, and some of the limitations associated with the use of these measures, please refer to the Company's Current Report on Form 8-K regarding this earnings press release filed today with the Securities and Exchange Commission. This Current Report on Form 8-K is available on the SEC's website at or on our website at . Investor Relations Contact: Chris Ward (609) 772-7736 chris.ward@integralife.com Media Contact: Laurene Isip (609) 208-8121 laurene.isip@integralife.com INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED) (In thousands, except per share amounts) Three Months Ended September 30, 2022 2021 Total revenues, net $ 385,191 $ 386,861 Costs and expenses: Cost of goods sold 148,445 144,468 Research and development 24,736 25,831 Selling, general and administrative 143,820 156,010 Intangible asset amortization 3,141 4,113 Total costs and expenses 320,142 330,422 Operating income 65,049 56,439 Interest income 3,264 1,786 Interest expense (12,809 ) (12,192 ) Gain (loss) from sale of business 644 (230 ) Other income, net 2,648 4,985 Income before income taxes 58,796 50,788 Income tax expense 8,881 7,559 Net income $ 49,915 $ 43,229 Net income per share: Diluted net income per share $ 0.60 $ 0.51 Weighted average common shares outstanding for diluted net income per share 83.399 85,447 The following table presents revenues disaggregated by the major sources for the three months ended September 30, 2022 and 2021 (amounts in thousands): Three Months Ended September 30, 2022 2021 Change Neurosurgery 193,848 199,210 (2.7 )% Instruments 55,948 57,287 (2.3 )% Total Codman Specialty Surgical 249,796 256,497 (2.6 )% Wound Reconstruction and Care 104,625 99,744 4.9 % Private Label 30,770 30,620 0.5 % Total Tissue Technologies 135,395 130,364 3.9 % Total reported revenues 385,191 386,861 (0.4 )% Impact of changes in currency exchange rates 11,786 Less contribution of revenues from acquisitions — — Less contribution of revenues from divested products (180 ) (3,125 ) Less contribution of revenues from discontinued products (2,004 ) (2,149 ) Total organic revenues(1) $ 394,793 $ 381,587 3.5 % (1) Organic revenues have been adjusted to exclude foreign currency (current period), acquisitions and to account for divested and discontinued products. Items included in GAAP net income and location where each item is recorded are as follows: (In thousands) Three Months Ended September 30, 2022 Item Total Amount COGS(a) SG&A(b) R&D(c) Amort.(d) OI&E(e) Tax(f) Acquisition, divestiture and integration-related charges(1) (13,841 ) 177 (12,151 ) (547 ) — (1,320 ) — Structural Optimization charges 10,112 2,765 7,356 (9 ) — — — EU Medical Device Regulation charges 13,208 1,257 5,672 6,279 — — — Intangible asset amortization expense 19,192 16,051 — — 3,141 — — Estimated income tax impact from above adjustments and other items (6,892 ) — — — — — (6,892 ) Depreciation expense 10,275 — — — — — — a) COGS - Cost of goods sold b) SG&A - Selling, general and administrative c) R&D - Research & development d) Amort. - Intangible asset amortization e) OI&E - Other income & expense f) Tax - Income tax expense (benefit) (1) Acquisition, divestiture and integration-related charges are associated with Arkis Biosciences, ACell acquisitions and the divestiture of Extremity Orthopedics and traditional wound care (TWC). Includes banking, legal, consulting, systems, and other income and expenses. Items included in GAAP net income and location where each item is recorded are as follows: (In thousands) Three Months Ended September 30, 2021 Item Total Amount COGS(a) SG&A(b) R&D(c) Amort.(d) OI&E(e) Tax(f) Acquisition, divestiture and integration-related charges(1) 2,637 1,954 2,166 (160 ) — (1,323 ) — Structural Optimization charges 6,719 2,993 2,235 1,492 — — — EU Medical Device Regulation charges 7,077 907 1,985 4,185 — — — Intangible Asset Amortization Expense 20,248 16,135 — — 4,113 — — Estimated income tax impact from above adjustments and other items (6,853 ) — — — — — (6,853 ) Depreciation expense 9,873 — — — — — — a) COGS - Cost of goods sold b) SG&A - Selling, general and administrative c) R&D - Research & development d) Amort. - Intangible asset amortization e) OI&E - Other income & expense f) Tax - Income tax expense (benefit) (1) Acquisition, divestiture and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, Rebound Therapeutics and ACell acquisitions and the divestiture of Extremity Orthopedics and includes banking, legal, consulting, systems, and other income and expenses. RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME TO ADJUSTED EBITDA (UNAUDITED) (In thousands) Three Months Ended September 30, 2022 2021 GAAP net income 49,915 43,229 Non-GAAP adjustments: Depreciation and intangible asset amortization expense 29,467 30,121 Other (income) expense, net (1,972 ) (3,432 ) Interest expense, net 9,545 10,406 Income tax expense 8,881 7,559 Structural optimization charges 10,112 6,719 Acquisition, divestiture and integration-related charges(1) (13,841 ) 2,637 EU Medical Device Regulation charges 13,208 7,077 Total of non-GAAP adjustments 55,400 61,087 Adjusted EBITDA $ 105,315 $ 104,315 (1) Acquisition, divestiture and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, Rebound Therapeutics and ACell acquisitions and the divestiture of Extremity Orthopedics and TWC. Includes banking, legal, consulting, systems, and other income and expenses. RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME TO MEASURES OF ADJUSTED NET INCOME AND ADJUSTED EARNINGS PER SHARE (UNAUDITED) (In thousands, except per share amounts) Three Months Ended September 30, 2022 2021 GAAP net income 49,915 43,229 Non-GAAP adjustments: Structural optimization charges 10,112 6,719 Acquisition, divestiture and integration-related charges(1) (13,841 ) 2,637 EU Medical Device Regulation charges 13,208 7,077 Intangible asset amortization expense 19,192 20,248 Estimated income tax impact from adjustments and other items (6,892 ) (6,853 ) Total of non-GAAP adjustments 21,779 29,828 Adjusted net income $ 71,694 $ 73,058 Adjusted diluted net income per share $ 0.86 $ 0.86 Weighted average common shares outstanding for diluted net income per share 83,399 85,447 (1) Acquisition, divestiture and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, Rebound Therapeutics and ACell acquisitions and the divestiture of Extremity Orthopedics and TWC. Includes banking, legal, consulting, systems, and other income and expenses. CONDENSED BALANCE SHEET DATA (UNAUDITED) (In thousands) September 30, 2022 December 31, 2021 Cash and cash equivalents $ 511,937 $ 513,448 Trade accounts receivable, net 248,268 231,831 Inventories, net 311,060 317,386 Current and long-term borrowing under senior credit facility 870,780 869,257 Borrowings under securitization facility 106,000 112,500 Long-term convertible securities 566,612 564,426 Stockholders' equity $ 1,724,414 $ 1,684,804 CONDENSED STATEMENT OF CASH FLOWS (UNAUDITED) (In thousands) Nine Months Ended September 30, 2022 2021 Net cash provided by operating activities $ 179,135 $ 243,150 Net cash used in investing activities (3,760 ) (133,958 ) Net cash used by financing activities (154,254 ) (98,747 ) Effect of exchange rate changes on cash and cash equivalents (22,632 ) (10,380 ) Net increase (decrease) in cash and cash equivalents $ (1,511 ) $ 65 RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP OPERATING CASH FLOW TO MEASURES OF FREE CASH FLOW AND ADJUSTED FREE CASH FLOW CONVERSION (UNAUDITED) (In thousands) Three Months Ended September 30, 2022 2021 Net cash provided by operating activities $ 68,310 $ 82,778 Purchases of property and equipment $ (9,157 ) $ (7,286 ) Free cash flow 59,153 75,492 Adjusted net income(1) $ 71,694 $ 73,058 Adjusted free cash flow conversion 82.5 % 103.3 % Twelve Months Ended September 30, 2022 2021 Net cash provided by operating activities $ 248,418 $ 323,414 Purchases of property and equipment $ (55,315 ) $ (29,023 ) Free cash flow $ 193,103 $ 294,391 Adjusted net income(1) $ 274,183 $ 270,780 Adjusted free cash flow conversion 70.4 % 108.7 % (1) Adjusted net income for quarters ended September 30, 2022 and 2021 are reconciled above. Adjusted net income for remaining quarters in the trailing twelve months calculation have been previously reconciled and are publicly available in the Quarterly Earnings Call Presentations on our website at investor.integralife.com under Events & Presentations. The Company calculates adjusted free cash flow conversion by dividing its free cash flow by adjusted net income. The Company believes this measure is useful in evaluating the significance of the cash special charges in its adjusted earnings measures.

PRINCETON, N.J., Feb. 18, 2021 (GLOBE NEWSWIRE) -- Integra LifeSciences Holdings Corporation (NASDAQ: IART) today reported financial results for the fourth quarter and full-year ended December 31, 2020, consistent with its preliminary revenue results announced on January 14, 2021. Fourth Quarter 2020 Reported revenues were $388.6 million, representing a decrease of 1.6% on a reported basis and a decrease of 1.5% on an organic basis compared to the fourth quarter 2019. Fourth quarter revenues increased 5.0% compared to the third quarter of 2020. GAAP earnings per diluted share were $1.09, compared to $0.18 in the fourth quarter 2019. Adjusted earnings per diluted share were $0.84, compared to $0.68 in the fourth quarter of 2019. Full-Year 2020 Reported revenues were $1,371.9 million, representing a decrease of 9.6% on a reported basis and a decrease of 8.7% on an organic basis compared to full-year 2019. In the first half of 2020, reported revenues declined 18.0% compared to the prior year, reflecting the impact of the COVID-19 pandemic. Organic revenues declined 16.2% over the same period. In the second half of 2020, reported revenues declined 2.0% compared to the prior year, reflecting a recovery in surgical procedures and strong execution by the Company. Organic revenues declined 1.5% over the same period. GAAP earnings per diluted share were $1.57, compared to $0.58 in 2019. Adjusted earnings per diluted share were $2.45, compared to $2.74 in 2019. During 2020, the COVID-19 pandemic negatively impacted surgical procedure volumes which resulted in lower revenues compared to the prior year. The largest year over year revenue decline rates occurred in April, and surgical procedure volumes recovered over the balance of 2020. In the fourth quarter, the improvement in surgical procedure volumes resulted in five percent sequential revenue growth over the third quarter. Due to local or regional surges of COVID-19, the pace of our sales recovery differed across markets and product lines. "The safety and well-being of our colleagues has remained our number one priority throughout the pandemic, so they could continue to deliver critical, life-saving products to clinicians," said Peter Arduini, Integra's president and chief executive officer. "The revenue and profitability impact from surgical procedural deferrals caused by COVID were most significant in the first half of 2020. The Company's revenue and profitability improved in the second half of the year as procedures recovered. Over the course of 2020, we focused on enhancing our global operations, investing in critical growth programs, and optimizing our product portfolio. These accomplishments and our strong financial position increase our confidence that we will return to growth in 2021." Fourth Quarter 2020 Financial Summary Total reported revenues for the fourth quarter were $388.6 million, a decrease of 1.6% from the fourth quarter of 2019. Fourth quarter organic sales decreased 1.5% over the prior year. The Company reported GAAP net income of $92.7 million, or $1.09 per diluted share, in the fourth quarter of 2020, compared to GAAP net income of $15.3 million, or $0.18 per diluted share, in the prior year. The increase in GAAP net income was driven primarily by a one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property which resulted in the recognition of a deferred tax benefit in the amount of $59.2 million. Adjusted EBITDA for the fourth quarter of 2020 was $102.7 million, compared to $91.6 million in the fourth quarter of the prior year. For the fourth quarter of 2020, adjusted EBITDA as a percentage of revenue was 26.4%, an increase of 320 basis point from the prior year period. Adjusted net income for the fourth quarter of 2020 was $71.3 million, or $0.84 per diluted share, compared to adjusted net income of $58.9 million, or $0.68 per diluted share, in the fourth quarter of 2019. The increase was primarily driven by actions taken by the Company to reduce operating expenses during the pandemic to mitigate the impact of lower sales. Cash flows from operations totaled $80.3 million in the fourth quarter and capital expenditures were $8.4 million. Full-Year 2020 Financial Summary Total reported revenues for the full-year 2020 were $1,371.9 million, a decrease of 9.6%, from the prior year. Organic sales for the full-year 2020 decreased 8.7% compared to 2019. The Company reported GAAP net income of $133.9 million, or $1.57 per diluted share, for the full-year 2020, compared to GAAP net income of $50.2 million, or $0.58 per diluted share in 2019. The increase in GAAP net income was primarily driven by two components. The first is due to a one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property which resulted in the recognition of a deferred tax benefit in the amount of $59.2 million. The second component of the increase to net income in 2020 compared to 2019 resulted from a $64.9 million in-process R&D expense associated with the Rebound Therapeutics acquisition, which occurred during 2019. Excluding these components, net income for the year ended December 31, 2020 declined by $40.4 million compared to the prior year 2019. The decrease was attributable to the impact of the COVID-19 pandemic which resulted in lower revenues, and was partially offset by a decrease in the level of operating expenses due to cost-savings measures implemented by the Company during 2020. Adjusted EBITDA for the full-year 2020 was $334.5 million, a decrease of $34.1 million over the prior year. Despite the year-over-year decrease, adjusted EBITDA as a percentage of revenue for the full-year 2020 increased slightly to 24.4% from 24.3% in 2019. Adjusted net income for the full-year 2020 was $208.7 million, or $2.45 per diluted share, compared to $237.4 million, or $2.74 per diluted share in 2019. The decrease was attributable to lower sales as a result of COVID-19, partially offset by actions taken by the Company to reduce operating expenses during the pandemic. Cash flows from operations totaled $203.8 million for the full-year 2020 and capital expenditures were $38.9 million. Adjusted free cash flow conversion for the trailing twelve months ended December 31, 2020 was 79.0% versus 68.2% for the twelve months ended December 31, 2019. Integra's financial position and liquidity remain strong. As of December 31, 2020, the Company had $470.2 million in cash and cash equivalents, $1.2 billion in undrawn revolver capacity, and a consolidated total leverage ratio of 3.0x. 2021 Financial Guidance The Company is providing forward-looking guidance regarding adjusted earnings per diluted share, but is not providing a reconciliation to GAAP earnings per share, because certain GAAP expense items are highly variable and management is unable to predict them with reasonable certainty and without unreasonable effort. Specifically, the financial impact and timing of divestitures, acquisitions, integrations, structural optimization and efforts to comply with the EU Medical Device Regulation are uncertain, depend on various dynamic factors and are not reasonably ascertainable at this time. These expense items could have a material impact on GAAP results. Adjusted earnings per diluted share also excludes the impact of intangible asset amortization associated with prior business acquisitions, which we expect to be approximately $0.73 per diluted share for the full-year 2021. In addition, the Company will continue to monitor the ongoing uncertainty around the scope and duration of the pandemic and its impact on financial performance. The Company does not expect the ongoing impact of the pandemic to be uniform across all markets and product lines. The Company's guidance assumes a gradual improvement in surgical procedures with no further setbacks from new surges or new COVID variants. For the first quarter 2021, the Company expects reported revenues in the range of $345 million to $355 million, representing reported growth of approximately (3.0%) to 0.0% and organic growth of approximately 0.0% to 3.0%. Adjusted earnings per diluted share are expected to be in a range of $0.54 to $0.58. For the full-year 2021, the Company expects revenues to be in a range of $1,520 million to $1,535 million, representing reported growth of 11% to 12% and organic growth of 12% to 13%. Adjusted earnings per diluted share are expected to be in a range of $2.86 to $2.93. Organic sales growth excludes both the divestiture of the Extremity Orthopedics business, which was completed on January 4, 2021, and the acquisition of ACell Inc., which was completed on January 20, 2021. Organic growth also excludes the effects of foreign currency and discontinued products. The Company expects a reported revenue contribution from ACell in the range of $83 million to $88 million for the full-year 2021, with approximately $14 million to $15 million in the first quarter of 2021. In the future, the Company may record, or expects to record, certain additional revenues, gains, expenses or charges as described in the Discussion of Adjusted Financial Measures below that it will exclude in the calculation of organic revenue growth, adjusted EBITDA, adjusted net income, adjusted EPS and adjusted free cash flow conversion for historical periods and in providing adjusted EPS guidance. Conference Call and Presentation Available Online Integra has scheduled a conference call for 8:30 a.m. ET on Thursday, February 18, 2021 to discuss fourth quarter and full-year 2020 financial results, and forward-looking financial guidance. The conference call will be hosted by Integra's senior management team and will be open to all listeners. Additional forward-looking information may be discussed in a question and answer session following the call. Integra's management team will reference a presentation during the conference call, which can be found on the Investor section of the website at investor.integralife.com. Access to the live call is available by dialing (888) 394-8218 and using the passcode 5905980. A simultaneous webcast of the call will be available via the Company’s website at . A webcast replay of the call can be accessed through the Investor Relations homepage of Integra's website at A replay of the call will be available until February 28, 2021 by dialing (888) 203-1112 and using the passcode 5905980. About Integra Integra LifeSciences is a global leader in regenerative tissue technologies and neurosurgical solutions dedicated to limiting uncertainty for clinicians, so they can focus on providing the best patient care. Integra offers a comprehensive portfolio of high quality, leadership brands that include AmnioExcel®, Bactiseal®, CerebroFlo®, Certas® Plus, Codman®, CUSA®, DuraGen®, DuraSeal®, ICP Express®, Integra®, MatriStem UBMTM, MediHoney®, MicroFrance®, PriMatrix®, SurgiMend®, TCC-EZ®, and VersaTru®. For the latest news and information about Integra and its products, please visit . This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that involve risks and uncertainties and reflect the Company's judgment as of the date of this release. All statements, other than statements of historical fact, are statements that could be deemed forward-looking statements. Some of these forward-looking statements may contain words like “will,” “believe,” “may,” “could,” “would,” “might,” “possible,” “should,” “expect,” “intend,” “plan,” “anticipate,” or “continue,” the negative of these words, other terms of similar meaning or they may use future dates. Forward-looking statements contained in this news release include, but are not limited to, statements concerning future financial performance, including projections for revenues, expected revenue growth (both reported and organic), GAAP and adjusted net income, GAAP and adjusted earnings per diluted share, non-GAAP adjustments such as divestiture, acquisition and integration-related charges, litigation charges, intangible asset amortization, structural optimization charges, EU Medical Device Regulation-related charges, convertible debt non-cash interest, and income tax expense (benefit) related to non-GAAP adjustments and other items. It is important to note that the Company’s goals and expectations are not predictions of actual performance. Such forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from predicted or expected results. Such risks and uncertainties include, but are not limited, to the following: the impact of COVID-19 on the Company; the Company's ability to execute its operating plan effectively; the Company’s ability to successfully integrate ACell, Inc., and other acquired businesses; the Company’s ability to achieve sales growth in a timely fashion and execute on its channel reorganization in its Tissue Technologies segment; the Company's ability to manufacture and ship sufficient quantities of its products to meet its customers' demands; the ability of third-party suppliers to supply us with raw materials and finished products; global macroeconomic and political conditions; the Company's ability to manage its direct sales channels effectively; the sales performance of third-party distributors on whom the Company relies to generate revenue for certain products and geographic regions; the Company's ability to maintain relationships with customers of acquired entities and businesses; physicians' willingness to adopt and third-party payors' willingness to provide or maintain reimbursement for the Company's recently launched, planned and existing products; initiatives launched by the Company's competitors; downward pricing pressures from customers; the Company's ability to secure regulatory approval for products in development; the Company's ability to remediate quality systems violations; fluctuations in hospitals' spending for capital equipment; the Company's ability to comply with and obtain approvals for products of human origin and comply with regulations regarding products containing materials derived from animal sources; difficulties in controlling expenses, including costs to procure and manufacture our products; the impact of changes in management or staff levels; the impact of goodwill and intangible asset impairment charges if future operating results of acquired businesses are significantly less than the results anticipated at the time of the acquisitions, the Company's ability to leverage its existing selling organizations and administrative infrastructure; the Company's ability to increase product sales and gross margins, and control non-product costs; the Company’s ability to achieve anticipated growth rates, margins and scale and execute its strategy generally; the amount and timing of divestiture, acquisition and integration-related costs; the geographic distribution of where the Company generates its taxable income; the effect of legislation effecting healthcare reform in the United States and internationally; fluctuations in foreign currency exchange rates; the amount of our bank borrowings outstanding and other factors influencing liquidity; and the economic, competitive, governmental, technological, and other risk factors and uncertainties identified under the heading “Risk Factors” included in Item 1A of Integra's Annual Report on Form 10-K for the year ended December 31, 2020 to be filed with the Securities and Exchange Commission. These forward-looking statements are made only as of the date hereof, and the Company undertakes no obligation to update or revise the forward-looking statements, whether as a result of new information, future events, or otherwise. Discussion of Adjusted Financial Measures In addition to our GAAP results, we provide certain non-GAAP measures, including organic revenues, adjusted earnings before interest, taxes, depreciation and amortization ("EBITDA"), adjusted net income, adjusted earnings per diluted share, free cash flow and adjusted free cash flow conversion. Organic revenues consist of total revenues excluding the effects of currency exchange rates, revenues from current-period acquisitions and product divestitures and discontinuances. Adjusted EBITDA consists of GAAP net income excluding: (i) depreciation and amortization; (ii) other income (expense); (iii) interest income and expense; (iv) income tax expense (benefit); and (v) those operating expenses also excluded from adjusted net income. The measure of adjusted net income consists of GAAP net income, excluding: (i) structural optimization charges; (ii) divestiture, acquisition and integration-related charges; (iii) discontinued product lines charges; (iv) EU Medical Device Regulation-related charges; (v) COVID-19 related charges; (vi) convertible debt non-cash interest; (vii) intangible asset amortization expense; (viii) litigation charges; and (ix) income tax impact from adjustments. The adjusted earnings per diluted share measure is calculated by dividing adjusted net income attributable to diluted shares by diluted weighted average shares outstanding. The measure of free cash flow consists of GAAP net cash provided by operating activities less purchases of property and equipment. Reconciliations of GAAP revenues to adjusted revenues and GAAP Adjusted Net Income to adjusted EBITDA, and adjusted net income, and GAAP earnings per diluted share to adjusted earnings per diluted share all for the quarters ended December 31, 2020 and 2019, and the free cash flow and free cash flow conversion for the quarters ended December 31, 2020 and 2019, appear in the financial tables in this release. The Company believes that the presentation of organic revenues and the other non-GAAP measures provide important supplemental information to management and investors regarding financial and business trends relating to the Company's financial condition and results of operations. For further information regarding why Integra believes that these non-GAAP financial measures provide useful information to investors, the specific manner in which management uses these measures, and some of the limitations associated with the use of these measures, please refer to the Company's Current Report on Form 10-K filed with the Securities and Exchange Commission. This Current Report on Form 8-K is available on the SEC's website at or on our website at . Contact: Investor Relations: Michael Beaulieu Director, Investor Relations (609) 750-2827 michael.beaulieu@integralife.com Media: Laurene Isip Vice President, Global Corporate Communications and Public Relations (609) 750-7984 laurene.isip@integralife.com INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED) (In thousands, except per share amounts) Three Months Ended December 31, Twelve Months Ended December 31, 2020 2019 2020 2019 Total revenues $ 388,647 $ 395,127 $ 1,371,868 $ 1,517,557 Costs and expenses: Cost of goods sold 147,069 149,462 520,834 564,681 Research and development 22,179 24,643 77,381 79,573 In-process research and development — 5,000 — 64,916 Selling, general and administrative 162,390 174,254 594,526 687,599 Intangible asset amortization 4,364 5,688 27,757 27,028 Total costs and expenses 336,002 359,047 1,220,498 1,423,797 Operating income 52,645 36,080 151,370 93,760 Interest income 2,173 2,728 9,297 10,779 Interest expense (17,351 ) (13,462 ) (71,581 ) (53,957 ) Other income, net 1,449 1,061 4,434 9,522 Income before taxes 38,916 26,407 93,520 60,104 Income tax expense (benefit) (53,828 ) 11,088 (40,372 ) 9,903 Net income $ 92,744 $ 15,319 $ 133,892 $ 50,201 Net income per share $ 1.09 $ 0.18 $ 1.57 $ 0.58 Weighted average common shares outstanding for diluted net income per share 84,929 86,773 85,228 86,494 Segment revenues and growth in total revenues excluding the effects of currency exchange rates, acquisitions and discontinued products are as follows: (In thousands) Three Months Ended December 31, Twelve Months Ended December 31, 2020 2019 Change 2020 2019 Change Neurosurgery $ 200,291 $ 200,015 0.1 % $ 716,339 $ 767,793 (6.7 )% Instruments 53,999 59,381 (9.1 )% 178,492 228,413 (21.9 )% Total Codman Specialty Surgical(1) $ 254,290 $ 259,396 (2.0 )% $ 894,831 $ 996,206 (10.2 )% Wound Reconstruction and Care $ 82,365 $ 83,330 (1.2 )% 293,038 322,739 (9.2 )% Extremity Orthopedics 23,760 24,734 (3.9 )% 78,316 90,082 (13.1 )% Private Label 28,232 27,667 2.0 % 105,683 108,530 (2.6 )% Total Orthopedics and Tissue Technologies $ 134,357 $ 135,731 (1.0 )% $ 477,037 $ 521,351 (8.5 )% Total Reported Revenues $ 388,647 $ 395,127 (1.6 )% $ 1,371,868 $ 1,517,557 (9.6 )% Impact of changes in currency exchange rates $ (4,517 ) — — (4,666 ) — — Less contribution of revenues from acquisitions(2) — — — (671 ) — — Less contribution of revenues from divested products (251 ) — — (823 ) (3,328 ) — Less contribution of revenues from discontinued products (5,449 ) (11,020 ) — (20,569 ) (40,747 ) — Total organic revenues(3) $ 378,430 $ 384,107 (1.5 )% $ 1,345,139 $ 1,473,482 (8.7 )% (1) Prior period amounts were reclassified between categories within Codman Specialty Surgical to conform to the current period presentation. (2) Includes revenues from Arkis Biosciences. (3) Organic revenues have been adjusted to exclude foreign currency (current period), acquisitions and to account for divested and discontinued products. Items included in GAAP net income and from continuing operations and locations where each item is recorded are as follows: (In thousands) Three Months Ended December 31, 2020 Item Total Amount COGS(a) SG&A(b) R&D(c) Amort.(d) OI&E(e) Tax(f) Structural optimization charges 6,348 5,970 (300 ) 679 — — — Divestiture, acquisition and integration-related charges(1) 13,050 4,628 6,373 2,049 — — — Discontinued product lines charges 855 855 — — — — — EU Medical Device Regulation charges 3,902 611 3,288 3 — — — COVID-19 related charges (161 ) (6 ) (155 ) — — — — Convertible debt non-cash interest 4,340 — — — — 4,340 — Intangible asset amortization expense 15,886 11,522 — — 4,364 — — Estimated income tax impact from adjustments and other items(2) (65,701 ) — — — — — (65,701 ) Depreciation expense 10,209 — — — — — — (a) COGS - Cost of goods sold (b) SG&A - Selling, general and administrative (c) R&D - Research and development (d) Amort. - Intangible asset amortization (e) OI&E - Other income and expense (f) Tax - Income tax expense (1) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, and Rebound Therapeutics acquisitions and the divestiture of extremity orthopedics and includes banking, legal, consulting, systems, and other expenses. (2) Estimated income tax impact includes a $59.2 million one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property. Three Months Ended December 31, 2019 (In thousands) Item Total Amount COGS(a) SG&A(b) R&D(c) IPR&D(d) Amort.(e) Tax(f) Structural optimization charges 4,413 1,918 2,495 — — — — Discontinued product lines charges 2,344 2,344 — — — — — Divestiture, acquisition and integration-related charges(1) 17,822 3,737 7,976 1,109 5,000 — — EU Medical Device Regulation charges 3,021 91 2,930 — — — — Litigation charges 50 — 50 — — — — Intangible asset amortization expense 17,339 11,651 — — — 5,688 — Estimated income tax impact from adjustments and other items (1,442 ) — — — — — (1,442 ) Depreciation expense 10,573 — — — — — — (a) COGS - Cost of goods sold (b) SG&A - Selling, general and administrative (c) R&D - Research and development (d) IPR&D - In-process research and development (e) Amort. - Intangible asset amortization (f) Tax - Income tax expense (1) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, and Rebound Therapeutics acquisitions and the divestiture of extremity orthopedics and includes banking, legal, consulting, systems, and other expenses. Items included in GAAP net income and location where each item is recorded are as follows: (In thousands) Twelve Months Ended December 31, 2020 Item Total Amount COGS(a) SG&A(b) R&D(c) Amort.(d) OI&E(e) Tax(f) Structural optimization charges 15,363 8,330 6,177 856 — — — Divestiture, acquisition and integration-related charges(1) 32,906 13,876 16,726 2,304 — — — Discontinued product lines charges 6,342 6,342 — — — — — EU Medical Device Regulation charges 9,372 2,241 7,128 3 — — — COVID-19 related charges 3,482 3,768 (286 ) — — — — Convertible debt non-cash interest 15,415 — — — — 15,415 — Expenses related to debt refinancing 6,168 — — — — 6,168 — Intangible asset amortization expense 74,505 46,748 — — 27,757 — — Estimated income tax impact from adjustments and other items(2) (88,779 ) — — — — — (88,779 ) Depreciation expense 41,136 — — — — — — . (a) COGS - Cost of goods sold (b) SG&A - Selling, general and administrative (c) R&D - Research and development (d) Amort. - Intangible asset amortization (e) OI&E - Interest (income) expense, net and other (income), net (f) Tax - Income tax expense (1) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences, and Rebound Therapeutics acquisitions and the divestiture of extremity orthopedics and includes banking, legal, consulting, systems, and other expenses. (2) Estimated income tax impact includes a $59.2 million one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property. Twelve Months Ended December 31, 2019 (In thousands) Item Total Amount COGS(a) SG&A(b) R&D(c) IPR&D(d) Amort.(e) OI&E(f) Tax(g) Structural optimization charges 17,582 6,218 10,860 — — — 504 — Divestiture, acquisition and integration-related charges(1) 124,665 9,788 47,174 2,787 64,916 — — — Discontinued product lines charges 9,168 9,168 — — — — — — Litigation charges 96 — 3,101 — — — (3,005 ) — EU Medical Device Regulation charges 6,221 91 6,130 — — — — — Impairment charges 5,764 — — — — 5,764 — — Intangible asset amortization expense 67,127 45,862 — — — 21,265 — — Estimated income tax impact from adjustments and other items (43,430 ) — — — — — — (43,430 ) Depreciation expense 41,722 — — — — — — — (a) COGS - Cost of goods sold (b) SG&A - Selling, general and administrative (c) R&D - Research and development (d) IPR&D - In-process research and development (e) Amort. - Intangible asset amortization (f) OI&E - Interest (income) expense, net and other (income), net (g) Tax - Income tax expense (1) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences and Rebound Therapeutics acquisitions and include banking, legal, consulting, systems, and other expenses. This includes a $59.9 million in-process research and development expense related to the Rebound Therapeutics acquisition from the third quarter 2019. INTEGRA LIFESCIENCES HOLDINGS CORPORATION RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME FROM CONTINUING OPERATIONS TO ADJUSTED EBITDA (UNAUDITED) (In thousands) Three Months Ended December 31, Twelve Months Ended December 31, 2020 2019 2020 2019 GAAP net income $ 92,744 $ 15,319 $ 133,892 50,201 Non-GAAP adjustments: Depreciation and intangible asset amortization expense 26,095 27,912 115,641 108,849 Other (income), net (1,449 ) (1,061 ) (4,434 ) (7,021 ) Interest expense, net 10,838 10,734 40,701 43,178 Income tax expense (benefit)(1) (53,828 ) 11,088 (40,372 ) 9,903 Structural optimization charges 6,348 4,413 15,363 17,582 EU Medical Device Regulation charges 3,902 3,021 9,372 6,221 COVID-19 related charges (161 ) — 3,482 — Convertible debt non-cash interest 4,340 — 15,415 — Expenses related to debt refinancing — — 6,168 — Discontinued product lines charges 855 2,344 6,342 9,168 Divestiture, acquisition and integration-related charges(2) 13,050 17,822 32,906 124,665 Impairment charges — — — 5,764 Litigation charges — 50 — 96 Total of non-GAAP adjustments 9,990 76,323 200,584 318,405 Adjusted EBITDA $ 102,734 $ 91,642 $ 334,474 $ 368,606 (1) Estimated income tax impact includes a $59.2 million one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property. (2) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences and Rebound Therapeutics acquisitions and include banking, legal, consulting, systems, and other expenses. This includes a $59.9 million in-process research and development expense related to the Rebound Therapeutics acquisition from the third quarter 2019. INTEGRA LIFESCIENCES HOLDINGS CORPORATION RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP NET INCOME FROM CONTINUING OPERATIONS TO MEASURES OF ADJUSTED NET INCOME AND ADJUSTED EARNINGS PER SHARE (UNAUDITED) (In thousands, except per share amounts) Three Months Ended December 31, Twelve Months Ended December 31, 2020 2019 2020 2019 GAAP net income $ 92,744 $ 15,319 $ 133,892 $ 50,201 Non-GAAP adjustments: Structural optimization charges 6,348 4,413 15,363 17,582 Divestiture, acquisition and integration-related charges(1) 13,050 17,822 32,906 124,665 Discontinued product lines charges 855 2,344 6,342 9,168 EU Medical Device Regulation charges 3,902 3,021 9,372 6,221 COVID-19 related charges (161 ) — 3,482 — Convertible debt non-cash interest 4,340 — 15,415 — Expenses related to debt refinancing — — 6,168 — Impairment charges — — — 5,764 Litigation charges — 50 — 96 Intangible asset amortization expense 15,886 17,339 74,505 67,127 Estimated income tax impact from adjustments and other items(2) (65,701 ) (1,442 ) (88,779 ) (43,430 ) Total of non-GAAP adjustments (21,481 ) 43,547 74,774 187,193 Adjusted net income $ 71,263 $ 58,866 $ 208,666 $ 237,394 Adjusted diluted net income per share $ 0.84 $ 0.68 $ 2.45 $ 2.74 Weighted average common shares outstanding for diluted net income per share 84,929 86,773 85,228 86,494 (1) Divestiture, acquisition and integration-related charges are associated with the Codman Neurosurgery, Arkis Biosciences and Rebound Therapeutics acquisitions and include banking, legal, consulting, systems, and other expenses. This includes a $59.9 million in-process research and development expense related to the Rebound Therapeutics acquisition from the third quarter 2019. (2) Estimated income tax impact includes a $59.2 million one-time net tax benefit in the fourth quarter of 2020, attributable to an intra-entity transfer of certain intellectual property. INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED BALANCE SHEET DATA (UNAUDITED) (In thousands) December 31, December 31, 2020 2019 Cash and cash equivalents $ 470,166 $ 198,911 Accounts receivable, net 225,532 275,296 Inventory, net 310,117 316,054 Current and long-term borrowing under senior credit facility 967,137 1,243,561 Borrowings under securitization facility 112,500 104,500 Long-term convertible securities 474,834 — Stockholders' equity 1,514,867 1,416,736 INTEGRA LIFESCIENCES HOLDINGS CORPORATION CONDENSED STATEMENT OF CASH FLOWS (UNAUDITED) Twelve Months Ending December 31, 2020 2019 Net cash provided by operating activities $ 203,832 $ 231,433 Net cash used in investing activities (68,073 ) (162,668 ) Net cash provided (used in) by financing activities 121,625 (8,766 ) Effect of exchange rate changes on cash and cash equivalents 13,871 74 Net increase (decrease) in cash and cash equivalents 271,255 60,073 RECONCILIATION OF NON-GAAP ADJUSTMENTS - GAAP OPERATING CASH FLOW TO MEASURES OF ADJUSTED FREE CASH FLOW AND ADJUSTED FREE CASH FLOW CONVERSION (UNAUDITED) (In thousands) Three Months Ended December 31, 2020 2019 GAAP Net cash provided by operating activities $ 80,262 $ 89,185 Purchases of property and equipment (8,428 ) (22,194 ) Adj. Free Cash Flow $ 71,834 $ 66,991 Adjusted net income (1) $ 71,263 $ 58,866 Adjusted Free Cash Flow Conversion 100.8 % 113.8 % Twelve Months Ending December 31, 2020 2019 GAAP Net cash provided by operating activities $ 203,834 $ 231,433 Purchases of property and equipment (38,890 ) (69,537 ) Adj. Free Cash Flow $ 164,944 $ 161,896 Adjusted net income (1) $ 208,666 $ 237,394 Adjusted Free Cash Flow Conversion 79.0 % 68.2 % (1) Adjusted net income for quarters and twelve months ended December 31, 2019 and 2020 are reconciled above. Adjusted net income for remaining quarters in the trailing twelve months calculation have been previously reconciled and are publicly available in the Quarterly Earnings Call Presentations on our website at investor.integralife.com. The Company calculates adjusted free cash flow conversion by dividing its free cash flow by adjusted net income. The Company believes this measure is a useful metric in evaluating the significance of the cash special charges in its adjusted earnings measures.