0001562762-23-000048 | 10-K | XBRL Viewer

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Document and Entity Information - USD ($) $ in Billions	12 Months Ended
Document and Entity Information - USD ($) $ in Billions	Dec. 31, 2022	Feb. 17, 2023	Jun. 30, 2022
Document and Entity Information [Abstract]
Document Transition Report	false
Document Type	10-K
Document Period End Date	Dec. 31, 2022
Entity Registrant Name	GLOBUS MEDICAL, INC.
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Shell Company	false
Entity Small Business	false
Entity Emerging Growth Company	false
Title of 12(b) Security	Class A Common Stock, par value $.001 per share
Trading Symbol	GMED
Security Exchange Name	NYSE
Entity File Number	001-35621
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	04-3744954
Entity Address, Address Line One	2560 General Armistead Avenue
Entity Address, City or Town	Audubon
Entity Address, State or Province	PA
Entity Address, Postal Zip Code	19403
City Area Code	610
Local Phone Number	930-1800
Document Annual Report	true
Amendment Flag	false
Entity Common Stock, Shares Outstanding		100,302,483
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Central Index Key	0001237831
ICFR Auditor Attestation Flag	true
Current Fiscal Year End Date	--12-31
EntityPublicFloat			$ 4.3
Entity Well Known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Documents Incorporated By Reference [Text Block]	DOCUMENTS INCORPORATED BY REFERENCE Portions of our Proxy Statement for our 2023 Annual Meeting of Stockholders, to be filed within 120 days of December 31, 2022, are incorporated by reference in Part III, Items 10, 11, 12, 13 and 14 herein of this Annual Report. Such Proxy Statement, except for the parts therein which have been specifically incorporated by reference, shall not be deemed “filed” for the purposes of this Annual Report on Form 10-K.
Auditor Firm ID	34
Auditor Location	Philadelphia, Pennsylvania
Auditor Name	Deloitte & Touche LLP

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 150,466	$ 193,069
Short-term marketable securities	295,592	250,378
Accounts receivable, net of allowances of $4,724 and $4,962, respectively	213,247	164,436
Inventories	298,981	237,001
Prepaid expenses and other current assets	20,997	18,417
Income taxes receivable	4,061	1,215
Total current assets	983,344	864,516
Property and equipment, net of accumulated depreciation of $343,036 and $305,575, respectively	243,729	221,076
Long-term marketable securities	495,852	562,475
Intangible assets, net	63,574	68,660
Goodwill	197,471	179,708
Other assets	43,311	36,334
Deferred income taxes	48,845	24,494
Total assets	2,076,126	1,957,263
Current liabilities:
Accounts payable	36,101	21,955
Accrued expenses	94,705	91,168
Income taxes payable	990	1,046
Business acquisition liabilities	13,308	11,770
Deferred revenue	14,100	12,025
Payable to broker		2,200
Total current liabilities	159,204	140,164
Business acquisition liabilities, net of current portion	54,950	58,755
Deferred income taxes	1,779	4,314
Other liabilities	13,820	12,642
Total liabilities	229,753	215,875
Commitments and contingencies (Note 15)
Equity:
Additional paid-in capital	630,952	553,787
Accumulated other comprehensive income/(loss)	(24,630)	(6,772)
Retained earnings	1,239,951	1,194,272
Total equity	1,846,373	1,741,388
Total liabilities and equity	2,076,126	1,957,263
Common Class A [Member]
Equity:
Common stock	78	79
Common Class B [Member]
Equity:
Common stock	$ 22	$ 22

CONSOLIDATED BALANCE SHEETS (Parentheticals) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Accounts receivable, allowances	$ 4,724	$ 4,962
Property and equipment
Accumulated depreciation	$ 343,036	$ 305,575
Equity:
Common stock, shares authorized	775,000,000
Common Class A [Member]
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	77,762,282	79,113,916
Common stock, shares outstanding	77,762,282	79,113,916
Common Class B [Member]
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	275,000,000	275,000,000
Common stock, shares issued	22,430,097	22,430,097
Common stock, shares outstanding	22,430,097	22,430,097

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME [Abstract]
Net sales	$ 1,022,843	$ 958,102	$ 789,042
Cost of goods sold	263,725	239,223	217,463
Gross profit	759,118	718,879	571,579
Operating expenses:
Research and development	73,015	97,346	84,519
Selling, general and administrative	432,117	408,149	354,757
Provision for litigation	2,341	5,921	9
Amortization of intangibles	17,735	18,526	16,831
Acquisition related costs	5,959	16,984	4,030
Total operating expenses	531,167	546,926	460,146
Operating income/(loss)	227,951	171,953	111,433
Other income/(expense), net
Interest income/(expense), net	14,233	9,297	13,952
Foreign currency transaction gain/(loss)	(1,020)	(1,423)	(279)
Other income/(expense)	1,855	580	793
Total other income/(expense), net	15,068	8,454	14,466
Income/(loss) before income taxes	243,019	180,407	125,899
Income tax provision	52,850	31,216	23,614
Net income/(loss)	190,169	149,191	102,285
Other comprehensive income/(loss), net of tax:
Unrealized gain/(loss) on marketable securities	(14,040)	(6,054)	1,402
Foreign currency translation gain/(loss)	(3,818)	(4,673)	5,451
Total other comprehensive income/(loss), net of tax	(17,858)	(10,727)	6,853
Comprehensive income/(loss)	$ 172,311	$ 138,464	$ 109,138
Earnings per share:
Basic	$ 1.89	$ 1.48	$ 1.04
Diluted	$ 1.85	$ 1.44	$ 1.01
Weighted average shares outstanding:
Basic	100,469	100,734	98,580
Diluted	102,643	103,623	100,971

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) shares in Thousands, $ in Thousands	Cumulative Effect Of Adoption Of Accounting Standards [Member] Retained Earnings [Member]	Cumulative Effect Of Adoption Of Accounting Standards [Member]	Common Stock [Member] Common Class A [Member]	Common Stock [Member] Common Class B [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Income/(Loss) [Member]	Retained Earnings [Member]	Total
Shares, Outstanding, Beginning Balance at Dec. 31, 2019			77,394	22,431
Total equity, beginning of period at Dec. 31, 2019	$ (468)	$ (468)	$ 77	$ 22	$ 357,320	$ (2,898)	$ 1,047,931	$ 1,402,452
Stock-based compensation					6,902			6,902
Exercise of stock options (shares)			190
Exercise of stock options			$ 1		5,762			5,763
Comprehensive income/(loss)						(3,368)	25,949	22,581
Repurchase and retirement of common stock (shares)			(1,920)
Repurchase and retirement of common stock			$ (2)				(73,862)	(73,864)
Total equity, end of period at Mar. 31, 2020			$ 76	$ 22	369,984	(6,266)	999,550	1,363,366
Shares, Outstanding, Ending Balance at Mar. 31, 2020			75,664	22,431
Shares, Outstanding, Beginning Balance at Dec. 31, 2019			77,394	22,431
Total equity, beginning of period at Dec. 31, 2019	$ (468)	$ (468)	$ 77	$ 22	357,320	(2,898)	1,047,931	1,402,452
Comprehensive income/(loss)								109,138
Total equity, end of period at Dec. 31, 2020			$ 77	$ 22	457,161	3,955	1,045,082	1,506,297
Shares, Outstanding, Ending Balance at Dec. 31, 2020			77,284	22,430
Shares, Outstanding, Beginning Balance at Mar. 31, 2020			75,664	22,431
Total equity, beginning of period at Mar. 31, 2020			$ 76	$ 22	369,984	(6,266)	999,550	1,363,366
Stock-based compensation					7,426			7,426
Exercise of stock options (shares)			434
Exercise of stock options (shares)				(1)
Exercise of stock options					10,201			10,201
Comprehensive income/(loss)						7,564	(20,837)	(13,273)
Repurchase and retirement of common stock (shares)			(771)
Repurchase and retirement of common stock			$ (1)				(30,804)	(30,805)
Total equity, end of period at Jun. 30, 2020			$ 75	$ 22	387,611	1,298	947,909	1,336,915
Shares, Outstanding, Ending Balance at Jun. 30, 2020			75,327	22,430
Stock-based compensation					7,007			7,007
Exercise of stock options (shares)			915
Exercise of stock options			$ 1		28,156			28,157
Comprehensive income/(loss)						909	44,216	45,125
Total equity, end of period at Sep. 30, 2020			$ 76	$ 22	422,774	2,207	992,125	1,417,204
Shares, Outstanding, Ending Balance at Sep. 30, 2020			76,242	22,430
Stock-based compensation					5,995			5,995
Grant of restricted stock units					191			191
Exercise of stock options (shares)			1,042
Exercise of stock options			$ 1		28,201			28,202
Comprehensive income/(loss)						1,748	52,957	54,705
Total equity, end of period at Dec. 31, 2020			$ 77	$ 22	457,161	3,955	1,045,082	1,506,297
Shares, Outstanding, Ending Balance at Dec. 31, 2020			77,284	22,430
Stock-based compensation					7,883			7,883
Grant of restricted stock units					163			163
Exercise of stock options (shares)			303
Exercise of stock options			$ 1		9,100			9,101
Comprehensive income/(loss)						(5,779)	45,329	39,550
Total equity, end of period at Mar. 31, 2021			$ 78	$ 22	474,307	(1,824)	1,090,411	1,562,994
Shares, Outstanding, Ending Balance at Mar. 31, 2021			77,587	22,430
Shares, Outstanding, Beginning Balance at Dec. 31, 2020			77,284	22,430
Total equity, beginning of period at Dec. 31, 2020			$ 77	$ 22	457,161	3,955	1,045,082	1,506,297
Comprehensive income/(loss)								138,464
Total equity, end of period at Dec. 31, 2021			$ 79	$ 22	553,787	(6,772)	1,194,272	1,741,388
Shares, Outstanding, Ending Balance at Dec. 31, 2021			79,114	22,430
Shares, Outstanding, Beginning Balance at Mar. 31, 2021			77,587	22,430
Total equity, beginning of period at Mar. 31, 2021			$ 78	$ 22	474,307	(1,824)	1,090,411	1,562,994
Stock-based compensation					7,788			7,788
Grant of restricted stock units					197			197
Exercise of stock options (shares)			716
Exercise of stock options			$ 1		26,496			26,497
Comprehensive income/(loss)						252	41,545	41,797
Total equity, end of period at Jun. 30, 2021			$ 79	$ 22	508,788	(1,572)	1,131,956	1,639,273
Shares, Outstanding, Ending Balance at Jun. 30, 2021			78,303	22,430
Stock-based compensation					7,621			7,621
Grant of restricted stock units					1,311			1,311
Exercise of stock options (shares)			727
Exercise of stock options					24,335			24,335
Comprehensive income/(loss)						(1,482)	47,211	45,729
Total equity, end of period at Sep. 30, 2021			$ 79	$ 22	542,055	(3,054)	1,179,167	1,718,269
Shares, Outstanding, Ending Balance at Sep. 30, 2021			79,030	22,430
Stock-based compensation					7,962			7,962
Grant of restricted stock units					207			207
Exercise of stock options (shares)			84
Exercise of stock options					3,563			3,563
Comprehensive income/(loss)						(3,718)	15,105	11,387
Total equity, end of period at Dec. 31, 2021			$ 79	$ 22	553,787	(6,772)	1,194,272	1,741,388
Shares, Outstanding, Ending Balance at Dec. 31, 2021			79,114	22,430
Stock-based compensation					8,353			8,353
Grant of restricted stock units					196			196
Exercise of stock options (shares)			184
Exercise of stock options					7,746			7,746
Comprehensive income/(loss)						(10,395)	38,084	27,689
Total equity, end of period at Mar. 31, 2022			$ 79	$ 22	570,082	(17,167)	1,232,356	1,785,372
Shares, Outstanding, Ending Balance at Mar. 31, 2022			79,298	22,430
Shares, Outstanding, Beginning Balance at Dec. 31, 2021			79,114	22,430
Total equity, beginning of period at Dec. 31, 2021			$ 79	$ 22	553,787	(6,772)	1,194,272	$ 1,741,388
Exercise of stock options (shares)								999
Comprehensive income/(loss)								$ 172,311
Total equity, end of period at Dec. 31, 2022			$ 78	$ 22	630,952	(24,630)	1,239,951	1,846,373
Shares, Outstanding, Ending Balance at Dec. 31, 2022			77,762	22,430
Shares, Outstanding, Beginning Balance at Mar. 31, 2022			79,298	22,430
Total equity, beginning of period at Mar. 31, 2022			$ 79	$ 22	570,082	(17,167)	1,232,356	1,785,372
Stock-based compensation					8,020			8,020
Grant of restricted stock units					220			220
Exercise of stock options (shares)			90
Exercise of stock options					3,585			3,585
Comprehensive income/(loss)						(8,201)	54,590	46,389
Repurchase and retirement of common stock (shares)			(2,351)
Repurchase and retirement of common stock			$ (2)				(144,491)	(144,493)
Total equity, end of period at Jun. 30, 2022			$ 77	$ 22	581,907	(25,368)	1,142,455	1,699,093
Shares, Outstanding, Ending Balance at Jun. 30, 2022			77,037	22,430
Stock-based compensation					8,434			8,434
Grant of restricted stock units					1,116			1,116
Exercise of stock options (shares)			364
Exercise of stock options					14,895			14,895
Comprehensive income/(loss)						(6,858)	47,431	40,573
Total equity, end of period at Sep. 30, 2022			$ 77	$ 22	606,352	(32,226)	1,189,886	1,764,111
Shares, Outstanding, Ending Balance at Sep. 30, 2022			77,401	22,430
Stock-based compensation					8,659			8,659
Grant of restricted stock units					453			453
Exercise of stock options (shares)			361
Exercise of stock options			$ 1		15,488			15,489
Comprehensive income/(loss)						7,596	50,065	57,661
Total equity, end of period at Dec. 31, 2022			$ 78	$ 22	$ 630,952	$ (24,630)	$ 1,239,951	$ 1,846,373
Shares, Outstanding, Ending Balance at Dec. 31, 2022			77,762	22,430

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net income	$ 190,169	$ 149,191	$ 102,285
Adjustments to reconcile net income to net cash provided by operating activities:
Acquired in-process research and development	150	34,312	24,418
Depreciation and amortization	68,252	69,867	62,874
Amortization of premium (discount) on marketable securities	5,389	2,781	587
Write-down for excess and obsolete inventories, net	6,400	6,143	17,741
Stock-based compensation expense	32,810	30,586	27,073
Allowance for doubtful accounts	(1)	1,200	2,960
Change in fair value of business acquisition liabilities	5,132	16,807	2,674
Change in deferred income taxes	(22,223)	(17,615)	(4,338)
(Gain)/loss on disposal of assets, net	299	464	809
Payment of business acquisition related liabilities	(2,647)	(210)	(700)
(Increase)/decrease in:
Accounts receivable	(50,843)	(25,895)	10,696
Inventories	(61,745)	(11,971)	(50,111)
Prepaid expenses and other assets	(10,292)	(6,178)	(11,088)
Increase/(decrease) in:
Accounts payable	14,418	3,684	(6,352)
Accrued expenses and other liabilities	6,087	17,896	17,608
Income taxes payable/receivable	(2,887)	5,212	1,657
Net cash provided by/(used in) operating activities	178,468	276,274	198,793
Cash flows from investing activities:
Purchases of marketable securities	(419,534)	(622,359)	(223,540)
Maturities of marketable securities	312,221	227,908	134,462
Sales of marketable securities	102,433	109,898	68,897
Purchases of property and equipment	(74,047)	(56,898)	(63,658)
Acquisition of businesses, net of cash acquired and purchases of intangible and other assets	(31,435)	(34,488)	(33,483)
Net cash provided by/(used in) investing activities	(110,362)	(375,939)	(117,322)
Cash flows from financing activities:
Payment of business acquisition liabilities	(7,185)	(9,349)	(6,316)
Proceeds from exercise of stock options	41,716	63,496	72,322
Repurchase of common stock	(144,493)		(104,669)
Net cash provided by/(used in) financing activities	(109,962)	54,147	(38,663)
Effect of foreign exchange rates on cash	(747)	(810)	865
Net increase/(decrease) in cash and cash equivalents	(42,603)	(46,328)	43,673
Cash and cash equivalents at beginning of period	193,069	239,397	195,724
Cash and cash equivalents at end of period	150,466	193,069	239,397
Supplemental disclosures of cash flow information:
Income taxes paid	77,823	45,027	25,437
Purchases of property and equipment included in accounts payable and accrued expenses	$ 7,423	$ 4,551	$ 4,210

BACKGROUND

12 Months Ended

Dec. 31, 2022

BACKGROUND [Abstract]

Background

NOTE 1. BACKGROUND

(a) The Company

Globus Medical, Inc., together with its subsidiaries, is a medical device company that develops and commercializes healthcare solutions with a mission to improve the quality of life of patients with musculoskeletal disorders. We are primarily focused on implants that promote healing in patients with musculoskeletal disorders, including the use of a robotic guidance and navigation system and products to treat patients who have experienced orthopedic traumas.

We are an engineering-driven company with a history of rapidly developing and commercializing advanced products and procedures to assist surgeons in effectively treating their patients and to address new treatment options. With over 230 products launched, we offer a comprehensive portfolio of innovative and differentiated technologies that address a variety of musculoskeletal pathologies, anatomies, and surgical approaches.

We are headquartered in Audubon, Pennsylvania, and market and sell our products through our exclusive sales force in the United States, as well as within North, Central & South America, Europe, Asia, Africa and Australia. The sales force consists of direct sales representatives and distributor sales representatives employed by exclusive independent distributors.

The terms the “Company,” “Globus,” “we,” “us” and “our” refer to Globus Medical, Inc. and, where applicable, our consolidated subsidiaries.

(b) COVID-19 Pandemic Impact

In March 2020, the World Health Organization declared the novel strain of coronavirus (“COVID-19”) a global pandemic and recommended containment and mitigation measures worldwide. COVID-19 has significantly impacted the economic conditions in the U.S. and globally as federal, state and local governments react to the public health crisis, creating significant uncertainties in the economy.

Although the Company cannot reasonably estimate the length or severity of the impact that COVID-19 will have on its financial results, the Company may experience a material adverse impact on its sales, results of operations, and cash flows in 2023 should there be a resurgence impacting hospitals, surgical facilities, our internal operations, or our suppliers.

In response to these developments, the Company will continue to monitor liquidity and cash flow. The Company has the ability to borrow from its existing credit facility, if needed, although we do not expect to do so due to our cash, cash equivalents and short-term marketable securities balances.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

12 Months Ended

Dec. 31, 2022

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]

Summary Of Significant Accounting Policies

NOTE 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

(a) Basis of Presentation

The accompanying consolidated financial statements have been prepared in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”).

(b) Principles of Consolidation

The accompanying consolidated financial statements include the accounts of Globus and its wholly owned subsidiaries. All intercompany balances and transactions are eliminated in consolidation.

The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements, and the reported amounts of revenues and expenses during the reporting period. We base our estimates, in part, on historical experience that management believes to be reasonable under the circumstances. Actual results could differ from those estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the consolidated financial statements in the period they are determined to be necessary.

Significant areas that require estimates include revenue recognition, intangible assets, business acquisition liabilities, allowance for doubtful accounts, stock-based compensation, reserves for excess and obsolete inventory, useful lives of assets, the outcome of litigation,

recoverability of intangible assets and income taxes. We are subject to risks and uncertainties due to changes in the healthcare environment, regulatory oversight, competition, and legislation that may cause actual results to differ from estimated results.

(d) Revenue Recognition

Revenue is recognized upon transfer of control of promised products or services to customers in an amount that reflects the consideration we expect to receive in exchange for those products or services. Sales and other taxes we collect concurrent with revenue-producing activities are excluded from revenue. For purposes of disclosure, we disaggregate our revenue into two categories, Musculoskeletal Solutions and Enabling Technologies. Our Musculoskeletal Solutions products consist primarily of the implantable devices, disposables, and unique instruments used in an expansive range of spine, orthopedic trauma, hip, knee and extremity procedures. The majority of our Musculoskeletal Solutions contracts have a single performance obligation and revenue is recognized at a point in time. Our Enabling Technologies products are advanced hardware and software systems, and related technologies, that are designed to enhance a surgeon’s capabilities and streamline surgical procedures by making them less invasive, more accurate, and more reproducible to improve patient care. The majority of our Enabling Technologies product contracts contain multiple performance obligations, including maintenance and support, and revenue is recognized as we fulfill each performance obligation. When contracts have multiple performance obligations, we allocate the contract’s transaction price to each performance obligation using our best estimate of the standalone selling price of each distinct good or service in the contract. Our policy is to classify shipping and handling costs billed to customers as sales and the related expenses as cost of goods sold.

Nature of Products and Services

A significant portion of our Musculoskeletal Solutions product revenue is generated from consigned inventory maintained at hospitals or with sales representatives. Revenue from the sale of consigned musculoskeletal products is recognized when we transfer control, which occurs at the time the product is used or implanted. For all other Musculoskeletal Solutions product transactions, we recognize revenue when we transfer title to the goods, provided there are no remaining performance obligations that can affect the customer’s final acceptance of the sale.

Revenue from the sale of Enabling Technologies products is generally recognized when control transfers to the customer which occurs at the time the product is shipped or delivered. Any revenue related to the provision of maintenance and support is recognized as we satisfy the performance obligation. We use an observable price to determine the stand-alone selling price for each separate performance obligation.

Contract Balances

Timing of revenue recognition may differ from the timing of invoicing to customers. We record a receivable when revenue is recognized prior to invoicing, or deferred revenue when revenue is recognized subsequent to invoicing.

Deferred revenue is comprised mainly of unearned revenue related to the sales of certain Enabling Technologies products, which includes maintenance and support services. Maintenance and support services are generally invoiced annually, at the beginning of each contract period, and revenue is recognized ratably over the maintenance period. For the years ended December 31, 2022, 2021, and 2020, there was an immaterial amount of revenue recognized from previously deferred revenue.

(e) Concentrations of Credit Risk

Financial instruments, which potentially subject us to concentrations of credit risk, are primarily marketable securities and accounts receivable. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of entities comprising our customer base. We perform ongoing credit evaluations of our customers and generally do not require collateral.

There was no customer that accounted for 10% or more of sales for the years ended December 31, 2022, 2021, and 2020, respectively.

(f) Cash, Cash Equivalents, and Restricted Cash

The Company considers all short-term, highly liquid investments with original maturities of 90 days or less at acquisition date to be cash equivalents. Cash equivalents, which consist of money market accounts, commercial paper and corporate debt securities are stated at fair value.

(g) Marketable Securities

Our marketable securities include municipal bonds, corporate debt securities, commercial paper, asset-backed securities, and securities of government, federal agency, and other sovereign obligations, and are classified as available-for-sale as of December 31, 2022 and 2021.

Short-term and long-term marketable securities are recorded at fair value on our consolidated balance sheets. Any change in fair value for available-for-sale securities, that do not result in recognition or reversal of an allowance for credit loss or write down, is recorded, net of taxes, as a component of accumulated other comprehensive income or loss on our consolidated balance sheets. Premiums and discounts are recognized over the life of the related security as an adjustment to yield using the straight-line method. Realized gains or losses from the sale of marketable securities are determined on a specific identification basis. Realized gains and losses, interest income and the amortization/accretion of premiums/discounts are included as a component of other income/(expense), net, on our consolidated statements of operations and comprehensive income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our consolidated balance sheets.

We invest in securities that meet or exceed standards as defined in our investment policy. Our policy also limits the amount of credit exposure to any one issue, issuer or type of security. We review declines in the fair value of our securities to determine whether they are resulting from expected credit losses or other factors. If the assessment indicates a credit loss exists, we recognize any measured impairment as an allowance for credit loss in our consolidated statements of operations. Any other impairments not recorded through allowance for credit losses is recognized in our other comprehensive income.

(h) Fair Value Measurements

Assets and Liabilities That Are Measured at Fair Value on a Recurring Basis

Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or the liability in an orderly transaction between market participants on the measurement date. Additionally, a fair value hierarchy was established that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets and liabilities and the lowest priority to unobservable inputs. The level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement.

Our assets and liabilities measured at fair value on a recurring basis are classified and disclosed in one of the following three categories:

Level 1—quoted prices (unadjusted) in active markets for identical assets and liabilities;

Level 2—observable inputs other than quoted prices in active markets for identical assets and liabilities; and

Level 3—unobservable inputs in which there is little or no market data available, which require the reporting entity to use significant unobservable inputs or valuation techniques.

Assets and Liabilities That Are Measured at Fair Value on a Nonrecurring Basis

The purchase price of business acquisitions is primarily allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values on the acquisition date, with the excess recorded as goodwill. We utilize Level 3 inputs in the determination of the initial fair value.

Contingent consideration represents contingent milestone, performance and revenue-sharing payment obligations related to acquisitions and is measured at fair value, based on significant inputs that are not observable in the market, which represents a Level 3 measurement within the fair value hierarchy. The valuation of contingent consideration uses assumptions we believe would be made by a market participant. We assess these assumptions on an ongoing basis as additional data impacting the assumptions is obtained. The fair value of contingent consideration is recorded in business acquisition liabilities on our consolidated balance sheets, and changes in the fair value of contingent consideration is recognized in acquisition related costs in the consolidated statements of operations and comprehensive income. The fair value of contingent restricted stock unit (“RSU”) grants are recorded as additional paid-in capital in the consolidated balance sheet on the day of the grant due to the remote likelihood of forfeiture.

(i) Inventories

Inventories are stated at the lower of cost or net realizable value. Cost is determined on a first-in, first-out basis. The majority of our inventory is finished goods and we utilize both in-house manufacturing and third-party suppliers to produce our products. We periodically evaluate the carrying value of our inventories in relation to estimated forecasts of product demand, which takes into consideration the life cycle of product releases. When quantities on hand exceed estimated sales forecasts, we record a write-down for such excess inventories. Once inventory has been written down, it creates a new cost basis for inventory that is not subsequently written up.

(j) Property and Equipment

Property and equipment is recorded at cost less accumulated depreciation. Additions or improvements are capitalized, while repairs and maintenance are expensed as incurred. Depreciation is recognized using the straight-line method over the related useful lives of the assets.

When assets are sold or otherwise disposed of, the related property, equipment, and accumulated depreciation amounts are relieved from the accounts, and any gain or loss is recorded in the consolidated statements of operations and comprehensive income.

(k) Goodwill and Intangible Assets

Goodwill represents the excess of purchase price over the fair values of the identifiable assets acquired less the liabilities assumed in the acquisition of a business. Goodwill is tested for impairment at least annually or whenever events or circumstances indicate that a carrying amount may not be recoverable. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. Fair values are estimated using an income and discounted cash flow approach. We perform our annual impairment test of goodwill in the fourth quarter of each year. We consider qualitative indicators of the fair value of a reporting unit when it is unlikely that a reporting unit has impaired goodwill. During the years ended December 31, 2022, 2021, and 2020, we did not record any impairment charges related to goodwill.

Intangible assets consist of purchased in-process research and development (“IPR&D”), developed technology, supplier network, patents, customer relationships, re-acquired rights, and non-compete agreements. Intangible assets with finite useful lives are amortized over the period of estimated benefit using the straight-line method and estimated useful lives ranging from one to twenty-one years. Intangible assets with finite useful lives are tested whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If an impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset. Fair value is generally determined using a discounted future cash flow analysis. There were no impairments of finite-lived intangible assets during the years ended December 31, 2022, 2021, and 2020.

IPR&D has an indefinite life and is not amortized until completion of the project at which time the IPR&D becomes an amortizable asset. Intangible assets with indefinite useful lives are tested for impairment annually or whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If the related project is not completed in a timely manner, we may have an impairment related to the IPR&D, calculated as the excess of the asset’s carrying value over its fair value. There were no impairments of IPR&D during the years ended December 31, 2022, 2021, and 2020.

(l) Impairment of Long-Lived Assets

We periodically evaluate the recoverability of the carrying amount of long-lived assets, which include property and equipment, as well as whenever events or changes in circumstances indicate that the carrying amount of an asset group may not be fully recoverable. An impairment is assessed when the undiscounted future cash flows from the use and eventual disposition of an asset group are less than its carrying value. If an impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset group. Our fair value methodology is based on quoted market prices, if available. If quoted market prices are not available, an estimate of fair value is made based on prices of similar assets or other valuation techniques including present value techniques. During the years ended December 31, 2022, 2021, and 2020, we did not record any impairment charges related to long-lived assets.

(m) Cost of Goods Sold

Cost of goods sold consists primarily of costs from our manufacturing operations, costs of products purchased from third-party suppliers, reserves for excess and obsolete inventory, depreciation of surgical instruments and cases, royalties, shipping, inspection and related costs incurred in making our products available for sale or use.

(n) Research and Development

Research and development costs are expensed as incurred. Research and development costs include salaries, employee benefits, supplies, consulting services, clinical services and clinical trial costs, and facilities costs. Costs incurred in obtaining technology licenses and patents are charged immediately to research and development expense if the technology licensed has not reached technological feasibility and has no alternative future use.

(o) Stock-Based Compensation

The cost of employee and non-employee director awards is measured at the grant date fair value of the award and is recognized as expense over the requisite service period, which is generally the vesting period of the equity award. Compensation expense for awards includes the impact of forfeiture in the period when they occur.

We estimate the fair value of stock options utilizing the Black-Scholes option-pricing model. Inputs to the Black-Scholes model include our stock price, expected volatility, expected term, risk-free interest rate and expected dividends. Expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options offering period which is derived from historical experience. The risk-free interest rate assumption is based on observed interest rates of U.S. Treasury securities appropriate for the expected terms of the stock options. The dividend yield assumption is based on the history and expectation of no dividend payouts. The fair value of restricted stock units is estimated on the day of grant based on the closing price of the Company’s common stock.

(p) Provision for Litigation

We are involved in a number of proceedings, legal actions, and claims. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is considered probable and the amount can be reasonably estimated. If the reasonable estimate of a probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. We expense legal costs related to loss contingencies as incurred.

(q) Acquisition Related Costs

Acquisition related costs represents the change in fair value of business acquisition related contingent consideration; costs related to integrating recently acquired businesses including but not limited to costs to exit or convert contractual obligations, severance, and information system conversion; and specific costs related to the consummation of the acquisition process such as banker fees, legal fees, and other acquisition related professional fees.

(r) Foreign Currency Translation

The functional currency of our foreign subsidiaries is generally their local currency. Assets and liabilities of the foreign subsidiaries are translated at the period end currency exchange rate and revenues and expenses are translated at an average currency exchange rate for the period. The resulting foreign currency translation gains and losses are included as a component of accumulated other comprehensive income. Gains and losses arising from intercompany foreign transactions are included in other income, net on the consolidated statements of operations and comprehensive income.

(s) Income Taxes

Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the year in which such items are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period that includes the enactment date. A valuation allowance is established to offset any deferred tax assets if, based upon available evidence, it is more likely than not that some or all of the deferred tax assets will not be realized.

Significant judgment is required in determining income tax provisions and in evaluating tax positions. We will establish additional provisions for income taxes when, despite the belief that tax positions are fully supportable, there remain certain positions that do not meet the minimum probability threshold that a tax position is more likely than not to be sustained upon examination by the taxing authority. In the normal course of business, we and our subsidiaries are examined by various federal, state, and foreign tax authorities. We regularly assess the potential outcomes of these examinations and any future examinations for the current or prior years in determining the adequacy of the provision for income taxes. We periodically assess the likelihood and amount of potential adjustments and adjust the income tax provision, the current tax liability, and deferred taxes in the period in which the facts that give rise to a revision become known.

(t) Recently Issued Accounting Pronouncements

None applicable.

(u) Recently Adopted Accounting Pronouncements

On March 12, 2020, the FASB issued ASU No. 2020-04, Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying generally accepted accounting principles to contract modifications and hedging relationships, subject to meeting certain criteria, that reference LIBOR or another reference rate expected to be discontinued. The ASU is effective for all entities as of March 12, 2020, and will apply, as later extended by ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, through December 31, 2024. To date, we have had no impacts on our investment portfolio or our credit agreement with Citizens Bank, N.A. related to reference rate reform. We will continue to evaluate the impact this guidance could have on our consolidated financial statements and related disclosures.

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”), which is intended to simplify various aspects related to accounting for income taxes. ASU 2019-12 removes certain exceptions to the general principles in Topic 740 and also clarifies and amends existing guidance to improve consistent application. ASU 2019-12 is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. We adopted ASU 2019-12 on January 1, 2021. This standard did not have a material impact on our financial position, results of operations and disclosures.

In June 2016, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-13 replaces the incurred loss impairment methodology for measuring and recognizing credit losses with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to inform credit loss estimates. This amendment is effective for fiscal years beginning after December 15, 2019. We adopted the updated guidance on January 1, 2020 on a prospective basis recording $0.5 million as a cumulative effect adjustment to retained earnings and as a result, prior period amounts were not adjusted. Adoption of the standard did not have a material impact on our financial position, results of operations, and disclosures.

ASSET ACQUISITIONS AND BUSINESS COMBINATIONS

12 Months Ended

Dec. 31, 2022

ASSET ACQUISITIONS AND BUSINESS COMBINATIONS [Abstract]

Asset Acquisitions And Business Combinations

NOTE 3. ASSET ACQUISITIONS AND BUSINESS COMBINATIONS

Asset Acquisitions

During the fourth quarter of 2021, the Company acquired substantially all the assets of Capstone Surgical Technologies, LLC (“Capstone”), which engages in the business of advanced drill and robotic surgery platforms. The purchase price consisted of $24.5 million of cash paid at closing, subject to net working capital and other post-closing adjustments, if applicable. The transaction also provides for additional consideration contingent upon the developed products obtaining approval from the U.S. Food and Drug Administration (the “FDA”) of up to $15.0 million, and additional consideration contingent upon the achievement of certain performance obligations of up to $10.0 million. Contingent consideration is not recorded in an asset acquisition until the milestone is met.

Also during the fourth quarter of 2021, the Company acquired substantially all the assets of a company that engages in the development of technology for use in robotic surgery platforms which was not considered material to the consolidated financial statements during the periods presented. The purchase price consisted of $10.0 million of cash paid at closing and also provides for additional consideration contingent upon the achievement of certain performance obligations of $5.0 million. Contingent consideration is not recorded in an asset acquisition until the milestone is met.

During the second quarter of 2020, the Company acquired Synoste, a Finnish engineering company that specializes in the research and development of a limb lengthening system. The fair value of the net assets acquired was $25.3 million, and the consideration consisted of approximately $22.8 million of cash paid at closing plus $2.5 million of a contractual holdback obligation payable eighteen months from the closing date of the transaction, subject to net working capital and other post-closing adjustments, if applicable. During the fourth quarter of 2021, the contractual holdback and net working capital and other post-closing adjustments were settled for $2.7 million. The transaction also provides for additional consideration of $8.0 million contingent upon the developed product obtaining approval from the FDA within the third anniversary, or $4.0 million within the fourth anniversary of the acquisition closing date, respectively. Contingent consideration is not recorded in an asset acquisition until the milestone is met.

The Company accounted for all of these transactions as asset acquisitions as substantially all of the fair value of the assets acquired in each transaction was concentrated in a single identified asset, in-process research and development (“IPR&D”) of the acquired technology, thus satisfying the requirements of the screen test in ASU 2017-1. At the date of the acquisitions, the Company determined that the development of the projects underway had not yet reached technological feasibility and that the research in process had no alternative future use. Accordingly,

the acquired IPR&D of $34.3 million and $24.4 million was charged to research and development expense in the consolidated statements of operations and comprehensive income for years ended 2021 and 2020, respectively.

Business Combinations

During the fourth quarter of 2022, the Company acquired the membership interests of Harvest Biologics LLC (the “Harvest Acquisition”), which engages in the business of selling systems that produce autologous biologics. The purchase price was a cash payment of $30 million, subject to post-closing adjustments, if applicable. The Company has included the financial results from the Harvest Acquisition in our consolidated financial statements from the acquisition date. At acquisition date, the preliminary fair value of the net assets acquired was $30.1 million. The purchase price consisted of approximately $30.0 million of cash paid at closing, plus $0.1 million of preliminary post-closing adjustments. The Company recorded identifiable net assets, based on their estimated fair values, for inventory of $3.0 million, goodwill of $14.2 million, customer relationships and other intangibles of $10.5 million with a weighted average useful life of 20 years, and developed technology of $2.4 million with a weighted average useful life of 8 years. The Company will finalize the purchase price allocation of the assets and liabilities acquired within one year from the date of acquisition.

During the second quarter of 2022, the Company completed one acquisition that was not considered material to the consolidated financial statements during the periods presented. This acquisition has been included in the condensed consolidated financial statements from the date of acquisition. The purchase price consisted of approximately $0.2 million of cash paid at closing and $4.4 million of contingent consideration payments, resulting in goodwill of $4.6 million based on the estimated fair values. The contingent payments for this acquisition are based upon achieving various performance milestones over a period of 10 years and are payable in a combination of cash and RSUs.

During 2021, the Company completed three acquisitions that were not considered material, individually or collectively, to the consolidated financial statements during the periods presented. Two acquisitions were completed in the third quarter, while the third acquisition was completed in the fourth quarter. These acquisitions have been included in the consolidated financial statements from the date of acquisition. The purchase price of the acquisition in the fourth quarter consisted of approximately $0.3 million of cash paid at closing and $13.0 million of contingent consideration payments, resulting in goodwill of $13.3 million based on the estimated fair values. The combined purchase price of the two acquisitions in the third quarter consisted of approximately $12.6 million of contingent consideration payments. The Company recorded other intangible assets of $1.6 million, with a weighted average useful life of 3.8 years, and goodwill of $11.0 million based on their estimated fair values. The contingent payments for all three acquisitions are based upon achieving various performance obligations over a period of 10 years and are payable in a combination of cash and RSUs.

During the fourth quarter of 2020, the Company completed two acquisitions that were not considered material, individually or collectively, to the overall consolidated financial statements during the periods presented. These acquisitions have been included in the consolidated financial statements from the date of acquisition. The combined purchase price consisted of approximately $1.5 million of cash paid at closing, plus $0.3 million of other liabilities and $33.2 million of contingent consideration payments. The contingent payments are based upon achieving various performance obligations over a period of 10 years, and are payable in a combination of cash and RSUs. The Company recorded other intangible assets of $8.8 million, with a weighted average useful life of 4.2 years, and goodwill of $26.2 million based on their fair values.

NET SALES

12 Months Ended

Dec. 31, 2022

NET SALES [Abstract]

Net Sales

NOTE 4. NET SALES

The following table represents net sales by product category:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Musculoskeletal Solutions	$	926,703	$	876,780	$	748,446
Enabling Technologies		96,140		81,322		40,596
Total net sales	$	1,022,843	$	958,102	$	789,042

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI https://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

+ Details

MARKETABLE SECURITIES

12 Months Ended

Dec. 31, 2022

MARKETABLE SECURITIES [Abstract]

Marketable Securities

NOTE 5. MARKETABLE SECURITIES

The composition of our short-term and long-term marketable securities is as follows:



	December 31, 2022
(In thousands)	Amortized ‎Cost		Gross ‎Unrealized ‎Gains		Gross Unrealized Losses		Fair ‎Value
Short-term:
Municipal bonds	$	83,279	$	9	$	(1,680)	$	81,608
Corporate debt securities		187,174		2		(3,438)		183,738
Commercial paper		5,583		—		(1)		5,582
Asset-backed securities		4,200		—		(181)		4,019
Government, federal agency, and other sovereign obligations		21,102		1		(458)		20,645
Total short-term marketable securities	$	301,338	$	12	$	(5,758)	$	295,592

Long-term:
Municipal bonds	$	61,986	$	44	$	(1,549)	$	60,481
Corporate debt securities		268,524		72		(8,947)		259,649
Asset-backed securities		120,929		217		(2,795)		118,351
Government, federal agency, and other sovereign obligations		58,453		18		(1,100)		57,371
Total long-term marketable securities	$	509,892	$	351	$	(14,391)	$	495,852



	December 31, 2021
(In thousands)	Amortized ‎Cost		Gross ‎Unrealized ‎Gains		Gross ‎Unrealized ‎Losses		Fair ‎Value
Short-term:
Municipal bonds	$	66,379	$	99	$	(11)	$	66,467
Corporate debt securities		107,102		434		(65)		107,471
Commercial paper		38,252		2		(1)		38,253
Asset-backed securities		12,931		58		—		12,989
Government, federal agency, and other sovereign obligations		25,231		—		(33)		25,198
Total short-term marketable securities	$	249,895	$	593	$	(110)	$	250,378

Long-term:
Municipal bonds	$	91,185	$	4	$	(409)	$	90,780
Corporate debt securities		324,492		351		(1,318)		323,525
Asset-backed securities		128,139		101		(578)		127,662
Government, federal agency, and other sovereign obligations		20,539		—		(31)		20,508
Total long-term marketable securities	$	564,355	$	456	$	(2,336)	$	562,475

The short-term marketable securities have effective maturity dates of less than one year and the long-term marketable securities have effective maturity dates ranging from one to three years as of December 31, 2022 and 2021, respectively.

Purchases of marketable securities include amounts payable to brokers of $2.2 million as of December 31, 2021. Purchases of marketable securities included no amounts payable to brokers as of December 31, 2022.

FAIR VALUE MEASUREMENTS

12 Months Ended

Dec. 31, 2022

FAIR VALUE MEASUREMENTS [Abstract]

Fair Value Measurements

NOTE 6. FAIR VALUE MEASUREMENTS

Assets and liabilities measured at fair value on a recurring basis as of December 31, 2022 and 2021, respectively included the following:



(In thousands)	Balance at December 31, 2022		Level 1		Level 2		Level 3
Assets:
Cash equivalents	$	17,655	$	17,655	$	—	$	—
Municipal bonds		142,089		—		142,089		—
Corporate debt securities		443,387		—		443,387		—
Commercial paper		5,582		—		5,582		—
Asset-backed securities		122,370		—		122,369		—
Government, federal agency, and other sovereign obligations		78,016		—		78,016		—
Liabilities:
Business acquisition liabilities		68,258		—		—		68,258



(In thousands)	Balance at December 31, 2021		Level 1		Level 2		Level 3
Assets:
Cash equivalents	$	26,684	$	3,768	$	22,916	$	—
Municipal bonds		157,247		—		157,247		—
Corporate debt securities		430,996		—		430,996		—
Commercial paper		38,253		—		38,253		—
Asset-backed securities		140,651		—		140,651		—
Government, federal agency, and other sovereign obligations		45,706		—		45,706		—
Liabilities:
Business acquisition liabilities		70,525		—		—		70,525

Our marketable securities are classified as Level 2 within the fair value hierarchy, as we measure their fair value using quoted market prices for similar instruments and inputs such as actual trade data, benchmark yields, broker/dealer quotes and other similar data obtained from quoted market prices or independent pricing vendors.

Assets and Liabilities That Are Measured at Fair Value on a Nonrecurring Basis

Fair value of the revenue-based business acquisition liabilities was determined using a discounted cash flow model and an option pricing methodology. The significant inputs of such models are not observable in the market, such as certain financial metric growth rates, volatility and discount rates, market price risk adjustment, projections associated with the applicable milestone, the interest rate, and the related probabilities and payment structure in the contingent consideration arrangement. The following are the significant unobservable inputs used in the two valuation techniques:


Unobservable input	Range			Weighted Average*
Revenue risk premium	2.4%	-	4.9%	2.8%
Revenue volatility	14.0%	-	15.8%	14.8%
Discount rate	5.9%	-	8.5%	6.7%
Projected year of payment	2022	-	2032

* The weighted average rates were calculated based on the relative fair value of each business acquisition liability.

The change in the carrying value of the business acquisition liabilities during the years ended December 31, 2022 and 2021, respectively included the following:



	Year Ended
	December 31,
(In thousands)	2022		2021
Beginning balance	$	70,525	$	37,270
Purchase price contingent consideration		4,414		25,662
Contingent cash payments		(9,787)		(6,753)
Contingent RSU grants		(1,986)		(1,877)
Changes in fair value of business acquisition liabilities		5,132		16,597
Contractual payable reclassification		(40)		(374)
Ending balance	$	68,258	$	70,525

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

INVENTORIES

12 Months Ended

Dec. 31, 2022

INVENTORIES [Abstract]

Inventories

NOTE 7. INVENTORIES

Inventories as of December 31, 2022 and 2021, respectively included the following:



	December 31,
(In thousands)	2022		2021
Raw materials	$	60,324	$	41,819
Work in process		18,699		17,401
Finished goods		219,958		177,781
Total inventories	$	298,981	$	237,001

During years ended December 31, 2022, 2021, and 2020, net adjustments to cost of sales related to excess and obsolete inventory were $6.4 million, $6.1 million, and $17.7 million, respectively. The net adjustments for the years ended December 31, 2022, 2021, and 2020 reflect a combination of additional expense for excess and obsolete related provisions ($18.5 million, $20.2 million, and $27.4 million, respectively) offset by sales and disposals ($12.1 million, $14.1 million, and $9.7 million, respectively) of inventory for which an excess and obsolete provision was previously recorded.

PROPERTY AND EQUIPMENT

12 Months Ended

Dec. 31, 2022

PROPERTY AND EQUIPMENT [Abstract]

Property And Equipment

NOTE 8. PROPERTY AND EQUIPMENT

Property and equipment as of December 31, 2022 and 2021, respectively included the following:



	Useful	December 31,
(In thousands)	Life	2022		2021
Land	—	$	8,277	$	8,296
Buildings and improvements	31.5		51,510		44,672
Equipment	5-15		148,803		113,301
Instruments	5		312,055		285,762
Modules and cases	5		48,023		44,185
Other property and equipment	3-5		18,097		30,435
			586,765		526,651
Less: accumulated depreciation			(343,036)		(305,575)
Total		$	243,729	$	221,076

Instruments are hand-held devices used by surgeons to install implants during surgery. Modules and cases are used to store and transport the instruments and implants.

Depreciation expense related to property and equipment was as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Depreciation	$	50,517	$	51,342	$	46,043

GOODWILL AND INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2022

GOODWILL AND INTANGIBLE ASSETS [Abstract]

Goodwill And Intangible Assets

NOTE 9. GOODWILL AND INTANGIBLE ASSETS

The change in the carrying amount of goodwill during the years ended December 31, 2022 and 2021, respectively included the following:



(In thousands)
December 31, 2020	$	156,716
Additions and adjustments		24,251
Foreign exchange		(1,259)
December 31, 2021		179,708
Additions and adjustments		18,799
Foreign exchange		(1,036)
December 31, 2022	$	197,471

Intangible assets as of December 31, 2022 included the following:



		December 31, 2022
(In thousands)	Weighted Average Amortization Period (in years)	Gross ‎Carrying ‎Amount		Accumulated ‎Amortization		Intangible ‎Assets, ‎net
Supplier network	10.0	$	4,000	$	(3,267)	$	733
Customer relationships & other intangibles	8.7		62,324		(41,651)		20,673
Developed technology	8.0		75,087		(37,984)		37,103
Patents	16.1		8,885		(3,820)		5,065
Total intangible assets		$	150,296	$	(86,722)	$	63,574

Intangible assets as of December 31, 2021 included the following:



		December 31, 2021
(In thousands)	Weighted Average Amortization Period (in years)	Gross ‎Carrying ‎Amount		Accumulated ‎Amortization		Intangible ‎Assets, ‎net
Supplier network	10.0	$	4,000	$	(2,867)	$	1,133
Customer relationships & other intangibles	6.4		56,264		(37,842)		18,422
Developed technology	8.0		71,947		(28,545)		43,402
Patents	16.1		8,938		(3,235)		5,703
Total intangible assets		$	141,149	$	(72,489)	$	68,660

The following table summarizes amortization of intangible assets for future periods as of December 31, 2022:


(In thousands)	Annual ‎Amortization
2023	$	16,894
2024		14,095
2025		9,810
2026		6,366
2027		4,647
Thereafter		11,762
Total	$	63,574

ACCRUED EXPENSES

12 Months Ended

Dec. 31, 2022

ACCRUED EXPENSES [Abstract]

Accrued Expenses

NOTE 10. ACCRUED EXPENSES

Accrued expenses as of December 31, 2022 and 2021, respectively included the following:



	December 31,
(In thousands)	2022		2021
Compensation and other employee-related costs	$	53,352	$	52,407
Legal and other settlements and expenses		5,564		6,124
Accrued non-income taxes		10,029		6,415
Royalties		4,375		4,558
Rebates		10,501		8,725
Other		10,884		12,939
Total accrued expenses	$	94,705	$	91,168

DEBT

12 Months Ended

Dec. 31, 2022

DEBT [Abstract]

Debt

NOTE 11. DEBT

Line of Credit

In August 2020, we entered into a credit agreement with Citizens Bank, N.A. (the “Credit Agreement”) that provides a revolving credit facility permitting borrowings up to $125.0 million (as amended, the “Revolving Credit Facility”), and has a termination date of August 2, 2023. The Revolving Credit Facility includes up to a $25.0 million sub limit for letters of credit. Revolving loans under the Credit Agreement will bear interest, at the Company’s option, at either a base rate or the Daily Bloomberg Short-Term Bank Yield (“BSBY”) (as defined in the Credit Agreement), plus, in each case, an applicable margin, as determined in accordance with the provisions of the Credit Agreement. The base rate will be the highest of: the rate of interest announced publicly by Citizens Bank, N.A. from time to time as its “prime rate”; the federal funds effective rate plus 1/2 of 1%; and the Daily BSBY Rate plus 1%. The applicable margin is subject to adjustment as provided in the Credit Agreement. The Credit Agreement contains financial and other customary covenants, including a maximum leverage ratio. As of December 31, 2022, we have not borrowed under the Revolving Credit Facility.

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
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+ Details

EQUITY

12 Months Ended

Dec. 31, 2022

EQUITY [Abstract]

Equity

NOTE 12. EQUITY

Stock Repurchases

On March 11, 2020, the Company announced a share repurchase program, which authorized the Company to repurchase up to $200 million of the Company’s Class A common stock. On March 4, 2022, the share repurchase program was expanded by authorizing the Company to repurchase an additional $200 million of the Company’s Class A common stock. The repurchase program has no time limit and may be suspended for periods or discontinued at any time. As of December 31, 2022, the Company has remaining authorization to repurchase a total of $150.8 million of Class A common stock. The timing and actual number of shares repurchased will depend on various factors including price, corporate and regulatory requirements, debt covenant requirements, alternative investment opportunities and other market conditions. Funding of share repurchases is expected to come from operating cash flows and excess cash.

Shares repurchased by the Company are accounted for under the constructive retirement method, in which the shares repurchased, are immediately retired, as there is no plan to reissue the shares. The Company made an accounting policy election to charge the excess of repurchase price over par value entirely to retained earnings.

The following table summarizes the activity related to share repurchases:

(In thousands except for per share prices)


Period	Total number of shares repurchased	Average price paid per share		Dollar amount of shares repurchased ⁽¹⁾		Approximate dollar value of shares that may yet be purchased under the plan
January 1, 2020 - March 31, 2020	1,920	$	38.49	$	73,902	$	126,098
April 1, 2020 - June 30, 2020	771		39.95		30,804		95,294
July 1, 2020 - September 30,2020	—		—		—		95,294
October 1, 2020 - December 31, 2020	—		—		—		95,294
January 1, 2021 - March 31, 2021	—		—		—		95,294
April 1, 2021 - June 30, 2021	—		—		—		95,294
July 1, 2021 - September 30, 2021	—		—		—		95,294
October 1, 2021 - December 31, 2021	—		—		—		95,294
January 1, 2022 - March 31, 2022	—		—		—		295,294
April 1, 2022 - June 30, 2022	2,351		61.45		144,493		150,801
July 1, 2022 - September 30, 2022	—		—		—		150,801
October 1, 2022 - December 31, 2022	—		—		—	$	150,801
January 1, 2020 - December 31, 2022	5,042	$	49.42	$	249,199

⁽¹⁾ Inclusive of an immaterial amount of commission fees

Common Stock

Our amended and restated Certificate of Incorporation provides for a total of 775,000,000 authorized shares of common stock. Of the authorized number of shares of common stock, 500,000,000 shares are designated as Class A common stock (“Class A Common”) and 275,000,000 shares are designated as Class B common stock (“Class B Common”).

The holders of Class A Common are entitled to one vote for each share of Class A Common held. Each share of our Class B common stock is convertible at any time at the option of the holder into one share of our Class A common stock. In addition, each share of our Class B common stock will convert automatically into one share of our Class A common stock upon any transfer, whether or not for value, except for permitted transfers. For more details relating to the conversion of our Class B common stock please see “Exhibit 4.2, Description of Securities of the Registrant” filed herein. The holders of Class B Common are entitled to 10 votes for each share of Class B Common held. The holders of Class A Common and Class B Common vote together as one class of common stock. Except for voting rights, the Class A Common and Class B Common have the same rights and privileges.

Accumulated Other Comprehensive Income (Loss)

The tables below present the changes in each component of accumulated other comprehensive income/(loss), including current period other comprehensive income/(loss) and reclassifications out of accumulated other comprehensive income/(loss) for the years ended December 31, 2022 and 2021, respectively:

(In thousands)	Unrealized loss on marketable securities, net of tax		Foreign currency translation adjustments		Accumulated other comprehensive loss
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2021	$	(1,053)	$	(5,719)	$	(6,772)
Other comprehensive income/(loss) before reclassifications		(18,494)		(3,818)		(22,312)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax		4,454		—		4,454
Other comprehensive income/(loss), net of tax		(14,040)		(3,818)		(17,858)
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2022	$	(15,093)	$	(9,537)	$	(24,630)


(In thousands)	Unrealized loss on marketable securities, net of tax		Foreign currency translation adjustments		Accumulated other comprehensive loss
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2020	$	5,001	$	(1,046)	$	3,955
Other comprehensive income/(loss) before reclassifications		(7,922)		(4,673)		(12,595)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax		1,868		—		1,868
Other comprehensive income/(loss), net of tax		(6,054)		(4,673)		(10,727)
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2021	$	(1,053)	$	(5,719)	$	(6,772)

Amounts reclassified from accumulated other comprehensive loss, net of tax, related to unrealized gains/losses on marketable securities were released to other income, net in our consolidated statements of operations and comprehensive income.

Earnings Per Common Share

The Company computes basic net income per share using the weighted-average number of common shares outstanding during the period. Diluted net income per share assumes the conversion, exercise or issuance of all potential common stock equivalents, unless the effect of inclusion would be anti-dilutive. For purposes of this calculation, common stock equivalents include the Company’s stock options and unvested RSUs. The contingently issuable shares are included in basic net income per share as of the date that all necessary conditions have been satisfied and are included in the denominator for dilutive calculation for the entire period if such shares would be issuable as of the end of the reporting period assuming the end of the reporting period was the end of the contingency period.

The following table sets forth the computation of basic and diluted earnings per share:


	Year Ended
	December 31,
(In thousands, except per share amounts)	2022		2021		2020
Numerator:
Net income/(loss)	$	190,169	$	149,191	$	102,285
Denominator for basic and diluted net income per share:
Weighted average shares outstanding for basic		100,469		100,734		98,580
Dilutive stock options and RSUs		2,174		2,889		2,391
Weighted average shares outstanding for diluted		102,643		103,623		100,971
Earnings per share:
Basic	$	1.89	$	1.48	$	1.04
Diluted	$	1.85	$	1.44	$	1.01

Anti-dilutive stock options and RSUs excluded from the calculation		3,851		2,139		5,454

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

+ References

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+ Details

STOCK-BASED AWARDS

12 Months Ended

Dec. 31, 2022

STOCK-BASED AWARDS [Abstract]

Stock-Based Awards

NOTE 13. STOCK-BASED AWARDS

We have two stock plans: our 2012 Equity Incentive Plan (the “2012 Plan”) and our 2021 Equity Incentive Plan (the “2021 Plan”), together with the 2012 Plan, the “Plans”. The 2021 Plan is the only active stock plan. The purpose of the 2012 Plan was, and of the 2021 Plan is, to provide incentive to employees, directors, and consultants of Globus. The Plans are administered by the Board of Directors of Globus (the “Board”) or its delegates. The number, type of option, exercise price, and vesting terms are determined by the Board or its delegates in accordance with the terms of the Plans. The options granted expire on a date specified by the Board, which is generally not more than ten years from the grant date. Options granted to employees generally vest in varying installments over a four-year period.

The 2012 Plan was approved by our Board in March 2012, and by our stockholders in June 2012. The 2012 Plan terminated as to new awards pursuant to its terms in 2022. Following effectiveness of the 2021 Plan, we have not issued any additional awards under the 2012 Plan; however, awards previously granted under the 2012 Plan remain outstanding and are administered by our Board under the terms and conditions of the 2012 Plan. Under the 2012 Plan, the aggregate number of shares of Class A Common stock that were able to be issued subject to options and other awards is equal to the sum of (i) 3,076,923 shares, (ii) any shares available for issuance under the 2008 Plan as of March 13, 2012, (iii) any shares underlying awards outstanding under the 2008 Plan as of March 13, 2012 that, on or after that date, are forfeited, terminated, expired or lapse for any reason, or are settled for cash without delivery of shares and (iv) starting January 1, 2013, an annual increase in the number of shares available under the 2012 Plan equal to up to 3% of the number of shares of our common and preferred stock outstanding at the end of the previous year, as determined by our Board. The number of shares that were able to be issued or transferred pursuant to incentive stock options under the 2012 Plan was limited to 10,769,230 shares. The shares of Class A Common covered by the 2012 Plan included authorized but unissued shares, treasury shares or shares of common stock purchased on the open market.

The 2021 Plan was approved by our Board in March 2021, and by our stockholders in June 2021. Under the 2021 Plan, as amended to date, the aggregate number of shares of Class A Common that were able to be issued subject to options and other awards is equal to the sum of (i) 4,000,000 shares, (ii) any shares available for issuance under the 2012 Plan as of June 3, 2021 and (iii) any shares underlying awards outstanding under the 2012 Plan or 2021 Plan as of June 3, 2021 that, on or after that date, are forfeited, terminated, expired or lapse for any reason, or are settled for cash without delivery of shares. The number of shares that could be issued or transferred pursuant to incentive stock options under the 2021 Plan is limited to 4,000,000 shares. The shares of Class A Common covered by the 2021 Plan include authorized but unissued shares, treasury shares or shares of common stock purchased on the open market.

As of December 31, 2022, pursuant to the 2021 Plan, there were 5,687,725 shares of Class A Common stock reserved and 2,634,899 shares of Class A Common stock available for future grants.

Stock Options

Stock option activity during the year ended December 31, 2022 is summarized as follows:



	Option ‎Shares (thousands)	Weighted average exercise price		Weighted ‎average ‎remaining ‎contractual ‎life (years)	Aggregate ‎intrinsic ‎value ‎(thousands)
Outstanding at December 31, 2021	9,463	$	48.01
Granted	2,736		64.06
Exercised	(999)		41.78
Forfeited	(862)		58.92
Outstanding at December 31, 2022	10,338	$	51.86	6.8	$	234,207
Exercisable at December 31, 2022	5,556	$	44.38	5.6	$	166,449
Expected to vest at December 31, 2022	4,782	$	60.54	8.2	$	67,758

The total intrinsic value of stock options exercised was $26.3 million, $71.3 million, and $76.1 million, during the years ended December 31, 2022, 2021, and 2020, respectively.

The fair value of the options was estimated on the date of the grant using a Black-Scholes option pricing model with the following assumptions:



	Year Ended
	December 31,
	2022			2021			2020
Risk-free interest rate	1.46%	-	4.04%	0.40%	-	1.14%	0.23%	-	1.67%
Expected term (years)	4.7	-	9.9	4.8			4.9
Expected volatility	33.0%	-	35.0%	33.0%	-	34.0%	28.0%	-	37.0%
Expected dividend yield		—%			—%			—%

The weighted average grant date fair value of stock options granted during the years ended December 31, 2022, 2021, and 2020 was $22.10, $20.34, and $14.81 per share, respectively.

Restricted Stock Units

Restricted stock unit activity during the year ended December 31, 2022 is summarized as follows:


	Restricted Stock ‎Units (thousands)	Weighted ‎average ‎grant date fair value ‎per share		Weighted ‎average ‎remaining ‎contractual ‎life (years)
Outstanding at December 31, 2021	29	$	72.54
Granted	31		62.77
Vested	—		—
Forfeited	—		—
Outstanding at December 31, 2022	60	$	67.40	7.8

Stock-Based Compensation

Compensation expense related to stock options granted to employees and non-employees under the Plans and the intrinsic value of stock options exercised was as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Stock-based compensation expense	$	32,810	$	30,586	$	27,073
Net stock-based compensation capitalized into inventory		657		667		257
Total stock-based compensation cost	$	33,467	$	31,253	$	27,330

As of December 31, 2022, there was $76.0 million of unrecognized compensation expense related to unvested employee stock options that vest over a weighted average period of three years.

INCOME TAXES

12 Months Ended

Dec. 31, 2022

INCOME TAXES [Abstract]

Income Taxes

NOTE 14. INCOME TAXES

The components of income before income taxes are as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Domestic	$	247,260	$	184,819	$	154,356
Foreign		(4,241)		(4,412)		(28,457)
Total	$	243,019	$	180,407	$	125,899

The components of the provision for income taxes are as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Current:
Federal	$	60,927	$	37,436	$	22,183
State		12,408		7,688		4,381
Foreign		1,845		3,741		991
		75,180		48,865		27,555
Deferred:
Federal		(16,429)		(13,535)		(3,293)
State		(3,142)		(2,265)		(678)
Foreign		(2,759)		(1,849)		30
		(22,330)		(17,649)		(3,941)
Total	$	52,850	$	31,216	$	23,614

A reconciliation of the statutory U.S. federal tax rate to our effective rate is as follows:



	Year Ended
	December 31,
	2022		2021		2020
Statutory U.S. federal tax rate	21.0	%	21.0	%	21.0	%
State income taxes, net of federal benefit	3.0		2.7		3.5
Foreign taxes	0.7		1.6		0.6
Valuation allowance	(0.5)		0.1		1.7
Domestic production activities deduction	—		(0.3)		(0.3)
Tax credits	(1.3)		(1.5)		(2.6)
Stock-based compensation windfall	(1.2)		(6.6)		(9.5)
Nondeductible expenses	—		0.5		0.5
Other	—		(0.2)		—
IPR&D	—		—		3.9
Effective tax rate	21.7	%	17.3	%	18.8	%

Deferred income taxes reflect the tax effects of temporary differences between the basis of assets and liabilities recognized for financial reporting purposes and tax purposes. Significant components of our deferred income taxes are as follows:



	December 31,
(In thousands)	2022		2021
Deferred tax assets:
Inventory reserve	$	29,649	$	29,417
Accruals, reserves, and other currently not deductible		27,608		23,102
Stock-based compensation		20,554		16,167
Capitalized R&E		14,279		—
Net operating loss carryforwards		4,182		3,812
Total deferred tax assets		96,272		72,498
Valuation allowance		(5,488)		(6,594)
Total deferred tax assets, net of valuation allowance		90,784		65,904
Deferred tax liabilities:
Depreciation and amortization		(43,718)		(45,724)
Total deferred tax liabilities		(43,718)		(45,724)
Net deferred tax assets/(liabilities)	$	47,066	$	20,180

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Based upon the level of historical taxable income and projections for future taxable income over the periods in which the deferred tax assets are deductible, management believes it is more likely than not that we will realize a portion of the benefits of these deductible differences at December 31, 2022 and 2021. The Company has established valuation allowances of $5.5 million and $6.6 million at December 31, 2022 and 2021, respectively, primarily related to the uncertainty of the utilization of certain deferred tax assets comprised of tax loss carryforwards in various jurisdictions. The decrease in the valuation allowance during fiscal year 2022 is primarily driven by foreign deferred tax assets that are expected to be realized. The amount of the deferred tax asset considered realizable, however, could be reduced in the near term if estimates of future taxable income during the carryforward period are reduced.

As of December 31, 2022 and 2021, we have NOL carryforwards of $20.2 million and $19.9 million, respectively, which, if unused, will expire in years 2023 through 2039.

A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Unrecognized tax benefits at the beginning of the year	$	1,052	$	1,600	$	2,399
Additions related to prior year tax positions		50		160		—
Reductions related to prior year tax positions		(116)		(708)		(799)
Unrecognized tax benefits at the end of the year	$	986	$	1,052	$	1,600

The reductions related to prior year tax positions for the year ended December 31, 2022 of $0.1 million are primarily related to the resolution of certain foreign tax positions.

The impact of our unrecognized tax benefits to the effective income tax rate is as follows:



	December 31,
(In thousands)	2022		2021		2020
Portion of total unrecognized tax benefits that, if recognized, would affect the effective income tax rate	$	1,355	$	1,471	$	2,032

The Company intends to indefinitely reinvest its foreign earnings abroad to ensure sufficient working capital for further expansion of its existing operations outside the United States, therefore the Company has not recorded income taxes on the undistributed earnings of its foreign subsidiaries. The undistributed earnings of our foreign subsidiaries as of December 31, 2022 are immaterial. In the event we are required to repatriate funds from outside of the United States, such repatriation may be subject to local laws, customs, and tax consequences.

Interest and penalties are recorded in the statement of income as provision for income taxes. The total interest and penalties recorded in the statement of income was immaterial for the years ended December 31, 2022, 2021, and 2020. We do not expect a significant change in our uncertain tax benefits in the next twelve months. We are subject to federal income tax as well as income tax of multiple state and foreign jurisdictions. With few exceptions, we are no longer subject to income tax examination by tax authorities in major jurisdictions for years prior to 2016 as of December 31, 2022.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

COMMITMENTS AND CONTINGENCIES

12 Months Ended

Dec. 31, 2022

COMMITMENTS AND CONTINGENCIES [Abstract]

Commitments And Contingencies

NOTE 15. COMMITMENTS AND CONTINGENCIES

We are involved in a number of proceedings, legal actions, and claims arising in the ordinary course of business. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is considered probable and the amount can be reasonably estimated. If the reasonable estimate of a probable loss is a range, and no amount in the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. While it is not possible to predict the outcome for most of the matters discussed, we believe it is possible that costs associated with them could have a material adverse impact on our consolidated earnings, financial position or cash flows.

Moskowitz Family LLC Litigation

On November 20, 2019, Moskowitz Family LLC filed suit against us in the U.S. District Court for the Western District of Texas for patent infringement. Moskowitz, a non-practicing entity, alleges that Globus willfully infringes one or more claims of six patents by making, using, offering for sale or selling the COALITION®, COALITION MIS®, COALITION AGX®, CORBEL®, MONUMENT®, MAGNIFY®-S, HEDRON IATM, HEDRON IC®, INDEPENDENCE®, INDEPENDENCE MIS®, INDEPENDENCE MIS AGX®, FORTIFY® and XPAND® families, SABLE®, RISE®, RISE® INTRALIF, RISE®-L, ELSA®, ELSA® ATP, ALTERA®, ARIEL®, CALIBER® and CALIBER®-L products. Moskowitz seeks monetary damages and injunctive relief. On July 2, 2020, this suit was transferred from the U.S. District Court for the Western District of Texas to the U.S. District Court for the Eastern District of Pennsylvania. The outcome of this litigation cannot be determined, nor can we estimate a range of potential loss, therefore, we have not recorded a liability related to this litigation as of December 31, 2022.

RETIREMENT BENEFIT PLANS

12 Months Ended

Dec. 31, 2022

RETIREMENT BENEFIT PLANS [Abstract]

Retirement Benefit Plans

NOTE 16. RETIREMENT BENEFIT PLANS

We sponsor a 401(k) Plan covering all eligible U.S. employees. Under the 401(k) Plan, we make nondiscretionary matching contributions at the rate of 100% of employee’s contributions up to a maximum annual contribution of $6,000 per eligible employee, limited to 3% of the employee’s compensation for the period.

Additionally, we contribute to various foreign retirement benefit plans required by local law or coordinated with government sponsored plans which cover many of our international employees. The benefits offered under these plans are reflective of local customs and practices in the countries concerned.

Company contributions to these retirement plans were as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
401(k) and other retirement plan contributions	$	7,154	$	6,588	$	5,798

SEGMENT AND GEOGRAPHIC INFORMATION

12 Months Ended

Dec. 31, 2022

SEGMENT AND GEOGRAPHIC INFORMATION [Abstract]

Segment And Geographic Information

NOTE 17. SEGMENT AND GEOGRAPHIC INFORMATION

Operating segments are defined as components of an enterprise for which separate financial information is available and evaluated regularly by the chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. We manage our business globally within one operating segment. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance.

The following table represents total net sales by geographic area, based on the location of the customer for the years ended December 31, 2022, 2021 and 2020, respectively:



	Year Ended
	December 31,
(In thousands)		2022		2021	2020
United States	$	871,939	$	819,571	$	664,454
International		150,904		138,531		124,588
Total net sales	$	1,022,843	$	958,102	$	789,042

- Definition

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

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+ Details

SUBSEQUENT EVENT

12 Months Ended

Dec. 31, 2022

SUBSEQUENT EVENT [Abstract]

Subsequent Event

NOTE 18. SUBSEQUENT EVENT

On February 8, 2023, the Company and its wholly-owned subsidiary, Zebra Merger Sub, Inc. (“Merger Sub”), entered into an Agreement and Plan of Merger (the “Merger Agreement”) with NuVasive, Inc., a Delaware corporation (“NuVasive”). The Merger Agreement provides, among other things, that subject to the satisfaction or waiver of the conditions set forth in the Merger Agreement, Merger Sub will merge with and into NuVasive (the “Merger”), with NuVasive surviving the Merger as a wholly owned subsidiary of the Company. The transaction brings together these two technology companies in the musculoskeletal industry, which have a shared vision focused on innovation in a relentless pursuit of unmet clinical needs to improve patient care.

Under the Merger Agreement, at the effective time of the Merger, each share of common stock, par value $0.001 per share, of NuVasive (“NuVasive Common Stock”) issued and outstanding immediately prior to the effective time (other than certain excluded shares as described in the Merger Agreement) will be cancelled and converted into the right to receive 0.75 fully paid and non-assessable shares of Class A common stock of Globus Medical, $0.001 par value per share (the “Globus Medical Class A Common Stock”), and the right to receive cash in lieu of fractional shares.

Following the close of the transaction, NuVasive shareholders will own approximately 28% of the combined company, and Globus Medical shareholders will own approximately 72%, on a fully diluted basis.

Either NuVasive or Globus Medical may terminate the Merger Agreement under certain circumstances described in the Merger Agreement, resulting in a termination fee payable to the other equal to $120 million or $75 million, depending on such circumstances. NuVasive will also be required to make a payment to Globus Medical equal to $60 million if the Merger Agreement is terminated because NuVasive’s stockholders fail to adopt the Merger Agreement and at the time of such failure, NuVasive’s board of directors has not changed its recommendation to its stockholders in favor of the Merger.

The transaction is expected to close in the middle of 2023, subject to approval by both companies’ shareholders, regulatory approval, and other customary closing conditions.

For additional information about the Merger Agreement, please refer to our Form 8-K filed on February 9, 2023.

No Offer or Solicitation

This filing is not intended to and does not constitute an offer to subscribe for, buy or sell, or the solicitation of an offer to subscribe for, buy or sell, or a solicitation of any vote or approval in any jurisdiction, nor shall there be any sale, issuance or transfer of securities in any jurisdiction in which such offer, sale or solicitation would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. No offer of securities shall be made except by means of a prospectus meeting the requirements of Section 10 of the Securities Act of 1933, as amended, and otherwise in accordance with applicable law.

Important Information About the Transaction and Where To Find It

In connection with the proposed transaction, Globus Medical will file with the U.S. Securities and Exchange Commission (“SEC”) a registration statement on Form S-4 that will include a joint proxy statement of Globus Medical and NuVasive and that will also constitute a prospectus of Globus Medical for shares of its class A common stock to be offered in the proposed transaction. Globus Medical and NuVasive may also file other documents with the SEC regarding the proposed transaction. This document is not a substitute for the joint proxy statement statement/prospectus or registration statement or any other document which Globus Medical or NuVasive may file with the SEC. INVESTORS AND SECURITY HOLDERS OF GLOBUS MEDICAL AND NUVASIVE ARE URGED TO READ THE REGISTRATION STATEMENT, WHICH WILL INCLUDE THE JOINT PROXY STATEMENT/PROSPECTUS, AND ANY OTHER RELEVANT DOCUMENTS THAT ARE FILED OR WILL BE FILED WITH THE SEC, AS WELL AS ANY AMENDMENTS OR SUPPLEMENTS TO THESE DOCUMENTS, CAREFULLY AND IN THEIR ENTIRETY BECAUSE THEY CONTAIN OR WILL CONTAIN IMPORTANT INFORMATION ABOUT THE PROPOSED TRANSACTION AND RELATED MATTERS. The registration statement, definitive joint proxy statement/ prospectus and other documents filed by Globus Medical and NuVasive with the SEC will be available free of charge at the SEC’s website (www.sec.gov) and from Globus Medical and NuVasive. Requests for copies of the joint proxy statement/ prospectus and other documents filed by Globus Medical with the SEC may be made by contacting Keith Pfeil, Chief Financial Officer by phone at (610) 930-1800 or by email at kpfeil@globusmedical.com, and request for copies of the joint proxy statement/prospectus and other documents filed by NuVasive may be made by contacting Matt Harbaugh, Chief Financial Officer, by phone at (858) 210-2129 or by email at investorrelations@nuvasive.com.

Participants in the Solicitation

Globus Medical, NuVasive, their respective directors and certain of their executive officers and other employees may be deemed to be participants in the solicitation of proxies from Globus Medical’s and NuVasive’s shareholders in connection with the proposed transaction. Information about the directors and executive officers of Globus Medical and their ownership of Globus Medical stock is set forth in Globus Medical’s annual report on Form 10-K for the fiscal year ended December 31, 2021, which was filed with the SEC on February 17, 2022 and its proxy statement for its 2022 annual meeting of stockholders, which was filed with the SEC on April 21, 2022. Information regarding NuVasive’s directors and executive officers is contained in NuVasive’s annual report on Form 10-K for the fiscal year ended December 31, 2021, which was filed with the SEC on February 23, 2022, and its proxy statement for its 2022 annual meeting of stockholders, which was filed with the SEC on March 30, 2022. Certain directors and executive officers of Globus Medical and NuVasive may have a direct or indirect interest in the transaction due to securities holdings, vesting of equity awards and rights to severance payments. Additional information regarding the persons who may, under the rules of the SEC, be deemed participants in the solicitation of Globus Medical’s and NuVasive’s shareholders in connection with the proposed transaction will be included in the joint proxy statement/prospectus. These documents can be obtained free of charge from the sources indicated above.

Cautionary Notes on Forward-Looking Statements

This Form 10-K contains “forward-looking statements” within the meaning of the federal securities laws, including Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. In this context, forward-looking statements often address expected future business and financial performance and financial condition, and often contain words such as “expect,” “anticipate,” “intend,” “plan,” “believe,” “seek,” “see,” “will,” “would,” “may,” “target,” and similar expressions and variations or negatives of these words. Forward-looking statements by their nature address matters that are, to different degrees, uncertain, such as statements about the consummation of the proposed transaction and the anticipated benefits thereof. These and other forward-looking statements are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to differ materially from those expressed in any forward-looking statements, including the failure to consummate the proposed transaction or to make any filing or take other action required to consummate such transaction in a timely matter or at all. Important risk factors that may cause such a difference include, but are not limited to: (i) the proposed transaction may not be completed on anticipated terms and timing, (ii) a condition to closing of the transaction may not be satisfied, including obtaining shareholder and regulatory approvals, (iii) the anticipated tax treatment of the transaction may not be

obtained, (iv) the potential impact of unforeseen liabilities, future capital expenditures, revenues, costs, expenses, earnings, synergies, economic performance, indebtedness, financial condition and losses on the future prospects, business and management strategies for the management, expansion and growth of the combined business after the consummation of the transactions, (v) potential litigation relating to the proposed transaction that could be instituted against Globus Medical, NuVasive or their respective directors, (vi) potential adverse reactions or changes to business relationships resulting from the announcement or completion of the transactions, (vii) any negative effects of the announcement, pendency or consummation of the transactions on the market price of Globus Medical’s or NuVasive’s common stock and on Globus Medical’s or NuVasive’s businesses or operating results, (viii) risks associated with third party contracts containing consent and/or other provisions that may be triggered by the proposed transaction, (ix) the risks and costs associated with the integration of, and the ability of Globus Medical and NuVasive to integrate, their businesses successfully and to achieve anticipated synergies, (x) the risk that disruptions from the proposed transaction will harm Globus Medical’s or NuVasive’s business, including current plans and operations, (xi) the ability of Globus Medical or NuVasive to retain and hire key personnel and uncertainties arising from leadership changes, (xii) legislative, regulatory and economic developments, and (xiii) the other risks described in Globus Medical’s and NuVasive’s most recent annual reports on Form 10-K and quarterly reports on Form 10-Q.

These risks, as well as other risks associated with the proposed transaction, will be more fully discussed in the joint proxy statement/prospectus that will be included in the registration statement on Form S-4 that will be filed with the SEC in connection with the proposed transaction. While the list of factors presented here is, and the list of factors to be presented in the registration statement on Form S-4 are, considered representative, no such list should be considered to be a complete statement of all potential risks and uncertainties. Unlisted factors may present significant additional obstacles to the realization of forward-looking statements. Consequences of material differences in results as compared with those anticipated in the forward-looking statements could include, among other things, business disruption, operational problems, financial loss, legal liability to third parties and similar risks, any of which could have a material adverse effect on Globus Medical’s or NuVasive’s consolidated financial condition, results of operations, credit rating or liquidity. Neither Globus Medical nor NuVasive assumes any obligation to publicly provide revisions or updates to any forward looking statements, whether as a result of new information, future developments or otherwise, should circumstances change, except as otherwise required by securities and other applicable laws.

SCHEDULE II VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS

12 Months Ended

Dec. 31, 2022

SCHEDULE II VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS [Abstract]

Schedule II Valuation Accounts and Qualifying Accounts

SCHEDULE II. VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS

Allowance for doubtful accounts:



(In thousands)	Beginning ‎of period		Charged ‎to expenses		Write-offs		End ‎of period
Year ended December 31, 2020	$	5,599	$	2,960	$	(4,151)	$	4,408
Year ended December 31, 2021		4,408	$	1,200	$	(646)	$	4,962
Year ended December 31, 2022	$	4,962	$	(1)	$	(237)	$	4,724

Deferred tax valuation allowance:



			Additions				Deductions
(In thousands)	Beginning ‎of period		Charged ‎to expenses		Charged to ‎other accounts		Other ‎deductions		End ‎of period
Year ended December 31, 2020	$	2,846		2,132		1,509		—		6,487
Year ended December 31, 2021		6,487	$	107	$	—	$	—	$	6,594
Year ended December 31, 2022	$	6,594	$	(1,106)	$	—	$	—	$	5,488

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policy)	12 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policy)	Dec. 31, 2022
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Basis of Presentation	Basis of Presentation The accompanying consolidated financial statements have been prepared in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”).
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of Globus and its wholly owned subsidiaries. All intercompany balances and transactions are eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements, and the reported amounts of revenues and expenses during the reporting period. We base our estimates, in part, on historical experience that management believes to be reasonable under the circumstances. Actual results could differ from those estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the consolidated financial statements in the period they are determined to be necessary. Significant areas that require estimates include revenue recognition, intangible assets, business acquisition liabilities, allowance for doubtful accounts, stock-based compensation, reserves for excess and obsolete inventory, useful lives of assets, the outcome of litigation, recoverability of intangible assets and income taxes. We are subject to risks and uncertainties due to changes in the healthcare environment, regulatory oversight, competition, and legislation that may cause actual results to differ from estimated results.
Revenue Recognition	Revenue Recognition Revenue is recognized upon transfer of control of promised products or services to customers in an amount that reflects the consideration we expect to receive in exchange for those products or services. Sales and other taxes we collect concurrent with revenue-producing activities are excluded from revenue. For purposes of disclosure, we disaggregate our revenue into two categories, Musculoskeletal Solutions and Enabling Technologies. Our Musculoskeletal Solutions products consist primarily of the implantable devices, disposables, and unique instruments used in an expansive range of spine, orthopedic trauma, hip, knee and extremity procedures. The majority of our Musculoskeletal Solutions contracts have a single performance obligation and revenue is recognized at a point in time. Our Enabling Technologies products are advanced hardware and software systems, and related technologies, that are designed to enhance a surgeon’s capabilities and streamline surgical procedures by making them less invasive, more accurate, and more reproducible to improve patient care. The majority of our Enabling Technologies product contracts contain multiple performance obligations, including maintenance and support, and revenue is recognized as we fulfill each performance obligation. When contracts have multiple performance obligations, we allocate the contract’s transaction price to each performance obligation using our best estimate of the standalone selling price of each distinct good or service in the contract. Our policy is to classify shipping and handling costs billed to customers as sales and the related expenses as cost of goods sold. Nature of Products and Services A significant portion of our Musculoskeletal Solutions product revenue is generated from consigned inventory maintained at hospitals or with sales representatives. Revenue from the sale of consigned musculoskeletal products is recognized when we transfer control, which occurs at the time the product is used or implanted. For all other Musculoskeletal Solutions product transactions, we recognize revenue when we transfer title to the goods, provided there are no remaining performance obligations that can affect the customer’s final acceptance of the sale. Revenue from the sale of Enabling Technologies products is generally recognized when control transfers to the customer which occurs at the time the product is shipped or delivered. Any revenue related to the provision of maintenance and support is recognized as we satisfy the performance obligation. We use an observable price to determine the stand-alone selling price for each separate performance obligation. Contract Balances Timing of revenue recognition may differ from the timing of invoicing to customers. We record a receivable when revenue is recognized prior to invoicing, or deferred revenue when revenue is recognized subsequent to invoicing. Deferred revenue is comprised mainly of unearned revenue related to the sales of certain Enabling Technologies products, which includes maintenance and support services. Maintenance and support services are generally invoiced annually, at the beginning of each contract period, and revenue is recognized ratably over the maintenance period. For the years ended December 31, 2022, 2021, and 2020, there was an immaterial amount of revenue recognized from previously deferred revenue.
Concentrations of Credit Risk	Concentrations of Credit Risk Financial instruments, which potentially subject us to concentrations of credit risk, are primarily marketable securities and accounts receivable. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of entities comprising our customer base. We perform ongoing credit evaluations of our customers and generally do not require collateral. There was no customer that accounted for 10% or more of sales for the years ended December 31, 2022, 2021, and 2020, respectively.
Cash, Cash Equivalents, and Restricted Cash	Cash, Cash Equivalents, and Restricted Cash The Company considers all short-term, highly liquid investments with original maturities of 90 days or less at acquisition date to be cash equivalents. Cash equivalents, which consist of money market accounts, commercial paper and corporate debt securities are stated at fair value.
Marketable Securities	Marketable Securities Our marketable securities include municipal bonds, corporate debt securities, commercial paper, asset-backed securities, and securities of government, federal agency, and other sovereign obligations, and are classified as available-for-sale as of December 31, 2022 and 2021. Short-term and long-term marketable securities are recorded at fair value on our consolidated balance sheets. Any change in fair value for available-for-sale securities, that do not result in recognition or reversal of an allowance for credit loss or write down, is recorded, net of taxes, as a component of accumulated other comprehensive income or loss on our consolidated balance sheets. Premiums and discounts are recognized over the life of the related security as an adjustment to yield using the straight-line method. Realized gains or losses from the sale of marketable securities are determined on a specific identification basis. Realized gains and losses, interest income and the amortization/accretion of premiums/discounts are included as a component of other income/(expense), net, on our consolidated statements of operations and comprehensive income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our consolidated balance sheets. We invest in securities that meet or exceed standards as defined in our investment policy. Our policy also limits the amount of credit exposure to any one issue, issuer or type of security. We review declines in the fair value of our securities to determine whether they are resulting from expected credit losses or other factors. If the assessment indicates a credit loss exists, we recognize any measured impairment as an allowance for credit loss in our consolidated statements of operations. Any other impairments not recorded through allowance for credit losses is recognized in our other comprehensive income.
Fair Value Measurements	Fair Value Measurements Assets and Liabilities That Are Measured at Fair Value on a Recurring Basis Fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or the liability in an orderly transaction between market participants on the measurement date. Additionally, a fair value hierarchy was established that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets and liabilities and the lowest priority to unobservable inputs. The level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. Our assets and liabilities measured at fair value on a recurring basis are classified and disclosed in one of the following three categories: Level 1—quoted prices (unadjusted) in active markets for identical assets and liabilities; Level 2—observable inputs other than quoted prices in active markets for identical assets and liabilities; and Level 3—unobservable inputs in which there is little or no market data available, which require the reporting entity to use significant unobservable inputs or valuation techniques. Assets and Liabilities That Are Measured at Fair Value on a Nonrecurring Basis The purchase price of business acquisitions is primarily allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values on the acquisition date, with the excess recorded as goodwill. We utilize Level 3 inputs in the determination of the initial fair value. Contingent consideration represents contingent milestone, performance and revenue-sharing payment obligations related to acquisitions and is measured at fair value, based on significant inputs that are not observable in the market, which represents a Level 3 measurement within the fair value hierarchy. The valuation of contingent consideration uses assumptions we believe would be made by a market participant. We assess these assumptions on an ongoing basis as additional data impacting the assumptions is obtained. The fair value of contingent consideration is recorded in business acquisition liabilities on our consolidated balance sheets, and changes in the fair value of contingent consideration is recognized in acquisition related costs in the consolidated statements of operations and comprehensive income. The fair value of contingent restricted stock unit (“RSU”) grants are recorded as additional paid-in capital in the consolidated balance sheet on the day of the grant due to the remote likelihood of forfeiture.
Inventories	Inventories Inventories are stated at the lower of cost or net realizable value. Cost is determined on a first-in, first-out basis. The majority of our inventory is finished goods and we utilize both in-house manufacturing and third-party suppliers to produce our products. We periodically evaluate the carrying value of our inventories in relation to estimated forecasts of product demand, which takes into consideration the life cycle of product releases. When quantities on hand exceed estimated sales forecasts, we record a write-down for such excess inventories. Once inventory has been written down, it creates a new cost basis for inventory that is not subsequently written up.
Property and Equipment	Property and Equipment Property and equipment is recorded at cost less accumulated depreciation. Additions or improvements are capitalized, while repairs and maintenance are expensed as incurred. Depreciation is recognized using the straight-line method over the related useful lives of the assets. When assets are sold or otherwise disposed of, the related property, equipment, and accumulated depreciation amounts are relieved from the accounts, and any gain or loss is recorded in the consolidated statements of operations and comprehensive income.
Goodwill and Intangible Assets	Goodwill and Intangible Assets Goodwill represents the excess of purchase price over the fair values of the identifiable assets acquired less the liabilities assumed in the acquisition of a business. Goodwill is tested for impairment at least annually or whenever events or circumstances indicate that a carrying amount may not be recoverable. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. Fair values are estimated using an income and discounted cash flow approach. We perform our annual impairment test of goodwill in the fourth quarter of each year. We consider qualitative indicators of the fair value of a reporting unit when it is unlikely that a reporting unit has impaired goodwill. During the years ended December 31, 2022, 2021, and 2020, we did not record any impairment charges related to goodwill. Intangible assets consist of purchased in-process research and development (“IPR&D”), developed technology, supplier network, patents, customer relationships, re-acquired rights, and non-compete agreements. Intangible assets with finite useful lives are amortized over the period of estimated benefit using the straight-line method and estimated useful lives ranging from one to twenty-one years. Intangible assets with finite useful lives are tested whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If an impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset. Fair value is generally determined using a discounted future cash flow analysis. There were no impairments of finite-lived intangible assets during the years ended December 31, 2022, 2021, and 2020. IPR&D has an indefinite life and is not amortized until completion of the project at which time the IPR&D becomes an amortizable asset. Intangible assets with indefinite useful lives are tested for impairment annually or whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If the related project is not completed in a timely manner, we may have an impairment related to the IPR&D, calculated as the excess of the asset’s carrying value over its fair value. There were no impairments of IPR&D during the years ended December 31, 2022, 2021, and 2020.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets We periodically evaluate the recoverability of the carrying amount of long-lived assets, which include property and equipment, as well as whenever events or changes in circumstances indicate that the carrying amount of an asset group may not be fully recoverable. An impairment is assessed when the undiscounted future cash flows from the use and eventual disposition of an asset group are less than its carrying value. If an impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset group. Our fair value methodology is based on quoted market prices, if available. If quoted market prices are not available, an estimate of fair value is made based on prices of similar assets or other valuation techniques including present value techniques. During the years ended December 31, 2022, 2021, and 2020, we did not record any impairment charges related to long-lived assets.
Cost of Goods Sold	Cost of Goods Sold Cost of goods sold consists primarily of costs from our manufacturing operations, costs of products purchased from third-party suppliers, reserves for excess and obsolete inventory, depreciation of surgical instruments and cases, royalties, shipping, inspection and related costs incurred in making our products available for sale or use.
Research and Development	Research and Development Research and development costs are expensed as incurred. Research and development costs include salaries, employee benefits, supplies, consulting services, clinical services and clinical trial costs, and facilities costs. Costs incurred in obtaining technology licenses and patents are charged immediately to research and development expense if the technology licensed has not reached technological feasibility and has no alternative future use.
Stock-Based Compensation	Stock-Based Compensation The cost of employee and non-employee director awards is measured at the grant date fair value of the award and is recognized as expense over the requisite service period, which is generally the vesting period of the equity award. Compensation expense for awards includes the impact of forfeiture in the period when they occur. We estimate the fair value of stock options utilizing the Black-Scholes option-pricing model. Inputs to the Black-Scholes model include our stock price, expected volatility, expected term, risk-free interest rate and expected dividends. Expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options offering period which is derived from historical experience. The risk-free interest rate assumption is based on observed interest rates of U.S. Treasury securities appropriate for the expected terms of the stock options. The dividend yield assumption is based on the history and expectation of no dividend payouts. The fair value of restricted stock units is estimated on the day of grant based on the closing price of the Company’s common stock.
Provision for Litigation	Provision for Litigation We are involved in a number of proceedings, legal actions, and claims. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is considered probable and the amount can be reasonably estimated. If the reasonable estimate of a probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. We expense legal costs related to loss contingencies as incurred.
Acquisition Related Costs	Acquisition Related Costs Acquisition related costs represents the change in fair value of business acquisition related contingent consideration; costs related to integrating recently acquired businesses including but not limited to costs to exit or convert contractual obligations, severance, and information system conversion; and specific costs related to the consummation of the acquisition process such as banker fees, legal fees, and other acquisition related professional fees.
Foreign Currency Translation	Foreign Currency Translation The functional currency of our foreign subsidiaries is generally their local currency. Assets and liabilities of the foreign subsidiaries are translated at the period end currency exchange rate and revenues and expenses are translated at an average currency exchange rate for the period. The resulting foreign currency translation gains and losses are included as a component of accumulated other comprehensive income. Gains and losses arising from intercompany foreign transactions are included in other income, net on the consolidated statements of operations and comprehensive income.
Income Taxes	Income Taxes Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the year in which such items are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period that includes the enactment date. A valuation allowance is established to offset any deferred tax assets if, based upon available evidence, it is more likely than not that some or all of the deferred tax assets will not be realized. Significant judgment is required in determining income tax provisions and in evaluating tax positions. We will establish additional provisions for income taxes when, despite the belief that tax positions are fully supportable, there remain certain positions that do not meet the minimum probability threshold that a tax position is more likely than not to be sustained upon examination by the taxing authority. In the normal course of business, we and our subsidiaries are examined by various federal, state, and foreign tax authorities. We regularly assess the potential outcomes of these examinations and any future examinations for the current or prior years in determining the adequacy of the provision for income taxes. We periodically assess the likelihood and amount of potential adjustments and adjust the income tax provision, the current tax liability, and deferred taxes in the period in which the facts that give rise to a revision become known.
Recently Issued Accounting Pronouncements & Recently Adopted Accounting Pronouncements	(t) Recently Issued Accounting Pronouncements None applicable. (u) Recently Adopted Accounting Pronouncements On March 12, 2020, the FASB issued ASU No. 2020-04, Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying generally accepted accounting principles to contract modifications and hedging relationships, subject to meeting certain criteria, that reference LIBOR or another reference rate expected to be discontinued. The ASU is effective for all entities as of March 12, 2020, and will apply, as later extended by ASU No. 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, through December 31, 2024. To date, we have had no impacts on our investment portfolio or our credit agreement with Citizens Bank, N.A. related to reference rate reform. We will continue to evaluate the impact this guidance could have on our consolidated financial statements and related disclosures. In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes (“ASU 2019-12”), which is intended to simplify various aspects related to accounting for income taxes. ASU 2019-12 removes certain exceptions to the general principles in Topic 740 and also clarifies and amends existing guidance to improve consistent application. ASU 2019-12 is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. We adopted ASU 2019-12 on January 1, 2021. This standard did not have a material impact on our financial position, results of operations and disclosures. In June 2016, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (ASU) 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-13 replaces the incurred loss impairment methodology for measuring and recognizing credit losses with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to inform credit loss estimates. This amendment is effective for fiscal years beginning after December 15, 2019. We adopted the updated guidance on January 1, 2020 on a prospective basis recording $0.5 million as a cumulative effect adjustment to retained earnings and as a result, prior period amounts were not adjusted. Adoption of the standard did not have a material impact on our financial position, results of operations, and disclosures.

NET SALES (Tables)

12 Months Ended

Dec. 31, 2022

NET SALES [Abstract]

Schedule of Net Sales by Product Category



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Musculoskeletal Solutions	$	926,703	$	876,780	$	748,446
Enabling Technologies		96,140		81,322		40,596
Total net sales	$	1,022,843	$	958,102	$	789,042

MARKETABLE SECURITIES (Tables)

12 Months Ended

Dec. 31, 2022

MARKETABLE SECURITIES [Abstract]

Composition of Marketable Securities

The composition of our short-term and long-term marketable securities is as follows:



	December 31, 2022
(In thousands)	Amortized ‎Cost		Gross ‎Unrealized ‎Gains		Gross Unrealized Losses		Fair ‎Value
Short-term:
Municipal bonds	$	83,279	$	9	$	(1,680)	$	81,608
Corporate debt securities		187,174		2		(3,438)		183,738
Commercial paper		5,583		—		(1)		5,582
Asset-backed securities		4,200		—		(181)		4,019
Government, federal agency, and other sovereign obligations		21,102		1		(458)		20,645
Total short-term marketable securities	$	301,338	$	12	$	(5,758)	$	295,592

Long-term:
Municipal bonds	$	61,986	$	44	$	(1,549)	$	60,481
Corporate debt securities		268,524		72		(8,947)		259,649
Asset-backed securities		120,929		217		(2,795)		118,351
Government, federal agency, and other sovereign obligations		58,453		18		(1,100)		57,371
Total long-term marketable securities	$	509,892	$	351	$	(14,391)	$	495,852



	December 31, 2021
(In thousands)	Amortized ‎Cost		Gross ‎Unrealized ‎Gains		Gross ‎Unrealized ‎Losses		Fair ‎Value
Short-term:
Municipal bonds	$	66,379	$	99	$	(11)	$	66,467
Corporate debt securities		107,102		434		(65)		107,471
Commercial paper		38,252		2		(1)		38,253
Asset-backed securities		12,931		58		—		12,989
Government, federal agency, and other sovereign obligations		25,231		—		(33)		25,198
Total short-term marketable securities	$	249,895	$	593	$	(110)	$	250,378

Long-term:
Municipal bonds	$	91,185	$	4	$	(409)	$	90,780
Corporate debt securities		324,492		351		(1,318)		323,525
Asset-backed securities		128,139		101		(578)		127,662
Government, federal agency, and other sovereign obligations		20,539		—		(31)		20,508
Total long-term marketable securities	$	564,355	$	456	$	(2,336)	$	562,475

FAIR VALUE MEASUREMENTS (Tables)

12 Months Ended

Dec. 31, 2022

FAIR VALUE MEASUREMENTS [Abstract]

Fair Value of Assets and Liabilities Measured on Recurring Basis



(In thousands)	Balance at December 31, 2022		Level 1		Level 2		Level 3
Assets:
Cash equivalents	$	17,655	$	17,655	$	—	$	—
Municipal bonds		142,089		—		142,089		—
Corporate debt securities		443,387		—		443,387		—
Commercial paper		5,582		—		5,582		—
Asset-backed securities		122,370		—		122,369		—
Government, federal agency, and other sovereign obligations		78,016		—		78,016		—
Liabilities:
Business acquisition liabilities		68,258		—		—		68,258



(In thousands)	Balance at December 31, 2021		Level 1		Level 2		Level 3
Assets:
Cash equivalents	$	26,684	$	3,768	$	22,916	$	—
Municipal bonds		157,247		—		157,247		—
Corporate debt securities		430,996		—		430,996		—
Commercial paper		38,253		—		38,253		—
Asset-backed securities		140,651		—		140,651		—
Government, federal agency, and other sovereign obligations		45,706		—		45,706		—
Liabilities:
Business acquisition liabilities		70,525		—		—		70,525

Significant Unobservable Inputs in Valuation Techniques


Unobservable input	Range			Weighted Average*
Revenue risk premium	2.4%	-	4.9%	2.8%
Revenue volatility	14.0%	-	15.8%	14.8%
Discount rate	5.9%	-	8.5%	6.7%
Projected year of payment	2022	-	2032

* The weighted average rates were calculated based on the relative fair value of each business acquisition liability.

Changes in Carrying Value of Business Acquisition Liabilities

The change in the carrying value of the business acquisition liabilities during the years ended December 31, 2022 and 2021, respectively included the following:



	Year Ended
	December 31,
(In thousands)	2022		2021
Beginning balance	$	70,525	$	37,270
Purchase price contingent consideration		4,414		25,662
Contingent cash payments		(9,787)		(6,753)
Contingent RSU grants		(1,986)		(1,877)
Changes in fair value of business acquisition liabilities		5,132		16,597
Contractual payable reclassification		(40)		(374)
Ending balance	$	68,258	$	70,525

INVENTORIES (Tables)

12 Months Ended

Dec. 31, 2022

INVENTORIES [Abstract]

Schedule of Inventory



	December 31,
(In thousands)	2022		2021
Raw materials	$	60,324	$	41,819
Work in process		18,699		17,401
Finished goods		219,958		177,781
Total inventories	$	298,981	$	237,001

PROPERTY AND EQUIPMENT (Tables)

12 Months Ended

Dec. 31, 2022

PROPERTY AND EQUIPMENT [Abstract]

Schedule of Property and Equipment



	Useful	December 31,
(In thousands)	Life	2022		2021
Land	—	$	8,277	$	8,296
Buildings and improvements	31.5		51,510		44,672
Equipment	5-15		148,803		113,301
Instruments	5		312,055		285,762
Modules and cases	5		48,023		44,185
Other property and equipment	3-5		18,097		30,435
			586,765		526,651
Less: accumulated depreciation			(343,036)		(305,575)
Total		$	243,729	$	221,076

Schedule of Depreciation Related to Property and Equipment



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Depreciation	$	50,517	$	51,342	$	46,043

GOODWILL AND INTANGIBLE ASSETS (Tables)

12 Months Ended

Dec. 31, 2022

GOODWILL AND INTANGIBLE ASSETS [Abstract]

Summary of Goodwill



(In thousands)
December 31, 2020	$	156,716
Additions and adjustments		24,251
Foreign exchange		(1,259)
December 31, 2021		179,708
Additions and adjustments		18,799
Foreign exchange		(1,036)
December 31, 2022	$	197,471

Summary of Intangible Assets

Intangible assets as of December 31, 2022 included the following:



		December 31, 2022
(In thousands)	Weighted Average Amortization Period (in years)	Gross ‎Carrying ‎Amount		Accumulated ‎Amortization		Intangible ‎Assets, ‎net
Supplier network	10.0	$	4,000	$	(3,267)	$	733
Customer relationships & other intangibles	8.7		62,324		(41,651)		20,673
Developed technology	8.0		75,087		(37,984)		37,103
Patents	16.1		8,885		(3,820)		5,065
Total intangible assets		$	150,296	$	(86,722)	$	63,574

Intangible assets as of December 31, 2021 included the following:



		December 31, 2021
(In thousands)	Weighted Average Amortization Period (in years)	Gross ‎Carrying ‎Amount		Accumulated ‎Amortization		Intangible ‎Assets, ‎net
Supplier network	10.0	$	4,000	$	(2,867)	$	1,133
Customer relationships & other intangibles	6.4		56,264		(37,842)		18,422
Developed technology	8.0		71,947		(28,545)		43,402
Patents	16.1		8,938		(3,235)		5,703
Total intangible assets		$	141,149	$	(72,489)	$	68,660

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense

The following table summarizes amortization of intangible assets for future periods as of December 31, 2022:


(In thousands)	Annual ‎Amortization
2023	$	16,894
2024		14,095
2025		9,810
2026		6,366
2027		4,647
Thereafter		11,762
Total	$	63,574

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
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-Paragraph 1
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+ Details

ACCRUED EXPENSES (Tables)

12 Months Ended

Dec. 31, 2022

ACCRUED EXPENSES [Abstract]

Schedule of Accrued Expenses



	December 31,
(In thousands)	2022		2021
Compensation and other employee-related costs	$	53,352	$	52,407
Legal and other settlements and expenses		5,564		6,124
Accrued non-income taxes		10,029		6,415
Royalties		4,375		4,558
Rebates		10,501		8,725
Other		10,884		12,939
Total accrued expenses	$	94,705	$	91,168

EQUITY (Tables)

12 Months Ended

Dec. 31, 2022

EQUITY [Abstract]

Schedule of Shares Repurchased

(In thousands except for per share prices)


Period	Total number of shares repurchased	Average price paid per share		Dollar amount of shares repurchased ⁽¹⁾		Approximate dollar value of shares that may yet be purchased under the plan
January 1, 2020 - March 31, 2020	1,920	$	38.49	$	73,902	$	126,098
April 1, 2020 - June 30, 2020	771		39.95		30,804		95,294
July 1, 2020 - September 30,2020	—		—		—		95,294
October 1, 2020 - December 31, 2020	—		—		—		95,294
January 1, 2021 - March 31, 2021	—		—		—		95,294
April 1, 2021 - June 30, 2021	—		—		—		95,294
July 1, 2021 - September 30, 2021	—		—		—		95,294
October 1, 2021 - December 31, 2021	—		—		—		95,294
January 1, 2022 - March 31, 2022	—		—		—		295,294
April 1, 2022 - June 30, 2022	2,351		61.45		144,493		150,801
July 1, 2022 - September 30, 2022	—		—		—		150,801
October 1, 2022 - December 31, 2022	—		—		—	$	150,801
January 1, 2020 - December 31, 2022	5,042	$	49.42	$	249,199

⁽¹⁾ Inclusive of an immaterial amount of commission fees

Accumulated Other Comprehensive Income (Loss)

(In thousands)	Unrealized loss on marketable securities, net of tax		Foreign currency translation adjustments		Accumulated other comprehensive loss
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2021	$	(1,053)	$	(5,719)	$	(6,772)
Other comprehensive income/(loss) before reclassifications		(18,494)		(3,818)		(22,312)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax		4,454		—		4,454
Other comprehensive income/(loss), net of tax		(14,040)		(3,818)		(17,858)
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2022	$	(15,093)	$	(9,537)	$	(24,630)


(In thousands)	Unrealized loss on marketable securities, net of tax		Foreign currency translation adjustments		Accumulated other comprehensive loss
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2020	$	5,001	$	(1,046)	$	3,955
Other comprehensive income/(loss) before reclassifications		(7,922)		(4,673)		(12,595)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax		1,868		—		1,868
Other comprehensive income/(loss), net of tax		(6,054)		(4,673)		(10,727)
Accumulated other comprehensive income/(loss), net of tax, at December 31, 2021	$	(1,053)	$	(5,719)	$	(6,772)

Schedule of Computation of Basic and Diluted Earnings


	Year Ended
	December 31,
(In thousands, except per share amounts)	2022		2021		2020
Numerator:
Net income/(loss)	$	190,169	$	149,191	$	102,285
Denominator for basic and diluted net income per share:
Weighted average shares outstanding for basic		100,469		100,734		98,580
Dilutive stock options and RSUs		2,174		2,889		2,391
Weighted average shares outstanding for diluted		102,643		103,623		100,971
Earnings per share:
Basic	$	1.89	$	1.48	$	1.04
Diluted	$	1.85	$	1.44	$	1.01

Anti-dilutive stock options and RSUs excluded from the calculation		3,851		2,139		5,454

STOCK-BASED AWARDS (Tables)

12 Months Ended

Dec. 31, 2022

STOCK-BASED AWARDS [Abstract]

Summary of Stock Option Activity



	Option ‎Shares (thousands)	Weighted average exercise price		Weighted ‎average ‎remaining ‎contractual ‎life (years)	Aggregate ‎intrinsic ‎value ‎(thousands)
Outstanding at December 31, 2021	9,463	$	48.01
Granted	2,736		64.06
Exercised	(999)		41.78
Forfeited	(862)		58.92
Outstanding at December 31, 2022	10,338	$	51.86	6.8	$	234,207
Exercisable at December 31, 2022	5,556	$	44.38	5.6	$	166,449
Expected to vest at December 31, 2022	4,782	$	60.54	8.2	$	67,758

Fair Value of Options Using Black Scholes Option Pricing Model



	Year Ended
	December 31,
	2022			2021			2020
Risk-free interest rate	1.46%	-	4.04%	0.40%	-	1.14%	0.23%	-	1.67%
Expected term (years)	4.7	-	9.9	4.8			4.9
Expected volatility	33.0%	-	35.0%	33.0%	-	34.0%	28.0%	-	37.0%
Expected dividend yield		—%			—%			—%

Summary of Restricted Stock Unit Activity


	Restricted Stock ‎Units (thousands)	Weighted ‎average ‎grant date fair value ‎per share		Weighted ‎average ‎remaining ‎contractual ‎life (years)
Outstanding at December 31, 2021	29	$	72.54
Granted	31		62.77
Vested	—		—
Forfeited	—		—
Outstanding at December 31, 2022	60	$	67.40	7.8

Stock-based Compensation Schedule



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Stock-based compensation expense	$	32,810	$	30,586	$	27,073
Net stock-based compensation capitalized into inventory		657		667		257
Total stock-based compensation cost	$	33,467	$	31,253	$	27,330

INCOME TAXES (Tables)

12 Months Ended

Dec. 31, 2022

INCOME TAXES [Abstract]

Schedule of Components of Income Before Income Taxes

The components of income before income taxes are as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Domestic	$	247,260	$	184,819	$	154,356
Foreign		(4,241)		(4,412)		(28,457)
Total	$	243,019	$	180,407	$	125,899

Schedule of Components of the Provision for Income Taxes

The components of the provision for income taxes are as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Current:
Federal	$	60,927	$	37,436	$	22,183
State		12,408		7,688		4,381
Foreign		1,845		3,741		991
		75,180		48,865		27,555
Deferred:
Federal		(16,429)		(13,535)		(3,293)
State		(3,142)		(2,265)		(678)
Foreign		(2,759)		(1,849)		30
		(22,330)		(17,649)		(3,941)
Total	$	52,850	$	31,216	$	23,614

Summary of Effective Tax Rate

A reconciliation of the statutory U.S. federal tax rate to our effective rate is as follows:



	Year Ended
	December 31,
	2022		2021		2020
Statutory U.S. federal tax rate	21.0	%	21.0	%	21.0	%
State income taxes, net of federal benefit	3.0		2.7		3.5
Foreign taxes	0.7		1.6		0.6
Valuation allowance	(0.5)		0.1		1.7
Domestic production activities deduction	—		(0.3)		(0.3)
Tax credits	(1.3)		(1.5)		(2.6)
Stock-based compensation windfall	(1.2)		(6.6)		(9.5)
Nondeductible expenses	—		0.5		0.5
Other	—		(0.2)		—
IPR&D	—		—		3.9
Effective tax rate	21.7	%	17.3	%	18.8	%

Schedule of Significant Components of Deferred Income Taxes



	December 31,
(In thousands)	2022		2021
Deferred tax assets:
Inventory reserve	$	29,649	$	29,417
Accruals, reserves, and other currently not deductible		27,608		23,102
Stock-based compensation		20,554		16,167
Capitalized R&E		14,279		—
Net operating loss carryforwards		4,182		3,812
Total deferred tax assets		96,272		72,498
Valuation allowance		(5,488)		(6,594)
Total deferred tax assets, net of valuation allowance		90,784		65,904
Deferred tax liabilities:
Depreciation and amortization		(43,718)		(45,724)
Total deferred tax liabilities		(43,718)		(45,724)
Net deferred tax assets/(liabilities)	$	47,066	$	20,180

Reconciliation of Unrecognized Tax Benefits

A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows:



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
Unrecognized tax benefits at the beginning of the year	$	1,052	$	1,600	$	2,399
Additions related to prior year tax positions		50		160		—
Reductions related to prior year tax positions		(116)		(708)		(799)
Unrecognized tax benefits at the end of the year	$	986	$	1,052	$	1,600

Impact Of Unrecognized Tax Benefits To Effective Income Tax Rate

The impact of our unrecognized tax benefits to the effective income tax rate is as follows:



	December 31,
(In thousands)	2022		2021		2020
Portion of total unrecognized tax benefits that, if recognized, would affect the effective income tax rate	$	1,355	$	1,471	$	2,032

RETIREMENT BENEFIT PLANS (Tables)

12 Months Ended

Dec. 31, 2022

RETIREMENT BENEFIT PLANS [Abstract]

Contributions To Retirement Plans



	Year Ended
	December 31,
(In thousands)	2022		2021		2020
401(k) and other retirement plan contributions	$	7,154	$	6,588	$	5,798

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

12 Months Ended

Dec. 31, 2022

SEGMENT AND GEOGRAPHIC INFORMATION [Abstract]

Schedule of Total Sales by Geographical Area

The following table represents total net sales by geographic area, based on the location of the customer for the years ended December 31, 2022, 2021 and 2020, respectively:



	Year Ended
	December 31,
(In thousands)		2022		2021	2020
United States	$	871,939	$	819,571	$	664,454
International		150,904		138,531		124,588
Total net sales	$	1,022,843	$	958,102	$	789,042

BACKGROUND (Narrative) (Details)	Dec. 31, 2022 item
BACKGROUND [Abstract]
Number of products launched	230

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Narrative) (Details)	12 Months Ended
	Dec. 31, 2022 USD ($) item	Dec. 31, 2021 USD ($) item	Dec. 31, 2020 USD ($) item
Summary Of Significant Accounting Policies [Line Items]
Number of customers that accounted for 10% or more of sales \| item	0	0	0
Goodwill impairment	$ 0	$ 0	$ 0
Impairment of finite-lived intangible assets	0	0	0
Impairment of intangible assets	0	0	0
Impairment of long-lived assets	$ 0	$ 0	$ 0
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	1 year
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives	21 years

ASSET ACQUISITIONS AND BUSINESS COMBINATIONS (Narrative) (Details) $ in Thousands	3 Months Ended						12 Months Ended
	Dec. 31, 2022 USD ($)	Jun. 30, 2022 USD ($) item	Dec. 31, 2021 USD ($)	Sep. 30, 2021 USD ($) item	Dec. 31, 2020 USD ($) item	Jun. 30, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($) item	Dec. 31, 2020 USD ($)
Business Acquisition [Line Items]
Contingent consideration liability	$ 68,258		$ 70,525				$ 68,258	$ 70,525
Goodwill	197,471		179,708		$ 156,716		197,471	179,708	$ 156,716
Acquired in-process research and development							$ 150	$ 34,312	24,418
Customer Relationships & Other Intangibles [Member]
Business Acquisition [Line Items]
Weighted average amortization period							8 years 8 months 12 days	6 years 4 months 24 days
Developed Technology [Member]
Business Acquisition [Line Items]
Weighted average amortization period							8 years	8 years
Capstone Surgical Technologies, LLC [Member]
Business Acquisition [Line Items]
Asset Acquisition, Consideration Transferred			24,500
Synoste Acquisition [Member]
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross						$ 22,800
Contingent consideration payment			2,700
Business Acquisitions, Contractual Holdback Obligation Payable Period						18 months
Acquired in-process research and development								$ 34,300	24,400
Asset Acquisition, Consideration Transferred						$ 25,300
Additional contingent consideration						$ 2,500
Development Of Technology, Robotic Surgery Platforms [Member]
Business Acquisition [Line Items]
Purchase price of assets			10,000
Additional contingent consideration			5,000
Approval Of FDA [Member] \| Capstone Surgical Technologies, LLC [Member]
Business Acquisition [Line Items]
Additional contingent consideration							$ 15,000
Achievement Of Certain Performance Obligation [Member] \| Capstone Surgical Technologies, LLC [Member]
Business Acquisition [Line Items]
Additional contingent consideration							10,000
Third Anniversary [Member] \| Synoste Acquisition [Member]
Business Acquisition [Line Items]
Additional contingent consideration							8,000
Fourth Anniversary [Member] \| Synoste Acquisition [Member]
Business Acquisition [Line Items]
Additional contingent consideration							4,000
Harvest Biologics, LLC [Member]
Business Acquisition [Line Items]
Preliminary fair value of the net assets acquired	30,100						30,100
Purchase price, preliminary post-closing adjustments	100						100
Inventory acquired	3,000						3,000
Payments to Acquire Businesses, Gross	30,000
Business combination, consideration transferred	30,000
Goodwill	14,200						14,200
Harvest Biologics, LLC [Member] \| Customer Relationships & Other Intangibles [Member]
Business Acquisition [Line Items]
Intangible assets acquired	$ 10,500						10,500
Weighted average amortization period	20 years
Harvest Biologics, LLC [Member] \| Developed Technology [Member]
Business Acquisition [Line Items]
Intangible assets acquired	$ 2,400						$ 2,400
Weighted average amortization period	8 years
Series of Individually Immaterial Business Acquisitions [Member]
Business Acquisition [Line Items]
Number of acquisitions \| item		1		2	2			3
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Intangible Assets, Other than Goodwill				$ 1,600	$ 8,800				8,800
Weighted average amortization period				3 years 9 months 18 days	4 years 2 months 12 days
Payments to Acquire Businesses, Gross			300		$ 1,500
Business combination, consideration transferred		$ 200
Contingent consideration liability			13,000		33,200			$ 13,000	33,200
Contingent payments, performance period		10 years
Goodwill		$ 4,600	$ 13,300	$ 11,000	$ 26,200			$ 13,300	$ 26,200
Contingent consideration payment		$ 4,400		$ 12,600
Business Acquisitions, Contractual Holdback Obligation Payable Period					10 years			10 years
Liabilities incurred from acquisition					$ 300

NET SALES (Schedule of Net Sales by Product Category) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Net sales	$ 1,022,843	$ 958,102	$ 789,042
Musculoskeletal Solutions [Member]
Disaggregation of Revenue [Line Items]
Net sales	926,703	876,780	748,446
Enabling Technologies [Member]
Disaggregation of Revenue [Line Items]
Net sales	$ 96,140	$ 81,322	$ 40,596

- Definition

Amount of revenue recognized from goods sold, services rendered, insurance premiums, or other activities that constitute an earning process. Includes, but is not limited to, investment and interest income before deduction of interest expense when recognized as a component of revenue, and sales and trading gain (loss).

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Reference 22: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 10
-Section S99
-Paragraph 1A
-Subparagraph (SX 210.13-01(a)(4)(ii))
-URI https://asc.fasb.org/extlink&oid=126975872&loc=SL124442526-122756

Reference 23: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(1))
-URI https://asc.fasb.org/extlink&oid=126953954&loc=SL114868664-224227

+ Details

MARKETABLE SECURITIES (Narrative) (Details) - USD ($)	12 Months Ended
MARKETABLE SECURITIES (Narrative) (Details) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Debt Securities, Available-for-sale [Line Items]
Payable to brokers	$ 0	$ 2,200,000
Short-term Investments [Member] \| Maximum [Member]
Debt Securities, Available-for-sale [Line Items]
Contractual Maturity	1 year	1 year
Long-term Investments [Member] \| Minimum [Member]
Debt Securities, Available-for-sale [Line Items]
Contractual Maturity	1 year	1 year
Long-term Investments [Member] \| Maximum [Member]
Debt Securities, Available-for-sale [Line Items]
Contractual Maturity	3 years	3 years

MARKETABLE SECURITIES (Composition of Marketable Securities) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	$ 301,338	$ 249,895
Gross Unrealized Gains, Short-term	12	593
Gross Unrealized Losses, Short-term	(5,758)	(110)
Fair Value, Short-term	295,592	250,378
Amortized Cost, Long-term	509,892	564,355
Gross Unrealized Gains, Long-term	351	456
Gross Unrealized Losses, Long-term	(14,391)	(2,336)
Fair Value, Long-term	495,852	562,475
Municipal Bonds [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	83,279	66,379
Gross Unrealized Gains, Short-term	9	99
Gross Unrealized Losses, Short-term	(1,680)	(11)
Fair Value, Short-term	81,608	66,467
Amortized Cost, Long-term	61,986	91,185
Gross Unrealized Gains, Long-term	44	4
Gross Unrealized Losses, Long-term	(1,549)	(409)
Fair Value, Long-term	60,481	90,780
Corporate Debt Securities [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	187,174	107,102
Gross Unrealized Gains, Short-term	2	434
Gross Unrealized Losses, Short-term	(3,438)	(65)
Fair Value, Short-term	183,738	107,471
Amortized Cost, Long-term	268,524	324,492
Gross Unrealized Gains, Long-term	72	351
Gross Unrealized Losses, Long-term	(8,947)	(1,318)
Fair Value, Long-term	259,649	323,525
Commercial Paper [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	5,583	38,252
Gross Unrealized Gains, Short-term		2
Gross Unrealized Losses, Short-term	(1)	(1)
Fair Value, Short-term	5,582	38,253
Asset-backed Securities [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	4,200	12,931
Gross Unrealized Gains, Short-term		58
Gross Unrealized Losses, Short-term	(181)
Fair Value, Short-term	4,019	12,989
Amortized Cost, Long-term	120,929	128,139
Gross Unrealized Gains, Long-term	217	101
Gross Unrealized Losses, Long-term	(2,795)	(578)
Fair Value, Long-term	118,351	127,662
Government, Federal Agency, And Other Sovereign Obligations [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost, Short-term	21,102	25,231
Gross Unrealized Gains, Short-term	1
Gross Unrealized Losses, Short-term	(458)	(33)
Fair Value, Short-term	20,645	25,198
Amortized Cost, Long-term	58,453	20,539
Gross Unrealized Gains, Long-term	18
Gross Unrealized Losses, Long-term	(1,100)	(31)
Fair Value, Long-term	$ 57,371	$ 20,508

FAIR VALUE MEASUREMENTS (Fair Value of Assets and Liabilities Measured on Recurring Basis) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents	$ 17,655	$ 26,684
Business acquisition liabilities	68,258	70,525
Municipal Bonds [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	142,089	157,247
Corporate Debt Securities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	443,387	430,996
Commercial Paper [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	5,582	38,253
Asset-backed Securities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	122,370	140,651
Government, Federal Agency, And Other Sovereign Obligations [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	78,016	45,706
Fair Value, Inputs, Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents	17,655	3,768
Fair Value, Inputs, Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash equivalents		22,916
Fair Value, Inputs, Level 2 [Member] \| Municipal Bonds [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	142,089	157,247
Fair Value, Inputs, Level 2 [Member] \| Corporate Debt Securities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	443,387	430,996
Fair Value, Inputs, Level 2 [Member] \| Commercial Paper [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	5,582	38,253
Fair Value, Inputs, Level 2 [Member] \| Asset-backed Securities [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	122,369	140,651
Fair Value, Inputs, Level 2 [Member] \| Government, Federal Agency, And Other Sovereign Obligations [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Securities	78,016	45,706
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business acquisition liabilities	$ 68,258	$ 70,525	$ 37,270

FAIR VALUE MEASUREMENTS (Significant Unobservable Inputs in Valuation Techniques) (Details) - Fair Value, Inputs, Level 3 [Member]

12 Months Ended

Dec. 31, 2022

item

Maximum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Projected year of payment

2032

Minimum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Projected year of payment

2022

Revenue Risk Premium [Member] | Maximum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

4.9

Revenue Risk Premium [Member] | Minimum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

2.4

Revenue Risk Premium [Member] | Weighted Average [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

2.8

^[1]

Revenue Volatility [Member] | Maximum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

15.8

Revenue Volatility [Member] | Minimum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

14.0

Revenue Volatility [Member] | Weighted Average [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

14.8

^[1]

Discount Rate [Member] | Maximum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

8.5

Discount Rate [Member] | Minimum [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

5.9

Discount Rate [Member] | Weighted Average [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business acquisition liabilities, measurement input

6.7

^[1]

[1]	The weighted average rates were calculated based on the relative fair value of each business acquisition liability.

FAIR VALUE MEASUREMENTS (Changes in Carrying Value of Business Acquisition Liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value measurement, beginning balance	$ 70,525
Fair value measurement, ending balance	68,258	$ 70,525
Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value measurement, beginning balance	70,525	37,270
Purchase price contingent consideration	4,414	25,662
Contingent cash payments	(9,787)	(6,753)
Contingent RSU grants	(1,986)	(1,877)
Changes in fair value of business acquisition liabilities	5,132	16,597
Contractual payable reclassification	(40)	(374)
Fair value measurement, ending balance	$ 68,258	$ 70,525

INVENTORIES (Narrative) (Details) - USD ($) $ in Millions	12 Months Ended
INVENTORIES (Narrative) (Details) - USD ($) $ in Millions	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INVENTORIES [Abstract]
Net adjustment to cost of sales related to excess and obsolete inventory	$ 6.4	$ 6.1	$ 17.7
Excess and obsolete related provisions	18.5	20.2	27.4
Inventory sales and disposals related provisions	$ 12.1	$ 14.1	$ 9.7

INVENTORIES (Schedule of Inventory) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
INVENTORIES [Abstract]
Raw materials	$ 60,324	$ 41,819
Work in process	18,699	17,401
Finished goods	219,958	177,781
Total inventories	$ 298,981	$ 237,001

PROPERTY AND EQUIPMENT (Schedule of Property and Equipment) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property and equipment	$ 586,765	$ 526,651
Less: accumulated depreciation	(343,036)	(305,575)
Total	243,729	221,076
Land [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	8,277	8,296
Building and Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	$ 51,510	44,672
Useful Life	31 years 6 months
Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	$ 148,803	113,301
Instruments [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	$ 312,055	285,762
Useful Life	5 years
Modules and cases [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	$ 48,023	44,185
Useful Life	5 years
Other Property and Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment	$ 18,097	$ 30,435
Maximum [Member] \| Equipment [Member]
Property, Plant and Equipment [Line Items]
Useful Life	15 years
Maximum [Member] \| Other Property and Equipment [Member]
Property, Plant and Equipment [Line Items]
Useful Life	5 years
Minimum [Member] \| Equipment [Member]
Property, Plant and Equipment [Line Items]
Useful Life	5 years
Minimum [Member] \| Other Property and Equipment [Member]
Property, Plant and Equipment [Line Items]
Useful Life	3 years

PROPERTY AND EQUIPMENT (Schedule of Depreciation Related to Property and Equipment) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
PROPERTY AND EQUIPMENT [Abstract]
Depreciation	$ 50,517	$ 51,342	$ 46,043

GOODWILL AND INTANGIBLE ASSETS (Summary of Goodwill) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
GOODWILL AND INTANGIBLE ASSETS [Abstract]
Goodwill, Beginning Balance	$ 179,708	$ 156,716
Additions and adjustments	18,799	24,251
Foreign exchange	(1,036)	(1,259)
Goodwill, Ending Balance	$ 197,471	$ 179,708

- Definition

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

+ References + Details

GOODWILL AND INTANGIBLE ASSETS (Summary of Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 150,296	$ 141,149
Accumulated amortization	(86,722)	(72,489)
Intangible Assets, net	$ 63,574	$ 68,660
Supplier Network [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted average amortization period	10 years	10 years
Gross Carrying Amount	$ 4,000	$ 4,000
Accumulated amortization	(3,267)	(2,867)
Intangible Assets, net	$ 733	$ 1,133
Customer Relationships & Other Intangibles [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted average amortization period	8 years 8 months 12 days	6 years 4 months 24 days
Gross Carrying Amount	$ 62,324	$ 56,264
Accumulated amortization	(41,651)	(37,842)
Intangible Assets, net	$ 20,673	$ 18,422
Developed Technology [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted average amortization period	8 years	8 years
Gross Carrying Amount	$ 75,087	$ 71,947
Accumulated amortization	(37,984)	(28,545)
Intangible Assets, net	$ 37,103	$ 43,402
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Weighted average amortization period	16 years 1 month 6 days	16 years 1 month 6 days
Gross Carrying Amount	$ 8,885	$ 8,938
Accumulated amortization	(3,820)	(3,235)
Intangible Assets, net	$ 5,065	$ 5,703

GOODWILL AND INTANGIBLE ASSETS (Schedule of Finite-Lived Intangible Assets, Future Amortization Expense) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
GOODWILL AND INTANGIBLE ASSETS [Abstract]
2023	$ 16,894
2024	14,095
2025	9,810
2026	6,366
2027	4,647
Thereafter	11,762
Intangible Assets, net	$ 63,574	$ 68,660

ACCRUED EXPENSES (Schedule of Accrued Expenses) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
ACCRUED EXPENSES [Abstract]
Compensation and other employee-related costs	$ 53,352	$ 52,407
Legal and other settlements and expenses	5,564	6,124
Accrued non-income taxes	10,029	6,415
Royalties	4,375	4,558
Rebates	10,501	8,725
Other	10,884	12,939
Total accrued expenses	$ 94,705	$ 91,168

DEBT (Narrative) (Details)	12 Months Ended
DEBT (Narrative) (Details)	Dec. 31, 2022 USD ($)
Citizens Bank [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity	$ 125,000,000.0
Line of credit facility, expiration date	Aug. 02, 2023
Line of credit, borrowed amount	$ 0
Federal Funds Effective Rate [Member]
Debt Instrument [Line Items]
Credit facility, basis spread on variable rate	0.50%
LIBOR [Member] \| Citizens Bank [Member]
Debt Instrument [Line Items]
Credit facility, basis spread on variable rate	1.00%
Letter of Credit [Member] \| Citizens Bank [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity	$ 25,000,000.0

- Definition

The carrying value as of the balance sheet date of the current and noncurrent portions of long-term obligations drawn from a line of credit, which is a bank's commitment to make loans up to a specific amount. Examples of items that might be included in the application of this element may consist of letters of credit, standby letters of credit, and revolving credit arrangements, under which borrowings can be made up to a maximum amount as of any point in time conditional on satisfaction of specified terms before, as of and after the date of drawdowns on the line. Includes short-term obligations that would normally be classified as current liabilities but for which (a) postbalance sheet date issuance of a long term obligation to refinance the short term obligation on a long term basis, or (b) the enterprise has entered into a financing agreement that clearly permits the enterprise to refinance the short-term obligation on a long term basis and the following conditions are met (1) the agreement does not expire within 1 year and is not cancelable by the lender except for violation of an objectively determinable provision, (2) no violation exists at the BS date, and (3) the lender has entered into the financing agreement is expected to be financially capable of honoring the agreement.

+ References + Details

EQUITY (Narrative) (Details) $ in Thousands	12 Months Ended
EQUITY (Narrative) (Details) $ in Thousands	Dec. 31, 2022 USD ($) item shares	Sep. 30, 2022 USD ($)	Jun. 30, 2022 USD ($)	Mar. 31, 2022 USD ($)	Mar. 04, 2022 USD ($)	Dec. 31, 2021 USD ($) shares	Sep. 30, 2021 USD ($)	Jun. 30, 2021 USD ($)	Mar. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Mar. 11, 2020 USD ($)
Class of Stock [Line Items]
Stock repurchase plan, authorized amount \| $														$ 200,000
Stock repurchase plan, remaining authorized amount \| $	$ 150,801	$ 150,801	$ 150,801	$ 295,294		$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 126,098
Common stock, shares authorized	775,000,000
Common Class A [Member]
Class of Stock [Line Items]
Additional stock repurchase plan, authorized amount \| $					$ 200,000
Common stock, shares authorized	500,000,000					500,000,000
Number of votes per share \| item	1
Shares converted from other class	1
Common Class A And B [Member]
Class of Stock [Line Items]
Number of votes per share \| item	1
Common Class B [Member]
Class of Stock [Line Items]
Common stock, shares authorized	275,000,000					275,000,000
Number of votes per share \| item	10

EQUITY (Schedule of Shares Repurchased) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended			36 Months Ended
	Jun. 30, 2022	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2022	Sep. 30, 2022	Mar. 31, 2022	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020
EQUITY [Abstract]
Total number of shares repurchased	2,351	771	1,920	5,042
Average Price Paid per Share	$ 61.45	$ 39.95	$ 38.49	$ 49.42
Dollar amount of shares repurchased	$ 144,493	$ 30,804	$ 73,902	$ 249,199
Approximate dollar value of shares that may yet be purchased under the plan	$ 150,801	$ 95,294	$ 126,098	$ 150,801	$ 150,801	$ 295,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294	$ 95,294

EQUITY (Accumulated Other Comprehensive Income (Loss)) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Line Items]
Total equity, beginning of period	$ 1,741,388	$ 1,506,297	$ 1,402,452
Total other comprehensive income/(loss), net of tax	(17,858)	(10,727)	6,853
Total equity, end of period	1,846,373	1,741,388	1,506,297
Accumulated Other Comprehensive Income/(Loss) [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Total equity, beginning of period	(6,772)	3,955	(2,898)
Other comprehensive (loss)/income before reclassifications	(22,312)	(12,595)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax	4,454	1,868
Total other comprehensive income/(loss), net of tax	(17,858)	(10,727)
Total equity, end of period	(24,630)	(6,772)	3,955
Unrealized Loss On Marketable Securities, Net Of Tax [Member] \| Accumulated Other Comprehensive Income/(Loss) [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Total equity, beginning of period	(1,053)	5,001
Other comprehensive (loss)/income before reclassifications	(18,494)	(7,922)
Amounts reclassified from accumulated other comprehensive income/(loss), net of tax	4,454	1,868
Total other comprehensive income/(loss), net of tax	(14,040)	(6,054)
Total equity, end of period	(15,093)	(1,053)	5,001
Foreign Currency Translation Adjustments [Member] \| Accumulated Other Comprehensive Income/(Loss) [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Total equity, beginning of period	(5,719)	(1,046)
Other comprehensive (loss)/income before reclassifications	(3,818)	(4,673)
Total other comprehensive income/(loss), net of tax	(3,818)	(4,673)
Total equity, end of period	$ (9,537)	$ (5,719)	$ (1,046)

- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 852
-SubTopic 10
-Section 55
-Paragraph 10
-URI https://asc.fasb.org/extlink&oid=84165509&loc=d3e56426-112766

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 310
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 4.E)
-URI https://asc.fasb.org/extlink&oid=122038336&loc=d3e74512-122707

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(31))
-URI https://asc.fasb.org/extlink&oid=120391452&loc=d3e13212-122682

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(29))
-URI https://asc.fasb.org/extlink&oid=120391452&loc=d3e13212-122682

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(30))
-URI https://asc.fasb.org/extlink&oid=120391452&loc=d3e13212-122682

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 825
-SubTopic 10
-Section 50
-Paragraph 28
-Subparagraph (f)
-URI https://asc.fasb.org/extlink&oid=123596393&loc=d3e14064-108612

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 323
-SubTopic 10
-Section 50
-Paragraph 3
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=114001798&loc=d3e33918-111571

+ Details

EQUITY (Schedule Of Computation of Basic and Diluted Earnings) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
EQUITY [Abstract]
Net income/(loss)	$ 190,169	$ 149,191	$ 102,285
Weighted average shares outstanding for basic	100,469	100,734	98,580
Dilutive stock options and RSUs	2,174	2,889	2,391
Weighted average shares outstanding for diluted	102,643	103,623	100,971
Basic	$ 1.89	$ 1.48	$ 1.04
Diluted	$ 1.85	$ 1.44	$ 1.01
Anti-dilutive stock options and RSUs excluded from the calculation	3,851	2,139	5,454

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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- Definition

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

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

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+ Details

STOCK-BASED AWARDS (Narrative) (Details) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($) ShareBasedCompensationPlan $ / shares shares	Dec. 31, 2021 USD ($) $ / shares	Dec. 31, 2020 USD ($) $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average period of recognition, unvested stock options	3 years
Number of stock plans \| ShareBasedCompensationPlan	2
Class A reserved under the 2012 Equity Incentive Plan	5,687,725
Class A number of shares available for grant under the 2012 Equity Incentive Plan	2,634,899
Intrinsic value of stock options exercised \| $	$ 26.3	$ 71.3	$ 76.1
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	4 years
Unrecognized compensation expense, unvested stock options \| $	$ 76.0
Maximum contractual term	10 years
Weighted average grant date fair value per share \| $ / shares	$ 22.10	$ 20.34	$ 14.81
2012 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Base number of shares that may be issuable under stock plan	3,076,923
2012 Plan [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized	10,769,230
Annual percentage limit for incremental shares that may be issued	3.00%
2021 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Base number of shares that may be issuable under stock plan	4,000,000
2021 Plan [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized	4,000,000

STOCK-BASED AWARDS (Summary of Stock Option Activity) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Option shares outstanding beginning balance	9,463
Option shares granted	2,736
Option shares exercised	(999)
Option shares forfeited	(862)
Option shares outstanding ending balance	10,338
Option shares exercisable	5,556
Option shares expected to vest	4,782
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price
Weighted average exercise price per share outstanding beginning balance	$ 48.01
Weighted average exercise price per share granted	64.06
Weighted average exercise price per share exercised	41.78
Weighted average exercise price per share forfeited	58.92
Weighted average exercise price per share outstanding ending balance	51.86
Weighted average exercise price per share exercisable	44.38
Weighted average exercise price per share expected to vest	$ 60.54
Weighted average remaining contractual life outstanding	6 years 9 months 18 days
Weighted average remaining contractual life exercisable	5 years 7 months 6 days
Weighted average remaining contractual life expected to vest	8 years 2 months 12 days
Aggregate intrinsic value outstanding	$ 234,207
Aggregate intrinsic value exercisable	166,449
Aggregate intrinsic value expected to vest	$ 67,758

STOCK-BASED AWARDS (Fair Value of Options Using Black Scholes Option Pricing Model) (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	1.46%	0.40%	0.23%
Risk-free interest rate, maximum	4.04%	1.14%	1.67%
Expected term (years)		4 years 9 months 18 days	4 years 10 months 24 days
Expected volatility, minimum	33.00%	33.00%	28.00%
Expected volatility, maximum	35.00%	34.00%	37.00%
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (years)	9 years 10 months 24 days
Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (years)	4 years 8 months 12 days

STOCK-BASED AWARDS (Summary of Restricted Stock Unit Activity) (Details) - Restricted Stock Units (RSUs) [Member] shares in Thousands	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding, Beginning Balance \| shares	29
Granted \| shares	31
Outstanding, Ending Balance \| shares	60
Weighted average grant date fair value per share, Beginning Balance \| $ / shares	$ 72.54
Weighted average grant date fair value per share, Granted \| $ / shares	62.77
Weighted average grant date fair value per share, Ending Balance \| $ / shares	$ 67.40
Weighted average remaining contractual life (years)	7 years 9 months 18 days

STOCK-BASED AWARDS (Stock-based Compensation Schedule) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
STOCK-BASED AWARDS [Abstract]
Stock-based compensation expense	$ 32,810	$ 30,586	$ 27,073
Net stock-based compensation capitalized into inventory	657	667	257
Total stock-based compensation cost	$ 33,467	$ 31,253	$ 27,330

INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Deferred tax assets, valuation allowance	$ 5,488	$ 6,594
NOL carryforwards	20,200	19,900
Reductions related to prior year tax positions	$ 116	$ 708	$ 799

INCOME TAXES (Schedule of Components of Income Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Domestic	$ 247,260	$ 184,819	$ 154,356
Foreign	(4,241)	(4,412)	(28,457)
Income/(loss) before income taxes	$ 243,019	$ 180,407	$ 125,899

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8906-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 940
-SubTopic 20
-Section 25
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=126941158&loc=d3e41242-110953

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-URI https://asc.fasb.org/extlink&oid=126953954&loc=SL114868664-224227

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(8))
-URI https://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 235
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-URI https://asc.fasb.org/extlink&oid=120399901&loc=d3e537907-122884

Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8924-108599

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-URI https://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

+ Details

INCOME TAXES (Schedule of Components of the Provision for Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Current: Federal	$ 60,927	$ 37,436	$ 22,183
Current: State	12,408	7,688	4,381
Current: Foreign	1,845	3,741	991
Current: Total	75,180	48,865	27,555
Deferred: Federal	(16,429)	(13,535)	(3,293)
Deferred: State	(3,142)	(2,265)	(678)
Deferred: Foreign	(2,759)	(1,849)	30
Deferred: Total	(22,330)	(17,649)	(3,941)
Income Tax Expense (Benefit), Total	$ 52,850	$ 31,216	$ 23,614

INCOME TAXES (Summary of Effective Tax Rate) (Details)	12 Months Ended
INCOME TAXES (Summary of Effective Tax Rate) (Details)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Statutory U.S. federal tax rate	21.00%	21.00%	21.00%
State income taxes, net of federal benefit	3.00%	2.70%	3.50%
Foreign taxes	0.70%	1.60%	0.60%
Valuation allowance	(0.50%)	0.10%	1.70%
Domestic production activities deduction		(0.30%)	(0.30%)
Tax credits	(1.30%)	(1.50%)	(2.60%)
Stock-based compensation windfall	(1.20%)	(6.60%)	(9.50%)
Nondeductible expenses		0.50%	0.50%
Other		(0.20%)
IPR&D			3.90%
Effective tax rate	21.70%	17.30%	18.80%

INCOME TAXES (Schedule of Significant Components of Deferred Income Taxes) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
INCOME TAXES [Abstract]
Inventory reserve	$ 29,649	$ 29,417
Accruals, reserves, and other currently not deductible	27,608	23,102
Stock-based compensation	20,554	16,167
Capitalized R&E	14,279
Net operating loss carryforwards	4,182	3,812
Total deferred tax assets	96,272	72,498
Valuation allowance	(5,488)	(6,594)
Total deferred tax assets, net of valuation allowance	90,784	65,904
Depreciation and amortization	(43,718)	(45,724)
Total deferred tax liabilities	(43,718)	(45,724)
Net deferred tax assets/(liabilities)	$ 47,066	$ 20,180

INCOME TAXES (Reconciliation of Unrecognized Tax Benefits) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Unrecognized tax benefits at the beginning of the year	$ 1,052	$ 1,600	$ 2,399
Additions related to prior year tax positions	50	160
Reductions related to prior year tax positions	(116)	(708)	(799)
Unrecognized tax benefits at the end of the year	$ 986	$ 1,052	$ 1,600

INCOME TAXES (Impact Of Unrecognized Tax Benefits To Effective Income Tax Rate) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
INCOME TAXES [Abstract]
Portion of total unrecognized tax benefits that, if recognized, would affect the effective income tax rate	$ 1,355	$ 1,471	$ 2,032

COMMITMENTS AND CONTINGENCIES (Narrative) (Details)	Dec. 31, 2022 USD ($)
Moskowitz Family LLC Litigation [Member]
Estimated Litigation Liability	$ 0

RETIREMENT BENEFIT PLANS (Narrative) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
RETIREMENT BENEFIT PLANS [Abstract]
Nondiscretionary employee contribution match rate	100.00%
Maximum annual contribution match, per employee	$ 6
Maximum annual contribution match, percent per employee	3.00%

RETIREMENT BENEFIT PLANS (Contributions To Retirement Plans) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
RETIREMENT BENEFIT PLANS [Abstract]
401(k) and other retirement plan contributions	$ 7,154	$ 6,588	$ 5,798

SEGMENT AND GEOGRAPHIC INFORMATION (Narrative) (Details)	12 Months Ended
	Dec. 31, 2022 segment
SEGMENT AND GEOGRAPHIC INFORMATION [Abstract]
Number of operating segments	1

SEGMENT AND GEOGRAPHIC INFORMATION (Schedule of Total Sales by Geographical Area) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Total net sales	$ 1,022,843	$ 958,102	$ 789,042
United States [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total net sales	871,939	819,571	664,454
International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total net sales	$ 150,904	$ 138,531	$ 124,588

- Definition

+ References

+ Details

SUBSEQUENT EVENT (Narrative) (Details) - USD ($) $ / shares in Units, $ in Millions		12 Months Ended
	Feb. 08, 2023	Dec. 31, 2022	Dec. 31, 2021
NuVasive [Member] \| Globus Medical Shareholders [Member]
Subsequent Event [Line Items]
Ownership percent after transaction	72.00%
NuVasive [Member] \| NuVasive Shareholders [Member]
Subsequent Event [Line Items]
Ownership percent after transaction	28.00%
Subsequent Event [Member] \| NuVasive [Member]
Subsequent Event [Line Items]
Termination fee payable, if agreement is terminated	$ 60
Common stock, par value	$ 0.001
Common Class A [Member]
Subsequent Event [Line Items]
Common stock, par value		$ 0.001	$ 0.001
Conversion ratio of common stock		1
Common Class A [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Common stock, par value	$ 0.001
Common Class A [Member] \| Subsequent Event [Member] \| Merger Agreement [Member]
Subsequent Event [Line Items]
Conversion ratio of common stock	0.75
Common Class B [Member]
Subsequent Event [Line Items]
Common stock, par value		$ 0.001	$ 0.001
Minimum [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Termination fee payable, if agreement is terminated	$ 75
Maximum [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Termination fee payable, if agreement is terminated	$ 120

SCHEDULE II VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
SEC Schedule, 12-09, Allowance, Credit Loss [Member]
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Beginning of period	$ 4,962	$ 4,408	$ 5,599
Charged to expenses	(1)	1,200	2,960
Write-offs/Deductions	(237)	(646)	(4,151)
End of period	4,724	4,962	4,408
SEC Schedule, 12-09, Valuation Allowance, Deferred Tax Asset [Member]
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Beginning of period	6,594	6,487	2,846
Charged to expenses	(1,106)	107	2,132
Charged to other accounts			1,509
End of period	$ 5,488	$ 6,594	$ 6,487