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Integer Holdings Corporation Reports Results for Fourth Quarter and Full Year 2021

February 17, 2022 8:00 AM

~ Strong 4Q and Full Year sales and profit increase versus last year ~~ Completed acquisition of Oscor Inc. ~ ~ Generated $157 million cash flow from operations in the full year ~

PLANO, Texas, Feb. 17, 2022 (GLOBE NEWSWIRE) -- Integer Holdings Corporation (NYSE: ITGR), a leading medical device outsource manufacturer, today announced results for the three and twelve months ended December 31, 2021. Unless otherwise stated, all results and comparisons are from continuing operations and include the results of operations from Oscor for the period December 1, 2021 through December 31, 2021.

Fourth Quarter 2021 Financial Results (compared to fourth quarter 2020, except as noted)

Full Year 2021 Financial Results (compared to full year 2020)

“Integer delivered strong year-over-year financial results in the fourth quarter and full year 2021 despite a challenging labor and supply chain environment. Looking forward to 2022, we expect our year-over-year sales and profit growth to increase throughout the year. The growth will come from the execution of our strategy as well as the integration of Oscor, which is well underway,” said Joseph Dziedzic, Integer’s president and CEO.

Mr. Dziedzic continued, “During 2021 we protected our associates, delivered for our customers and patients, strengthened our culture, and remained focused on executing our strategy. Integer’s unique position is enabling us to serve our customers through all phases of their products’ lifecycles. Our customers are rewarding us with more development programs in high-growth markets, in support of their product roadmaps. We are confident that our structured and disciplined product line strategy process combined with our targeted investments in high-growth markets will drive sustained above-market growth.”

Discussion of Product Line Fourth Quarter and Full Year Sales

2022 Outlook(a)

(dollars in millions, except per share amounts)

GAAP Non-GAAP(b)
As Reported Change Adjusted Change
Sales $1,340 to $1,365 10% to 12% $1,340 to $1,365 10% to 12%
Operating income $132 to $144 (3)% to 6% $201 to $213 7% to 14%
EBITDA N/A N/A $270 to $282 11% to 16%
Net income $91 to $101 (2)% to 9% $146 to $156 7% to 15%
Earnings per Diluted Share $2.72 to $3.02 (3)% to 8% $4.35 to $4.65 7% to 14%

(a) Except as described below, further reconciliations by line item to the closest corresponding GAAP financial measure for Adjusted operating income, Adjusted EBITDA, Adjusted net income, organic sales growth and Adjusted Earnings per Share (“EPS”), all from continuing operations, and free cash flow, included in our “2022 Outlook” above, and Adjusted interest expense and Adjusted effective tax rate below, are not available without unreasonable efforts on a forward-looking basis due to the high variability, complexity and visibility of the charges excluded from these non-GAAP financial measures.

(b) Adjusted operating income for 2022 is expected to consist of GAAP operating income, excluding items such as intangible amortization, certain legal expenses, reorganization and realignment costs, asset dispositions and severance, totaling approximately $69 million, pre-tax. Adjusted net income and Adjusted EPS for 2022 are expected to consist of GAAP net income and diluted EPS, excluding items such as intangible amortization, certain legal expenses, reorganization and realignment costs, asset dispositions, severance, gains and losses on equity investments and loss on extinguishment of debt totaling approximately $70 million, pre-tax. The after-tax impact of these items is estimated to be approximately $55 million, or approximately $1.63 per diluted share.

Adjusted EBITDA is expected to consist of Adjusted net income, excluding items such as depreciation, interest, stock-based compensation and taxes totaling approximately $124 to $126 million.

Supplemental Financial Information(dollars in millions)

2022Outlook 2021Actual
Capital expenditures, net$65 - $75 $53
Depreciation and amortization$90 - $100 $81
Stock-based compensation$18 - $21 $16
Other operating expense$10 - $15 $8
Adjusted interest expense(a)$24 - $28 $28
Adjusted effective tax rate(b)16.0% - 17.5% 15%
Cash tax payments$15 - $20 $20

(a) Adjusted interest expense refers to our expected full-year GAAP interest expense, expected to range from $25 million to $29 million for 2022, adjusted to remove the full-year impact of charges associated with the write-off of deferred issuance costs and unamortized discounts (loss on extinguishment of debt) included in GAAP interest expense.

(b) Adjusted effective tax rate refers to our full-year GAAP effective tax rate, expected to range from 14.0% to 15.5% for 2022, adjusted to reflect the full-year impact of the items that are excluded in providing adjusted net income and certain other identified items.

Summary Financial Results(dollars in thousands, except per share data)

Three Months Ended December 31,
2021 2020 Change
EBITDA from continuing operations(a)$48,529 $47,540 2.1%
Operating income$28,663 $27,593 3.9%
Income from continuing operations$20,001 $15,427 29.6%
Diluted EPS from continuing operations$0.60 $0.47 27.7%
Adjusted EBITDA(a)$58,469 $49,236 18.8%
Adjusted operating income(a)$44,019 $37,975 15.9%
Adjusted net income(a)$33,057 $23,424 41.1%
Adjusted EPS(a)$0.99 $0.71 39.4%
Year Ended December 31,
2021 2020 Change
EBITDA from continuing operations(a)$214,060 $203,751 5.1%
Operating income$135,711 $120,612 12.5%
Income from continuing operations$93,020 $77,258 20.4%
Diluted EPS from continuing operations$2.80 $2.33 20.2%
Adjusted EBITDA(a)$242,983 $189,616 28.1%
Adjusted operating income(a)$187,175 $143,782 30.2%
Adjusted net income(a)$135,550 $91,849 47.6%
Adjusted EPS(a)$4.08 $2.77 47.3%

(a) EBITDA from continuing operations, Adjusted EBITDA, Adjusted operating income, Adjusted net income, and Adjusted EPS are Non-GAAP financial measures. Please see “Notes Regarding Non-GAAP Financial Information” for additional information regarding our use of non-GAAP financial measures. Refer to Tables A, B and C at the end of this release for reconciliations of adjusted amounts to the closest corresponding GAAP financial measures.

Summary Product Line Results(dollars in thousands)

Three Months Ended December 31,
2021 2020 Change Organic Change(a)
Medical Sales
Cardio & Vascular$163,381 $137,063 19.2% 17.6%
Cardiac & Neuromodulation 111,869 93,838 19.2% 17.3%
Advanced Surgical, Orthopedics & Portable Medical 26,664 29,747 (10.4)% (10.4)%
Total Medical Sales 301,914 260,648 15.8% 14.3%
Non-Medical Sales 11,101 8,311 33.6% 33.6%
Total Sales$313,015 $268,959 16.4% 14.9%
Year Ended December 31,
2021 2020 Change Organic Change(a)
Medical Sales
Cardio & Vascular$626,013 $569,948 9.8% 9.0%
Cardiac & Neuromodulation 446,569 346,242 29.0% 28.5%
Advanced Surgical, Orthopedics & Portable Medical 110,044 121,788 (9.6)% (9.6)%
Total Medical Sales 1,182,626 1,037,978 13.9% 13.3%
Non-Medical Sales 38,453 35,464 8.4% 8.4%
Total Sales$1,221,079 $1,073,442 13.8% 13.2%

(a) Organic sales change is a Non-GAAP financial measure. Please see “Notes Regarding Non-GAAP Financial Information” for additional information regarding our use of non-GAAP financial measures and refer to Table D at the end of this release for a reconciliation of these amounts.

Conference Call InformationThe Company will host a conference call on Thursday, February 17, 2022, at 8 a.m. CT / 9 a.m. ET to discuss these results. The scheduled conference call will be webcast live and is accessible through our website at investor.integer.net or by dialing (888) 330-3567 (U.S.) or (646) 960-0842 (outside U.S.) and the conference ID is 9252310. The call will be archived on the Company’s website. An earnings call slide presentation containing supplemental information about the Company’s results will be posted to our website at investor.integer.net prior to the conference call and will be referenced during the conference call.

From time to time, the Company posts information that may be of interest to investors on its website at investor.integer.net. To automatically receive Integer financial news by email, please visit investor.integer.net and subscribe to email alerts.

About Integer®Integer Holdings Corporation (NYSE: ITGR) is one of the largest medical device outsource (MDO) manufacturers in the world serving the cardiac, neuromodulation, vascular, portable medical and orthopedics markets. The Company provides innovative, high-quality medical technologies that enhance the lives of patients worldwide. In addition, the Company develops batteries for high-end niche applications in energy, military, and environmental markets. The Company's brands include Greatbatch Medical®, Lake Region Medical® and Electrochem®. Additional information is available at www.integer.net.

Contact InformationTony BorowiczSVP, Investor Relations716.759.5809[email protected]

Notes Regarding Non-GAAP Financial Information In addition to our results reported in accordance with generally accepted accounting principles in the United States of America (“GAAP”), we provide adjusted net income, adjusted EPS, earnings before interest, taxes, depreciation and amortization (“EBITDA”), adjusted EBITDA, adjusted operating income, and organic sales change rates, all from continuing operations. Adjusted net income and adjusted EPS consist of GAAP amounts from continuing operations adjusted for the following to the extent occurring during the period: (i) acquisition and integration related expenses, including fair value adjustments to contingent consideration resulting from acquisitions, (ii) amortization of intangible assets, (iii) facility consolidation, optimization, manufacturing transfer and system integration charges, (iv) asset write-down and disposition charges, (v) charges in connection with corporate realignments or a reduction in force, (vi) certain legal expenses, charges and gains, (vii) unusual or infrequently occurring items, (viii) (gain) loss on equity investments, (ix) extinguishment of debt charges, (x) the income tax provision (benefit) related to these adjustments and (xi) certain tax items that are outside the normal tax provision for the period. Adjusted EPS is calculated by dividing adjusted net income by diluted weighted average shares outstanding. EBITDA is calculated by adding back interest expense, provision (benefit) for income taxes from continuing operations, depreciation and amortization expense, to income from continuing operations, which is the most directly comparable GAAP financial measure. Adjusted EBITDA consists of EBITDA plus adding back stock-based compensation and the same adjustments as listed above except for items (ii), (ix), (x) and (xi). Adjusted operating income consists of operating income from continuing operations adjusted for the same items listed above except for items (viii), (ix), (x) and (xi).

Organic sales change is reported sales growth adjusted for the impact of foreign currency and the contribution of acquisitions. To calculate the impact of foreign currency on sales growth rates, we convert any sale made in a foreign currency by converting current period sales into prior period sales using the exchange rate in effect at that time and then compare the two, negating any effect foreign currency had on our transactional revenue, and exclude the amount of sales acquired or divested during the period from the current/previous period amounts, respectively.

We believe that the presentation of adjusted net income, adjusted EPS, EBITDA, adjusted EBITDA, adjusted operating income, and organic sales change rates, provides important supplemental information to management and investors seeking to understand the financial and business trends relating to our financial condition and results of operations. In addition to the performance measures identified above, we believe that net total debt, free cash flow and leverage ratio provide meaningful measures of liquidity and a useful basis for assessing our ability to fund our activities, including the financing of acquisitions and debt repayments. Net total debt is calculated as total principal amount of debt outstanding less cash and cash equivalents. We calculate leverage ratio as net total debt divided by adjusted EBITDA for the trailing 4 quarters. Free cash flow is defined as Net cash provided by operating activities (as stated in our Condensed Consolidated Statements of Cash Flows) reduced by capital expenditures (acquisition of property, plant, and equipment (PP&E), net of proceeds from the sale of PP&E).

Forward-Looking StatementsSome of the statements contained in this press release are “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, including statements relating to recovery from the COVID-19 global pandemic; future sales, expenses, and profitability; future development and expected growth of our business and industry; our ability to execute our business model and our business strategy, including completion and integration of current or future acquisition targets; projected capital spending; and other events, conditions or developments that will or may occur in the future. You can identify forward-looking statements by terminology such as “may,” “will,” “should,” “could,” “expects,” “intends,” “plans,” “anticipates,” “believes,” “estimates,” “predicts,” “potential,” “projects,” or “continue” or variations or the negative of these terms or other comparable terminology. These statements are only predictions. Actual events or results may differ materially from those stated or implied by these forward-looking statements. In evaluating these statements and our prospects, you should carefully consider the factors set forth below.

Although it is not possible to create a comprehensive list of all factors that may cause actual results to differ from the results expressed or implied by our forward-looking statements or that may affect our future results, some of these factors and other risks and uncertainties that arise from time to time are described in Item 1A “Risk Factors” of our Annual Report on Form 10-K and in our other periodic filings with the SEC and include the following:

Except as may be required by law, we assume no obligation to update forward-looking statements in this press release whether to reflect changed assumptions, the occurrence of unanticipated events or changes in future operating results, financial conditions or prospects, or otherwise.

Condensed Consolidated Balance Sheets - Unaudited
(in thousands)
December 31,2021 December 31,2020
ASSETS
Current assets:
Cash and cash equivalents$17,885 $49,206
Accounts receivable, net 182,310 156,207
Inventories 155,699 149,323
Refundable income taxes 4,735 2,087
Contract assets 64,743 40,218
Prepaid expenses and other current assets 27,610 15,896
Total current assets 452,982 412,937
Property, plant and equipment, net 277,099 253,964
Goodwill 924,704 859,442
Other intangible assets, net 807,810 757,224
Deferred income taxes 5,711 4,398
Operating lease assets 70,053 45,153
Other long-term assets 43,856 38,739
Total assets$2,582,215 $2,371,857
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Current portion of long-term debt$15,250 $37,500
Accounts payable 76,859 51,570
Income taxes payable 725 1,847
Operating lease liabilities 9,862 8,431
Accrued expenses and other current liabilities 56,933 56,843
Total current liabilities 159,629 156,191
Long-term debt 812,876 693,758
Deferred income taxes 171,505 182,304
Operating lease liabilities 59,767 37,861
Other long-term liabilities 23,741 30,688
Total liabilities 1,227,518 1,100,802
Stockholders’ equity:
Common stock 33 33
Additional paid-in capital 713,150 700,814
Retained earnings 614,324 517,516
Accumulated other comprehensive income 27,190 52,692
Total stockholders’ equity 1,354,697 1,271,055
Total liabilities and stockholders’ equity$2,582,215 $2,371,857

Condensed Consolidated Statements of Operations - Unaudited
(in thousands except per share data)
Three Months EndedDecember 31, Year Ended December 31,
2021 2020 2021 2020
Sales$313,015 $268,959 $1,221,079 $1,073,442
Cost of sales 231,149 195,750 884,109 787,735
Gross profit 81,866 73,209 336,970 285,707
Operating expenses:
Selling, general and administrative (SG&A) 36,268 35,037 141,418 109,006
Research, development and engineering 12,736 10,589 51,985 48,468
Other operating expenses (OOE) 4,199 (10) 7,856 7,621
Total operating expenses 53,203 45,616 201,259 165,095
Operating income 28,663 27,593 135,711 120,612
Interest expense 5,511 9,218 31,628 38,220
(Gain) loss on equity investments, net 1,276 (1,383) 3,143 (5,337)
Other (income) loss, net (252) 1,755 (123) 1,522
Income from continuing operations before income taxes 22,128 18,003 101,063 86,207
Provision for income taxes 2,127 2,576 8,043 8,949
Income from continuing operations$20,001 $15,427 $93,020 $77,258
Discontinued operations:
Income from discontinued operations before taxes 4,931 — 4,931 —
Provision for income taxes 1,143 — 1,143 —
Income from discontinued operations$3,788 $— $3,788 $—
Net income$23,789 $15,427 $96,808 $77,258
Basic earnings per share:
Income from continuing operations$0.61 $0.47 $2.82 $2.35
Income from discontinued operations$0.11 $— $0.11 $—
Basic earnings per share$0.72 $0.47 $2.93 $2.35
Diluted earnings per share:
Income from continuing operations$0.60 $0.47 $2.80 $2.33
Income from discontinued operations$0.11 $— $0.11 $—
Diluted earnings per share$0.71 $0.47 $2.91 $2.33
Weighted average shares outstanding:
Basic 33,023 32,880 32,993 32,845
Diluted 33,280 33,129 33,258 33,113

Condensed Consolidated Statements of Cash Flows(a) - Unaudited
(in thousands)
Year Ended December 31,
2021 2020
Cash flows from operating activities:
Net income$96,808 $77,258
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization 81,369 79,324
Debt related charges included in interest expense 6,954 4,774
Stock-based compensation 16,185 9,163
Non-cash (gains) charges related to customer bankruptcy (348) 554
Non-cash lease expense 8,235 7,810
Non-cash (gain) loss on equity investments 3,143 (5,337)
Contingent consideration fair value adjustment 133 (2,000)
Other non-cash losses 2,202 600
Deferred income taxes (10,270) (6,966)
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable (17,539) 38,153
Inventories 4,700 18,441
Prepaid expenses and other assets (2,409) (864)
Contract assets (24,923) (15,451)
Accounts payable 19,525 (9,055)
Accrued expenses and other liabilities (22,984) (10,721)
Income taxes payable (4,115) (4,342)
Net cash provided by operating activities 156,666 181,341
Cash flows from investing activities:
Acquisition of property, plant and equipment (53,463) (46,832)
Purchase of intangible asset — (4,607)
Proceeds from sale of property, plant and equipment 443 82
Acquisitions, net (217,978) (5,219)
Net cash used in investing activities (270,998) (56,576)
Cash flows from financing activities:
Principal payments of term loans (741,786) (87,500)
Proceeds from issuance of term loans 818,250 —
Proceeds from revolving credit facility 82,300 185,000
Payments of revolving credit facility (63,000) (185,000)
Proceeds from the exercise of stock options 743 3,263
Payment of debt issuance costs (8,139) (515)
Tax withholdings related to net share settlements of restricted stock unit awards (4,592) (3,820)
Contingent consideration payments (1,621) —
Principal payments on finance leases (169) (6)
Net cash provided by (used in) financing activities 81,986 (88,578)
Effect of foreign currency exchange rates on cash and cash equivalents 1,025 (516)
Net increase (decrease) in cash and cash equivalents (31,321) 35,671
Cash and cash equivalents, beginning of year 49,206 13,535
Cash and cash equivalents, end of year$17,885 $49,206

(a) The Condensed Consolidated Statements of Cash Flows - Unaudited includes cash flows related to discontinued operations.

Reconciliations of Non-GAAP Financial Measures from Continuing OperationsTable A: Income from Continuing Operations and Diluted EPS Reconciliations(dollars in thousands, except per share data)

Three Months Ended December 31,
2021 2020
Pre-Tax Net of Tax PerDilutedShare Pre-Tax Net of Tax PerDilutedShare
Income from continuing operations (GAAP)$22,128 $20,001 $0.60 $18,003 $15,427 $0.47
Adjustments(a):
Amortization of intangibles 10,524 8,323 0.25 10,237 8,095 0.24
Certain legal expenses (SG&A)(b) 175 139 — 139 111 —
Other operating expenses (OOE)(c) 4,199 3,332 0.10 (10) 235 0.01
(Gain) loss on equity investments 1,276 1,008 0.03 (1,383) (1,093) (0.03)
Loss on extinguishment of debt — — — 550 435 0.01
Medical device regulations (COS)(d) 270 214 0.01 — — —
Customer bankruptcy(e) (113) (89) — 16 13 —
Inventory step-up amortization (COS) 301 266 0.01 — — —
Tax adjustments(f) — (137) — — 201 0.01
Adjusted net income (Non-GAAP)$38,760 $33,057 $0.99 $27,552 $23,424 $0.71
Diluted weighted average shares for adjusted EPS 33,280 33,129
Year Ended December 31,
2021 2020
Pre-Tax Net of Tax PerDilutedShare Pre-Tax Net of Tax PerDilutedShare
Income from continuing operations (GAAP)$101,063 $93,020 $2.80 $86,207 $77,258 $2.33
Adjustments(a):
Amortization of intangibles 41,597 32,898 0.99 41,131 32,520 0.98
Certain legal expenses (gains) (SG&A)(b) 1,454 1,149 0.03 (26,811) (21,180) (0.64)
Other operating expenses (OOE)(c) 7,856 6,178 0.19 7,621 6,177 0.19
(Gain) loss on equity investments 3,143 2,483 0.07 (5,337) (4,216) (0.13)
Loss on extinguishment of debt 3,774 2,981 0.09 550 435 0.01
Medical device regulations (COS)(d) 744 588 0.02 — — —
Customer bankruptcy(e) (488) (385) (0.01) 1,229 971 0.03
Inventory step-up amortization (COS) 301 266 0.01 — — —
Tax adjustments(f) — (3,628) (0.11) — (116) —
Adjusted net income (Non-GAAP)$159,444 $135,550 $4.08 $104,590 $91,849 $2.77
Diluted weighted average shares for adjusted EPS 33,258 33,113

(a) The difference between pre-tax and net of tax amounts is the estimated tax impact related to the respective adjustment. Net of tax amounts are computed using a 21% U.S. tax rate, and the statutory tax rates applicable in foreign tax jurisdictions, as adjusted for the existence of net operating losses (“NOLs”). Expenses that are not deductible for tax purposes (i.e. permanent tax differences) are added back at 100%.

(b) Expenses associated with non-ordinary course legal matters. The full year 2020 also include a net gain of $28.2 million recorded during the third quarter of 2020 in connection with the resolution of the AVX Corporation patent litigation matter.

(c) OOE includes acquisition and integration related expenses, facility consolidation, optimization, manufacturing transfer and system integration charges, asset write-down and disposition charges, charges in connection with corporate realignments or a reduction in force, unusual or infrequently occurring items. OOE for the fourth quarter and full year 2021 includes $2.0 million of acquisition costs related to the acquisition of Oscor. OOE for the fourth quarter and full year 2020 includes a $1.5 million adjustment to reduce the fair value of acquisition-related contingent consideration liabilities.

(d) The charges represent incremental costs of complying with the new European Union medical device regulations for previously registered products and primarily include charges for contractors supporting the project and other direct third-party expenses.

(e) In November 2019, one of our customers, Nuvectra Corporation, filed a voluntary Chapter 11 bankruptcy petition (the “Customer Bankruptcy”). The 2021 amounts are predominantly due to favorable settlements on supplier purchase order termination clauses and benefits recognized from the utilization of previously reserved inventory and the 2020 amounts primarily consist of charges related to inventory recorded in cost of sales in our consolidated statements of operations.

(f) Discrete tax benefits predominately related to the reversal of previously unrecognized tax benefits resulting from the effective settlement of tax audits and the utilization of acquired foreign tax credits during the periods presented.

Please see “Notes Regarding Non-GAAP Financial Information” for additional information regarding our use of non-GAAP financial measures.

Table B: Adjusted Operating Income Reconciliations(in thousands)

Three Months Ended December 31, Year EndedDecember 31,
2021 2020 2021 2020
Operating income (GAAP)$28,663 $27,593 $135,711 $120,612
Adjustments:
Amortization of intangibles 10,524 10,237 41,597 41,131
Certain legal expenses (gains) 175 139 1,454 (26,811)
Other operating expenses 4,199 (10) 7,856 7,621
Medical device regulations 270 — 744 —
Customer bankruptcy (113) 16 (488) 1,229
Inventory step-up amortization 301 — 301 —
Adjusted operating income (Non-GAAP)$44,019 $37,975 $187,175 $143,782

Table C: EBITDA Reconciliations(in thousands)

Three Months Ended December 31, Year EndedDecember 31,
2021 2020 2021 2020
Income from continuing operations (GAAP)$20,001 $15,427 $93,020 $77,258
Interest expense 5,511 9,218 31,628 38,220
Provision for income taxes 2,127 2,576 8,043 8,949
Depreciation 10,366 10,082 39,772 38,193
Amortization of intangibles 10,524 10,237 41,597 41,131
EBITDA from continuing operations (Non-GAAP) 48,529 47,540 214,060 203,751
Certain legal expenses (gains) 175 139 1,454 (26,811)
Stock-based compensation (excluding OOE) 3,832 2,934 15,913 9,163
Other operating expenses (OOE) 4,199 (10) 7,856 7,621
(Gain) loss on equity investments 1,276 (1,383) 3,143 (5,337)
Medical device regulations 270 — 744 —
Customer bankruptcy (113) 16 (488) 1,229
Inventory step-up amortization 301 — 301 —
Adjusted EBITDA (Non-GAAP)$58,469 $49,236 $242,983 $189,616

Table D: Organic Sales Change Reconciliation (% Change)

GAAP Reported Growth Impact of Acquisitions and Foreign Currency(a) Non-GAAP Organic Change
Quarter over Quarter Change (4Q 2021 vs. 4Q 2020)
Medical Sales
Cardio & Vascular19.2% (1.6)% 17.6%
Cardiac & Neuromodulation19.2% (1.9)% 17.3%
Advanced Surgical, Orthopedics & Portable Medical(10.4)% — (10.4)%
Total Medical Sales15.8% (1.5)% 14.3%
Non-Medical Sales33.6% — 33.6%
Total Sales16.4% (1.5)% 14.9%
Year over Year Change (2021 vs. 2020)
Medical Sales
Cardio & Vascular9.8% (0.8)% 9.0%
Cardiac & Neuromodulation29.0% (0.5)% 28.5%
Advanced Surgical, Orthopedics & Portable Medical(9.6)% — (9.6)%
Total Medical Sales13.9% (0.6)% 13.3%
Non-Medical Sales8.4% — 8.4%
Total Sales13.8% (0.6)% 13.2%

(a) Fourth quarter and full year 2021 and 2020 sales have been adjusted to exclude the contribution of business acquisitions and foreign currency exchange rate fluctuations.

Table E: Net Total Debt Reconciliation(in thousands)

December 31,2021 October 1,2021 December 31,2020
Total debt 828,126 630,655 731,258
Add: Unamortized discount and deferred debt issuance costs 7,361 6,645 6,715
Total principal amount of debt outstanding 835,487 637,300 737,973
LESS: Cash and cash equivalents 17,885 25,472 49,206
Net Total Debt (Non-GAAP)$817,602 $611,828 $688,767

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Source: Integer Holdings Corporation

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