Alrighty, morning everyone. Welcome to day three of the Morgan Stanley Global Healthcare Conference. Thanks so much everyone for joining. Patrick Wood, I run the US MedTech team. Most importantly and excitedly, disclaimers: morganstanley.com/researchdisclosures. It's a great website. I really recommend everyone goes there for fun. What is fun though is obviously having the Integra team here. Thanks so much, Lea, for joining. Thanks for having us. Yeah, no, really appreciate it. I guess, Marsha, maybe starting with like, it's been, what, a little over a year now? No, it's been, I'm in my ninth month now. Ninth month? Yes. Wow, you know, that's right. It's the start of the year, and, you know, how have you felt things have gone? I mean, everyone has a perception of what something will be before they get inside. How has it been relative to your expectations? Yeah, so many of the things that, to begin with, got me attracted to the company in terms of the strengths, I get to experience firsthand in my interactions with the customers and, quite frankly, the demand that's out there continues to be out there for our products. The fact that we have a leadership position in attractive markets, we have strong brand equity and commercial execution, and we have a team that really lives every day the purpose that we're all about, which is restoring patients' lives. More importantly, I see tremendous opportunity for us for continued growth across any of the platforms of neurosurgery and tissue technologies and ENT, both within the U.S. and internationally, and both through organic growth and innovation. Ultimately, when we're ready in the future, you know, potential additional inorganic opportunities for us. Those are all on the positive side. These are the things that I'm getting to experience. Now, on the other side, what I realized early on in the role is that just the operational and execution challenges that we have are deeper than I had anticipated. The good news is that they're fixable. We have been very focused throughout 2025 on three key priorities, which is to drive the implementation of our Compliance Master Plan, to continue to drive operational and execution excellence, and also to deliver on our financial commitments. Some of the work that we've completed, actually, in that regard, is we obviously strengthened the leadership teams in quality and operations. We stood up a transformation program management office to help us with prioritization and execution excellence. We also stood up a supply chain control tower in order to be able to get the visibility on the key operational metrics and then also be able to drive into the future a culture of accountability and continuous improvement. Last but not least, we are making great progress on the Compliance Master Plan. We finished the site assessments that we had planned ahead of time, and we're kind of gearing up to get into 2026. We're not done with 2025, but we're laying the foundation to also get into gear with 2026. To be fair, I think I've never heard an incoming executive say that the compliance things were easier than they expected. It's always, there's always, I mean, it's always more of a challenge in that way. Yeah. I mean, on that side, a lot of our companies have challenges on that side. The FDA is a tough taskmaster, if you like. How did you find the right people to get into place? Because, looking for a lot of quality and supply chain people, how did you find that experience of filling those roles? Yeah, we have actually had a pretty good track record in being able to attract really strong talent from strong backgrounds within the medical device and also some pharma industry. With some of the changes within the FDA, we've been able to get some folks that used to be former FDA folks. We actually have had a pretty good opportunity bringing talent on board. That hasn't been an issue for us. We've been investing a lot, especially on the side of the quality and compliance. You both have different backgrounds, but I'd love to hear how you both would characterize the overall culture at Integra LifeSciences relative to prior experience and what it's like as a place to work and what you think the defining attributes of the company are. Yeah, I would say what I mentioned earlier on, people really are committed to the purpose of the company. It drives them. The purpose that we have is to restore patients' lives. It speaks to them. That's what they come to work every day about. Very resilient team. They're very proud of working with their counterparts, with their colleagues. I've never had people say, "I actually enjoy working with my colleague because they're talented. They're going in the same direction that I'm going." I would say it's a great culture in terms of the team being committed to driving the priorities forward. We have needed to do a lot of prioritization to make sure that people are aligned in the same direction. Because when you get cultures like that, people tend to want to help everyone. People want to take on everything. We have been very focused on driving prioritization across the enterprise to align the efforts on the most important things for the company short and long term. Does that resonate with you, Lea? Yeah, absolutely. I've been with Integra LifeSciences for about two years now and absolutely agree with how Marsha characterized her experiences from a culture perspective. For my own, I've seen all of those things. I've also been able to witness in this moment, right, where we're dealing with a number of challenges across the business, how individuals and teams have stepped up to help fill the void and drive us forward. To Marsha's point, what's happening now is we're prioritizing the highest priority things first, the things that are going to have the most impact. I think that's what's going to make the difference in terms of us getting to where we need to be. Obviously, you guys have a lot of internal focus, but you're also a large company that's externally focused as well. I'd love to hear what are you hearing from your customers. How do you think the health of the healthcare system is at the moment? Patient volumes, just the broader ecosystem within you that you operate, how would you characterize it? One of the things that has struck me since I've joined the company is the resilience of the demand that's out there for our product, which really speaks to the clinical value that our products bring to the physicians. In the cases where we have been out of the market for a short period of time due to some shipholds and all that, we see the adoption and retention come right back. Obviously, our sales organization has a broad portfolio that's still relevant to the customers. We're constantly in front of them. We help them out through some of those intermittent supply challenges, and that continues to build trust and confidence with the customers. On the neurosurgery side, we're supported by some of the demographic shifts, whether it's aging population or increasing neurological conditions. Also, the technology and the surgical advancements continue to make available more options for treatment. That's also a tailwind. On the side of the tissue technologies, we see the demand as being stable, and we have really a lot of opportunity for growth both through innovation as well as advancing clinical evidence that gets us beyond even the acute care setting into the broader sites of care. On the ENT side, we see procedure and demand improvements both on the adult side as well as pediatric side. By the nature of the fact that these are minimally invasive procedures, they're more attractive anyway, so they increase access and improve adoption. The dynamics are pretty positive. Moving forward, for the longer-term growth, we have just completed a portfolio prioritization, a full thorough portfolio assessment of our portfolio in the process of strategic planning and long-range planning process. Moving forward, our capital allocation decisions are going to be made based on that prioritization. It's going to guide where we're going to put our resources in order to ultimately, over a period of time, shift the mix of our portfolio that's in high growth spaces to a higher degree. That would provide us the opportunity to have sustainable growth into the future and create value for the shareholders. We all love our children equally. I mean, apart from me, I despise them all equally. Other than that, if you must have had preconceptions about neuro and ENT and things like that before joining. Yes. Was one of the three, or were any of them different versus what you were expecting as end markets? Were there things that surprised you in the neuro portfolio, that kind of thing? No, honestly, as I said, I'm just amazed. Several of our products have been in the market for a while, but it's amazing to me the loyalty of the surgeons. In every interaction that I have, people talk about the quality of the products, the difference that they make in terms of addressing specific patient needs for them. In many of the markets that we're in, take neurosurgery, in any of the categories you look at, you're number one or two position. Nothing that I would say has surprised me except that I have never seen such strong loyalty across the portfolio, which is great. That's one of the reasons why I joined, because I think we have the platform to build upon. I'd say in terms of the portfolio prioritization and the portfolio assessment that we've done, what we want to do as we move into 2026 and beyond, we want to make sure that we make our portfolio, we set up our portfolio to work for us, right? Both in terms of optimization of it for growth and optimization of it, and along the other work that we're doing on the margin side, profitability of it. The first step for us is let's optimize the way that our portfolio is working for us, which is really the capital allocation decisions we've been making to support it. Beyond that, it's going to be, yeah, maybe there's opportunities for us to exit some parts of the portfolio later on or bring tuck-in acquisitions at the time we're ready for it. The first phase is let's get it to work for us to optimize it. Yeah. Just to put a finer point on it, the work that we've done with respect to the portfolio prioritization has actually confirmed in a lot of respects that there are products in each of those three markets, right? Tissue, neurosurgery, as well as ENT, that will deliver kind of those high growth outcomes. To your point on loving your children equally, maybe not totally across the board, but certainly within, there absolutely are assets across each of those three that will help drive our future. Yeah, every part of the portfolio has a role to play. You can't expect the same thing from every piece of the portfolio, and you have to make choices. Nobody likes to delay programs. Nobody likes to cut programs, but you have to do it in order to be able to make meaningful impact in the direction of the portfolio in the company. You have to allocate attention and resources. Exactly. On the high level update, maybe for the remediation and the CMP side of things, a reminder, there's obviously a lot going on, but where are we at today and how far through that process do you see? Yeah, compliance master plan has been a top priority for us, and we have been making great progress. You know, the CMP, the compliance master plan work streams are on track, we're continuing with them. The site assessments that we had conducted in all of our facilities were supposed to be done by the end of Q3. We completed them by the end of Q2, which really provided us more visibility to the work streams and the remediation that we have ahead of us. We've taken those findings. We have done a very thorough prioritization of that remediation work, and we've begun execution under the program management office oversight and rhythm. That prioritization and oversight on execution is something that we're bringing new. We didn't have that before. I think that's going to help us to continue to make progress. The remediation work is critical for us, not just in terms of regulatory compliance. Obviously, that's a big piece of it, but it's also critical as we try to drive consistency and, you know, sustainability in our quality systems across our network of sites. Also, to be able to build in place manufacturing reliability. Some of this remediation is going to go into 2026, but the work that we're doing is going to set us up well for continuing to improve in terms of our visibility ahead, as well as continuing to, in the future, deliver more predictable, reliable performance. People are always critical in these kind of things. I know Valerie joined you guys relatively recently. What went into the selection of her, and how does she fit into this plan? Early on when we were looking to fill the position, it was very evident that we needed a seasoned executive that had deep experience in operations and also would be good at driving cultural change and also bringing accelerated progress into what we're trying to accomplish here at Integra. We were looking for somebody that had worked in large organizations that had complex global supply chains. Valerie brings with her a track record of having led supply chain transformations over the years and bringing operational excellence and putting it in place, which are exactly the things that we need at Integra. As I told you, she initiated early on in her role a supply chain control tower. We're seeing the culture change that's coming along with it in terms of accountability and continuous improvement. I have known her for years and I have seen what she can do and what she can deliver. I'm confident in her ability to be able to make significant impact in Integra moving into the future. I mean, supply chain operations is a partner with Finance in a very real way. You know, Lea, how are you thinking about COGS and OPEX savings and the cost base of the business, ultimately going forward? As you would have heard in our Q2 call, we announced an initial cost reduction initiative that's the first phase of a longer-term margin expansion program. Its first phase is targeting about $25 to $30 million to be identified over the next 12 to 18 months, aimed at addressing moving us back from a profitability perspective to where we need to be and also mitigating some of the headwinds that we know will be happening in terms of the first full year of tariffs, full year impact of tariff implications, as well as inflationary pressures that we're seeing on the business. To your point, as we look at this, yes, we're targeting areas within COGS because we know there's opportunities to go after productivity improvements and yield improvements. We're targeting areas in terms of OPEX that will address third-party spend. It'll address operating model efficiencies, right, and how we are structured and whether or not it's optimized to drive the growth and profitability that we ultimately want to deliver. Along the way, we're embedding a very strong discipline around OPEX management to help ensure that we not only drive it, but we maintain it going forward. It sounds like it's a COGS efficiency and like an external, Asian supplier efficiency kind of a measure rather than big internal COGS. Is that a fair assumption? As part of the focus, yes, the initial focus in this first 12 to 18 month period will be primarily in COGS as well as on third-party spend. We are also looking at operating model efficiencies and whether or not we're structured to execute on the kind of portfolio prioritization work that we're doing in. Yeah, I would say workflow efficiencies, how the functions, you know, do handoffs in terms of our, you know, also processes. There are the processes and procedures, not just in operations, there are in every function. How do we become more efficient in terms of the way that we conduct the work every day? How do we increase agility and speed in decision making? As Lea said, it's phases and there are opportunities everywhere that we will be going after as we come upon them. I guess those savings also then help you reinvest internally in the control of the compliance, like, and so it's like a good flywheel to kind of keep running. Absolutely. In relation, you were mentioning earlier the customer tension side. Have you noticed the difference between the products that have been off the market longer versus those who have been off the market for a shorter period of time? Is there any kind of difference? Yeah, so the ones that are out of the market for a short period of time, as I said, we see pretty good bounce back. We see the demand being there, even afterwards. On the products that have been off the market, like SurgiMend and Prometrix, obviously it's going to be more challenging for us. It's going to require for us to be very focused in execution, and it's going to take time to get some of that share back. What we're also hearing from the clinicians every day is that they have used these products in the past, they know these products, and they still, to this date, prefer these products to the alternatives that they're having to go back to. You take SurgiMend, for example, it's been known for, first of all, it was growing faster than the category before it went off the market. It has played a critical role in the procedures. The physicians are saying, you know what, now that it's not in the market, it actually reinforces our preference for the product because we know we're missing it. The same thing goes with Prometrix. Do you hear this similar kind of feedback? These products are not only differentiated, but they also serve a certain purpose in certain patient settings. I think as we bring them back to the market, we're going to continue to be focused on supply reliability, making sure that we launch them with adequate and healthy supply and continue to drive clinical support as well as drive commercial excellence in order to be able to gain our share back. We're confident that we'll be able to, over a period of time. I guess you've got the base business, but then there's also your pipeline. Yeah. How are you guys thinking about things like DozeWorld, and how are you thinking about the balance of bringing new PMAs and things like that to market relative to the work that's going in, getting back in the market with the existing? Yeah, so both are obviously priorities for us to win a Compliance Master Plan and the regulatory efforts that go towards the PMAs are both important. We're not trading off one for the other. One of the things that I would say, the PMAs are critically important for us strategically, especially in the implant-based breast reconstruction market. $800 million market growing in high single digits. Our strategy has been a dual approach where we have SurgiMend®, which is a biologic matrix, as well as DozeWorld, which is synthetic. We are pursuing PMAs for both of them. To this date, no other company has the indication, PMA indication. For SurgiMend®, we have obtained an approvable status, which means that the clinical safety and efficacy have already been established for the product. All we have to complete is going to be the GMP inspection, which is closely tied to bringing BrainTree online. We would be ready for a PAI pre-approval inspection in 2026. We can't speak to when FDA is going to show up for that, but we should be ready for that inspection post readiness in operations. We also are pursuing the PMA, obviously, and it's going on track for DozeWorld. Those are both important PMAs for us. Nobody has the indication, so. Obviously, when you joined, your R&D team would have given you some insight into what the broader pipeline looks like. Obviously, no company would ever say what's in there for competitive reasons, what's in the pipeline coming up. Is it relatively well distributed between the divisions? Is there anything you can tell us about the forward look of where the R&D dollars are being disproportionately spent? I would say right now a lot of our efforts are on the remediation side as well. We have that third leg that's going on. I would say the investments in terms of capital and future growth, partly is the lifecycle management, which is the remediation work that needs to be done. Then you have the R&D investment and you have clinical evidence because, for example, when you look at tissue technologies, our mix of investment is higher on the clinical evidence than it is on actual products, versus, say, neurosurgery. I would say it's fair to say the innovation and new product opportunities we're looking at are going to be in category-leading parts of our portfolio because we want to continue to build on that leadership. That's both in the neurosurgery side as well as the ENT side as well. In the future, obviously, we have opportunities with tuck-in acquisitions when we're ready. Right now, our focus is on execution and bringing down our leverage. How should we, this is really to you, Lea, though, how should we think about the growth algorithm, I guess, midterm and maybe potentially in 2026? You're in an unenviable position because there's so many moving parts. Yeah. I mean, it's true for every business, but it's always challenging. If you're in our shoes, are there any key puts and takes or things that you think we should keep in our mind as we think about next year and midterm in general? Yeah, so point well taken. There are very many moving parts, certainly as we look ahead to 2026, and we are still very much early in our planning process for 2026. I can't get into a lot of specifics, but certainly can share some directional thinking. On the top line, we certainly expect to see growth in 2026 over 2025 as we continue to do the work to strengthen our quality management system, as we continue to put ourselves in a position to reestablish supply reliability and, quite frankly, give our commercial teams an opportunity to get back on offense. We also fully expect to see a benefit in 2026 versus 2025 from a comparison perspective due to shipholds, right? 2025 representing peak year impact from shipholds. We would expect to see, again, a benefit in 2026 versus that. On the bottom line, to my points earlier around the work we're doing around margin expansion, right? That work being a profitability initiative that'll help us not only drive profit, but also mitigate some of the headwinds that we know will happen in 2026. As I mentioned earlier, full year impact of tariffs, as well as other inflationary pressures. Those are some of the puts and takes that we're evaluating. In general, though, we are encouraged by the momentum that we're seeing on the business, and we look forward to coming back in our normal course to share our 2026 guide, which would be part of our Q4 call. Yeah, of course. You know, you've got to touch on capital allocation in general. How should we think about, you know, the convertible note leverage and the leverage structure of the business? Yeah, our converts actually matured in the middle of August this year, and we did satisfy that maturity leveraging our revolver, which was our plan. If we didn't have any other instruments in place, that would have meant the additional debt on our revolver would have incurred an interest rate of about 6% to 7%, somewhere in that range. Fortunately, at the same time that we entered into the converts in 2020, we also entered into an interest rate swap agreement that also became effective when the converts matured. What that allows us to do is to take up to $900 million of our debt and fix it at a rate of 3.5% through 2027. We're mitigating some of that otherwise potential headwind. We'll continue to look to construct our balance sheet in a very strong and flexible way as we move forward, and certainly, as we look forward to getting into kind of longer-term financial instruments, that will be consistent with that objective. In the interim, we remain compliant with our debt covenants, and we expect to do so. As it relates to capital allocation and priorities, our focus is in the near term, debt reduction. Makes complete sense. Maybe flipping back onto some of the product side, thinking of Integra® Dermal Regeneration Template, you know, how are you thinking about getting the production levels up, and supplying the market, and working your way through that? From a production standpoint, how do you think that applies to other lines and priorities within the portfolio? Yeah, yeah, there's a lot of efforts that are going on on the production side in general. I would say the buckets of investment that we've been making, and it goes back to really middle of last year, it's about capacity, the CapEx dollars. We've been investing more, and we are building where needed redundancies and resilience into our supply chain and value streams, and also operational efficiencies and yield improvements and so on and so forth. I think the poster child for that is actually Integra® Dermal Regeneration Template. It plays a critical role in our portfolio, almost a $200 million business with very attractive growth margins. We have been on a journey on improving the production of that product since last year, and we're pretty pleased with where we are over the last couple of quarters. Production has been able to meet demand. We've been able to deliver strong growth. It hasn't been just by chance. We have been very deliberate in terms of building redundancies in that supply chain, expanding capacity, and improving yields. That work is going on across the entire operations, and it's an opportunity that we are taking and replicating. It could be different elements of it for different product lines, but nonetheless, when we talk about building operational discipline, improving efficiencies in the operations, and investing in our operations to make the operations more stable and provide more steady supply of products to the customers, that's a great example. We're replicating it across the operations. Maybe Signal wouldn't care. I've looked at that industry for a long time, but it's been the volatility on the U.S. side for how it's being reimbursed, how it's been thought about. You get, from us, next time you get the feeling like there's not necessarily a clear vision, maybe from CMS, and it goes backwards and forwards. I'm not exactly sure what to do with it. How do you view the broad wound care landscape? Is there an idealized structure you think for how these products should be reimbursed? Do you think the proposals will then get delayed? How do you feel about the construct as a whole as it sits? Yeah, certainly very dynamic and continuously evolving. We see that as positive because obviously it's going in the favor, in the direction of products that have clinical evidence and cost-effectiveness evidence. It's also better for the patients. I think what the payers, the providers, and the policymakers are doing clearly is to improve access, increase the access to care, as well as the consistency of the care that's delivered across the different sites, and also be able to reward those companies and those products that are backed by clinical evidence. We actually see that as positive. If these changes in terms of Medicare rules and LCDs go into effect, it's going to be actually an opportunity for us, a growth opportunity for us because we have a broad portfolio of products that have evidence backing as well as cost effectiveness. It allows us to, right now, most of our business is obviously in the acute care setting, but this provides us an opportunity to grow our business in outpatient settings, like AACs and wound clinics. We're actually excited about that. We're making investments in clinical evidence in order to be able to continue to demonstrate the effectiveness and clinical effectiveness as well as cost effectiveness, not just in the acute care setting where we have good established reimbursement, but also across the sites of care. The funny thing about the market is there are a few larger players, but there's also a massive tail of companies who probably don't have the ability to invest in those trials and that evidence. Yeah. You're kind of hitting it. Do you see this like a broad consolidation across acute, maybe even chronic, and just like a consolidation of the players down towards a handful of winners, including yourself? I think there's definitely going to be shifts in the sites of care because the incentives, something is going to happen. We're thinking there is going to be shifts, remaining to be seen. There's also going to be, depending on where the ultimate numbers end in terms of reimbursement and so on and so forth, it's going to also be different as to whom, how many people are going to stay in the game, how many people are going to bow out. There's a lot that remains to be seen in terms of the dynamics of the market. I don't know if Lea, you had any additional comments? We were talking before we got up on stage. You know, you guys do a lot of these meetings, you deal with a lot of investors, and it's probably the same questions over and over again. I'm willing to bet there's a bunch of stuff for you internally that is a big focus but doesn't get asked. Do you know what I mean? Or doesn't get the focus that you feel like there's a mismatch between the focus externally and internally. What are you surprised you don't get asked about more? Alternatively, are there things you get asked about constantly, but they're just nowhere near the kind of priority that the external market seems to think that they are? Does the question make sense? Good question. Yeah, I can start. Maybe just do a compare and contrast. Certainly, having been in this forum, like a year ago, right? Clearly, everything is around operations and kind of that moment we're in, strengthening our quality. As you know, since the launch of the CMP, everything became operationally focused. You got away from talking about the exciting kind of the foundation of what we do, the impacts that we have on patients, where we see opportunities for growth that are still very much there, right? There's still very much the exciting part of who we are and what we have an opportunity to deliver on. You kind of understood, right? In that moment, there's very real reasons why that was the topic of conversation. I think you flash forward a year, we're still talking about this stuff, but it's starting to move in that direction where we're now talking about those things that represent growth opportunities for the future. We're talking about the rich clinical evidence that we have on the wound reconstruction parts of our portfolio. It's starting, you know, you get energy off of that. It becomes an exciting conversation to be part of. Yeah, I would say a lot of the external focus is on more of the challenges that we're facing. We have been facing not a lot of emphasis on the opportunity ahead of us for the company, which I think there's tremendous opportunity for us. As I said, the challenges we have in operations, execution, and quality, they're fixable. We need to fix them, and the opportunities that we have ahead of us is significant. Potentially next year, an ability to go more on offense, if you like, in terms of the story. Yes. Is that fair? Yes, that's fair. That's fair. We look forward to it. Yeah. Thanks, guys. Thank you. Thank you. Thank you. Thank you. Thanks for having us.