Executive Summary / Key Takeaways

• Strategic Evolution and Market Leadership: Integer Holdings Corporation has successfully transformed into a pure-play medical device contract development and manufacturing organization (CDMO), strategically shifting its focus to high-growth markets like Cardio & Vascular and Neuromodulation, underpinned by significant investments in product development and differentiated coating technologies.
• Robust Financial Performance Despite Headwinds: The company delivered strong Q3 2025 results with 8% sales growth and 14% adjusted operating income growth, maintaining a solid financial position with expanding margins and reduced debt leverage, even as it faces an "unusual" near-term sales headwind from slower new product adoption.
• Differentiated Technology and Vertical Integration: Recent tuck-in acquisitions, Precision Coating and VSi Parylene, significantly enhance Integer's proprietary coating capabilities, deepening its vertical integration and enabling earlier engagement with customers on novel product designs, thereby strengthening its competitive moat.
• Near-Term Challenges, Long-Term Confidence: While 2026 is projected to see flat to low single-digit organic sales growth due to specific new product headwinds and the Portable Medical exit, management expresses strong confidence in returning to above-market organic growth in 2027, driven by a robust and strategically aligned product development pipeline.
• Resilient Business Model and Competitive Edge: Integer's business model, characterized by sole-source relationships, a substantial backlog, and a focus on non-elective therapies, provides resilience against macroeconomic uncertainties and competitive pressures, positioning it as a critical partner for leading medical device OEMs.

Integer Holdings: Forging Ahead with Precision and Purpose Amidst Market Shifts

Integer Holdings Corporation (NYSE:ITGR) stands as a global leader in medical device contract development and manufacturing, a critical partner to original equipment manufacturers (OEMs) in the cardiac rhythm management, neuromodulation, and cardio and vascular markets. Founded in 1970 as Greatbatch, Inc., the company's strategic journey since 2017 has been marked by a deliberate and successful pivot towards sustained outperformance. This transformation has involved divesting non-medical assets, such as Electrochem Solutions in October 2024, and exiting low-growth segments like Portable Medical, which is expected to conclude by Q4 2025. The core of Integer's strategy is to achieve organic growth at least 200 basis points above the market, expand operating profit at twice the rate of sales growth, and maintain prudent debt leverage between 2.5 to 3.5 times EBITDA.

Integer's competitive advantage is deeply rooted in its technological differentiation and vertical integration. The company possesses extensive expertise in precision manufacturing and proprietary battery solutions, which are foundational to high-reliability medical devices. Recent strategic tuck-in acquisitions, Precision Coating LLC (January 2025) and VSi Parylene (February 2025), have significantly bolstered Integer's capabilities in high-value surface coating technology platforms, including fluoropolymer, anodic coatings, ion treatment solutions, laser processing, and parylene coating solutions. These acquisitions are crucial as they allow Integer to offer differentiated and proprietary coating services, a capability often outsourced by OEMs. This vertical integration enables Integer to engage with customers earlier in the product design and development process, simplifying their supply chains and accelerating time-to-market for innovative therapies. The tangible benefits of these specialized coating technologies include enhanced product performance, durability, and biocompatibility, which are critical in complex medical device applications like electrophysiology and neurovascular. Integer’s R&D initiatives are strategically aligned to these high-growth markets, with product development sales projected to increase over 300% from 2017 to 2025, with 80% of these opportunities concentrated in emerging and growth markets. This focus on early design wins and advanced capabilities strengthens Integer's competitive moat, ensuring it remains a partner of choice for OEMs seeking high-quality, customized components and sub-assemblies.

In the competitive landscape, Integer operates as a specialized supplier, contrasting with larger, more integrated players like Medtronic (MDT), Abbott Laboratories (ABT), Boston Scientific (BSX), and Johnson & Johnson (JNJ), who often focus on proprietary, branded end-devices. While these larger competitors benefit from extensive global distribution and brand recognition, Integer's strength lies in its operational adaptability, cost-effective production, and deep expertise in high-reliability components. For instance, in cardiac rhythm management and neuromodulation, Integer provides critical components like implantable pacemakers, leads, and spinal cord stimulators, often as a sole-source supplier. This specialized role allows Integer to achieve greater efficiency in high-volume, precision manufacturing, potentially offering a more agile and tailored production alternative to the comprehensive systems offered by its larger rivals. Integer's strong OEM relationships, built over decades, further solidify its position, making it a critical link in the medical device supply chain. The company's participation across the entire electrophysiology procedure, from access to ablation, including pulsed field ablation (PFA), demonstrates its broad engagement and ability to capitalize on market growth.

Financial Performance: Navigating Growth and Unexpected Shifts

Integer's recent financial performance underscores its strategic execution, even as it confronts unexpected near-term challenges. For the third quarter ended September 26, 2025, the company reported sales of $467.69 million, an 8% increase on a reported basis and 7% organically compared to the prior year. Adjusted operating income grew 14%, with the adjusted operating income margin expanding by approximately 80 basis points to 18.4%. This margin expansion was driven by a 10 basis point improvement in gross margin and 70 basis points from operating expense leverage. For the first nine months of 2025, sales reached $1.38 billion, up $114.50 million from the prior year, fueled by strong demand, new product ramps, and contributions from recent acquisitions. Gross profit for this period increased by $33.40 million, reflecting higher sales volume and improved supply chain efficiencies.

Liquidity remains robust, with cash and cash equivalents increasing by $12.40 million to $58.94 million as of September 26, 2025, primarily from $140.70 million in operating cash flows.

Working capital from continuing operations saw a significant increase of $124.40 million, driven by positive fluctuations in accounts receivable and inventory. The company's capital structure is well-managed, with $1.19 billion in net debt and 35.04 million shares outstanding. A strategic refinancing in March 2025, involving the issuance of $1 billion in 2030 Convertible Notes, has shifted approximately 92% of Integer's debt to fixed-rate borrowings, significantly reducing interest expense.

This proactive financial management ensures ample borrowing capacity of $794.70 million under its Revolving Credit Facility, providing flexibility for future strategic investments and acquisitions.

Despite this strong performance, Integer recently faced an "unusual" and "highly unusual" challenge: unexpected customer updates in Q3 2025 indicating slower-than-forecasted market adoption for three new products—two in electrophysiology and one in neuromodulation. This is not due to loss of share or products being pulled from the market, but rather customers adjusting their purchases to match actual market demand. As a result, Integer has revised its 2025 sales outlook, reducing the midpoint by $16 million to a range of $1.840 billion to $1.854 billion (7% to 8% growth). The impact on adjusted operating income and EPS has been minimized through active cost management, with the adjusted operating income midpoint reduced by only $3 million to a range of $319 million to $325 million.

Strategic Initiatives and Future Outlook

Integer's strategic roadmap continues to focus on both organic and inorganic growth. The recent acquisitions of Precision Coating and VSi Parylene are prime examples of its tuck-in acquisition strategy, adding differentiated coating capabilities that are accretive to margins and further vertical integration. These acquisitions are expected to contribute approximately $59 million to 2025 sales. The company's product development pipeline remains robust, with development sales projected to increase over 300% from 2017 to 2025, with 80% of these opportunities in high-growth markets. Sales from emerging PMA customers, a key growth driver, are expected to grow at a compound annual rate of 15% to 20% over the next three to five years.

Looking ahead, the preliminary 2026 outlook anticipates a "3% to 4% headwind" to total company sales from the slower adoption of the three new products, compounded by an approximate 2% headwind from the Portable Medical exit. This is expected to result in flat to low single-digit organic sales growth for 2026, with a more pronounced decline in the first half. However, management is confident in a "recovery to market growth during the second half as the new product headwinds moderate". For 2027, Integer expects to "return to above-market organic sales growth," aligning with its long-term strategic objectives, driven by new product launches across its growth markets.

Risks and Challenges

The primary near-term risk stems from the unexpected slower market adoption of new products, which has led to a reduction in 2025 guidance and a projected headwind for 2026. While management views this as a "short-lived" and "highly unusual" aberration, it highlights the inherent lumpiness of new product launches and the reliance on customer forecasts. Macroeconomic and geopolitical factors, including supply chain disruptions, inflationary pressures, elevated interest rates, and global conflicts, also pose potential risks, which could lead to increased borrowing costs, labor shortages, and delayed customer orders.

Tariffs, particularly those impacting trade with Mexico, remain a source of uncertainty. While Integer's direct exposure is estimated to be minimal ($1 million to $5 million for 2025 and 2026), the broader impact on the global supply chain and customer operations could indirectly affect the company. The conditional conversion features of Integer's convertible notes also present a potential risk to liquidity and could lead to dilution of common stock ownership.

Conclusion

Integer Holdings Corporation is a strategically focused medical device CDMO with a clear vision for sustained above-market growth and expanding margins. Despite facing an "unusual" near-term deceleration in sales due to slower new product adoption, the company's robust financial health, strategic tuck-in acquisitions, and a strong product development pipeline position it for a confident return to above-market growth in 2027. Integer's deep technological expertise in precision manufacturing and specialized coatings, coupled with its vertically integrated offerings, reinforces its competitive standing as a critical partner to leading OEMs. While macroeconomic uncertainties and specific product ramp challenges warrant monitoring, Integer's resilient business model, commitment to operational excellence, and disciplined capital allocation strategy provide a compelling investment thesis for discerning investors seeking long-term value in the medical device sector.