Welcome, everybody. Thanks for joining us. I'm Andrew Cooper. I cover life science tools, diagnostics, and a little bit of med tech as well here at Raymond James. Happy to have, for the first time for me, the Integer team here. We're going to start with a little bit of presentation and then go into some fireside chat as well to the degree there's time. So, without any further ado, I'm going to pass it to Joe Dziedzic, CEO, to walk us through some slides. Thanks, Joe.
Morning, everybody. All right. I'm here to present to you the best idea of the conference. Just checking to see who's checking email and who's listening. So, thank you, Andrew. Thanks for having us. It's great to be here. Hope you've all had as much fun at the conference as we've had. I'm going to skip the forward-looking statements. You know what those say. Integer is a leading medical device contract development and manufacturing outsourcer to the medical device industry. We serve everybody in the industry in some way, shape, or form, from the largest customers to the smallest customers, including startups. $1.7 billion in sales in 2024. Guidance said about $1.85 billion in 2025. 11,000 associates, 17 manufacturing sites, nine R&D centers spread around the world. Co-located with our customers in the med device hubs in Galway, Ireland, Minneapolis.
We have operations in Mexico, the Dominican Republic, Malaysia. We have a footprint that allows us to serve our customers where they want to do development side by side and launch complex, innovative products, as well as manufacturing locations where we can bring the low labor cost environment that helps the industry deliver very cost-effective solutions. You see at the bottom here, our sales are about 55% in the cardiovascular segment. I'm going to go into a little more depth on the sub-markets within cardiovascular. About 38% in cardiac rhythm management and neuromodulation, and 6% in other, which a portion of that we've been exiting for the last three years as part of exiting products that we don't have the level of differentiation and the profitability that we would desire. The balance in other are products that we continue to serve customers who bought businesses that we've divested.
So, we work on the left-hand side. You can take this slide home and read it later, but the takeaway here is very global footprint, serving the entire industry from the largest players to the smallest players and early-stage development companies. We work to have a very vertically integrated offering to simplify our customer supply chain and to help them get to market faster and bring innovative solutions that help our customers expand the markets that they're serving. We're following their lead on where the innovation is going in the industry that's increasing the available market by serving patients who are either unmet or underserved. So, we are very much following our customer's strategy of innovation into the markets where more patients need to be helped. When we help our customers execute and succeed with their strategy, we get the right to participate and win with them.
If there's only one slide out of this entire deck that you print and put on your wall, this is it. This is our favorite slide because it summarizes and captures what we characterize as the investment thesis when we talk to you. Internal to the company, we call this our North Star. This summarizes for you on the top left our portfolio strategy. These are the products, the end markets that we've decided to participate in, and we have made portfolio structure changes, which I'll highlight on the next slide. We have very clear product line strategies. I'll highlight the growth teams that we created to develop and execute those strategies that determine how we win in the markets that we're serving. The next block is our operational strategy. It's focused on customers, cost, and culture.
On the customers and cost, we have two strategic imperatives in each of those categories that we use operationally to execute and how we deliver excellence in these areas. The culture is an important one to us because our objective is sustained outperformance. We believe you can have a great strategy, you can have great customers, great technology, but the culture is what allows for sustain. It's what enables sustained outperformance. We spend a lot of effort and energy on culture because we do think that is the key to sustained outperformance, which leads me to the third block, which are our values. We talk about these as how we engage with each other. When you say culture, some people can't describe it. It's a soft, squishy, intangible thing. It's not. It's how you treat each other. It's that simple.
We spend a lot of time curating a culture that we believe enables us to be very candid with each other, to be very collaborative, and move the business forward in executing our strategy. We think the culture that we've created is a performance culture that allows us to deliver sustained outperformance. We define three very clear strategic financial objectives. You see those on the far right. The reason they're on the far right is they're the output. This is the financial quantification of all of the strategies and the operational execution and how we engage and work with each other. Our goal is to grow at least 200 basis points above the markets we serve on an organic basis to demonstrate we are winning in the markets we're serving. We want profit growth, operating profit, to grow at least twice as fast as sales.
Organically, our markets are growing based on the markets we're serving 4%-6%. We want at least 200 basis points above that. That's 6%-8%. We want profit growth of twice that 6%-8%. That's our strategy. That's our objective. We achieved that in 2024 with 10% sales growth and 20% profit growth. When I stepped in as CEO in 2017, we were six times leveraged from an acquisition we had done. We developed a very clear 2.5-3.5 times leverage that we want to live within. We are committed to that. We regulate our acquisitions and our investments to live within that 2.5-3.5. We think that gives us good capability to continue investing in the business organically while also doing strategic tuck-in acquisitions.
So, we think we have a very clear and compelling strategy. We think we have a resilient business model. We think we have a compelling growth strategy. We think we've built and continue to strengthen a performance culture and that we can deliver on that with the financial strength that allows us to continue investing in the business. So, there's only one slide you print and put on your wall. It's this one. So, maybe briefly, our journey. In 2017, we went through our strategy process to develop the strategy we're executing today. And on the top, what you see are the outcomes from a portfolio standpoint. The first decision we made was to divest $400 million of our $1.5 billion in sales back at the end of 2017. We executed on that strategy. Six months later, we sold $400 million, which was our Advanced Surgical and Orthopedics business.
Strategically, we could not find the technology differentiation for our customers. We weren't seeing the growth rates that we wanted, and the margins were below the company average. So, we divested that business. It helped us to deleverage. It helped us to simplify our manufacturing footprint and enabled us to begin the execution of our strategy in 2018. In late 2022, or late 2021, we announced the divestiture or the exit process in what we call Portable Medical, a piece of our business that we also said there's not enough technology differentiation. We were unhappy with the growth rate and the profitability. We'll complete the exit of that piece of business at the end of 2025.
In the fourth quarter of last year, we divested the only non-medical piece of our business that we had, which were batteries for primarily downhole oil and gas exploration and drilling. That was a $50 million sale proceeds, EPS neutral, and now we are a pure-play medical device company. The middle of the slide highlights for you our product line strategies. We developed what we call growth teams, which are product management organizations that own determining the strategy for how we're going to win in the markets that we sell. They're organized by market. They understand the end markets, where the innovation is occurring, what's the competitive landscape, what capabilities do we need, and they develop that value proposition and that go-to-market strategy. We developed those teams in 2018. We launched them, and they've been leading the execution of our product line strategies.
What you see on this slide are capability and capacity investments that we've made. Galway, Dominican Republic, New Ross, these are acquisitions and facilities where we've made meaningful investments or expansions in capability and capacity. Then underneath that, you see the acquisitions that we've done, where we have a very clear strategic criteria for the acquisitions that we pursue. These are tuck-ins. We look for acquisitions to supplement our strong organic growth and to bring capabilities that expand our vertically integrated offering. On the bottom is our operational strategy focused on manufacturing excellence and driving efficiencies. Pre-pandemic, we had great success in expanding margins, about 300 basis points in 2018-2019. The disruption of the pandemic created some challenges for us that we have now worked through, and our operating teams are now very focused on getting back to driving those efficiencies.
We've been expanding margins the last couple of years and have margin expansion of about 76 basis points in our 2025 guidance. The growth teams. This is how we drive the product line strategies. We have teams on the left. You see the structure. They're structured by end market. Their role is to understand everything about those markets, everything our customers are doing from an innovation to expand the patient population, competitive landscape, what's our value proposition. They analyze and assess the capabilities that we have. More importantly, they look for capabilities that could increase and expand our vertically integrated offering to then drive both organic investments as well as acquisitions. This is where the strategy work occurs. We have a very structured, disciplined process that we follow as an organization. We have teams that we have built and developed over time.
These are market-focused, highly technical teams that understand the markets and guide our strategy of execution. It has led us to continue to build on what we believe is the deepest and broadest offering in the industry relative to our competitor base. We show this slide because it provides you for cardiovascular, the sub-markets that we're focused on. The way to read this slide is anything on the far left is still early in the maturity of developing that technology. That's why you see renal denervation, which was outside of that blue box a year ago. It has moved now inside the box as it gets closer to becoming a more commercially available product. You see pulsed field ablation is growing and starting to move up the curve for growth. You see structural heart, neurovascular, electrophysiology, faster-growing sub-markets with technology that continues to innovate.
And if you look to the far, far right, you see interventional cardiology, which has a much more mature technology and therefore slower growth. So, the blue box, it gives you an indication of where we're focusing and spending our energies and where we are investing to drive growth. We have the exact same picture for cardiac rhythm management and neuromodulation. The color code there, the dark is neuromodulation. You see that is mostly in the faster-growing, still coming up the technology curve with the exception of, I'll call it traditional pain management, SCS, which you see kind of half in, half out. And then you see conventional CRM, pacemakers, defibrillators, still very mature, but a very big piece of the market. We are focusing very much in the higher-growth CRM markets that you see on the slide here, whether it's leadless pacemakers or cardiac monitoring or ventricular assist.
And you see the different applications and therapies in neuromodulation that we also are a strong provider of a very vertically integrated offering for both implantable pulse generators and complete lead systems. So, the growth starts with getting designed into new products. If there's one thing I'd leave you with, the most significant change in our strategy in 2018 was we went from trying to take business away from competitors that was already in production to getting designed into the next generation or the next new product, new therapy that our customers were working on. And so, when we started this journey, you see on this slide, 2017, you see the graph where our development sales were. This is customers paying us to do development work to design our technology of the components or to design our manufacturing processes into their devices.
You can see we've grown our sales from 2017, the year before we launched the strategy, which was 2018. We've grown these development sales by 270%. Last year, this slide showed 230% on it. We continue to grow the development work. This is what creates the pipeline for sustained above-market organic growth. Shots on goal have increased by 270%. That's the way to think about the left side. The right side breaks down of the programs we're working on for customers supporting that design and development of their devices. In 2017, we had about half of those programs were in what we would characterize as the faster-growing end markets, and half were in the more mature, slower-growing. This is the quality of those shots on goal. We've shifted that mix. We did that fairly quickly.
You see, 2021, we were at about 80% of the shots on goal. These development programs are in those faster-growing markets. This is how we're shifting the mix of our development programs. So, the new products we're getting designed into are in inherently faster-growing markets, which enables us to outgrow the markets that we're serving. And the markets we're serving based upon our sales mix is about 4%-6%, call it mid-single digits. So, our goal is at least 200 basis points above that. So, we have a very strong pipeline of development programs, significantly more shots on goal with a better mix in the markets that we're serving. We've been showing this slide since the third quarter of 2020. What you have on the left-hand side, so these are emerging customers in what we call or what's called premarket approval .
These are for devices that get implanted in the body for 10 years or longer. These are implantable pulse generators that are used to stimulate the central nervous system. And so, there's an IPG that gets implanted similar to a pacemaker. And then there's a lead system that connects to the implantable pulse generator that then reaches the central nervous system somewhere and stimulates the body to treat a condition. On the left-hand side, we've detailed out the five phases of this development process. And so, you start with development of an idea, develop a prototype, try to prove that it's safe, prove that it has efficacy, take it through development, take it through regulatory, and then you move into the two phases of commercial launch. You see 39 different customers, 39 different products on the left-hand side.
The first time we showed this in the third quarter of 2020, there were 27 customers and products on this slide, so that 270% growth in development revenue, this is contributing to that growth because we have 44% more shots on goal in this market with these customers. On the right-hand side, we show the sales that we had from the customers that are in that one of two phases of product launch.
On the left, we've got a blue box around it. You see the growth that we've been able to generate in 2018, we had $10 million, so in 2020, we said we'd be around $20 million, and in 2021, we said we would grow 2022 to about $40 million. We ended up at $50 million. We started the 2024 outlook at $80 million-$100 million, then we increased it to $120 million, and we ended up slightly above that.
You see the very strong growth trajectory. We've gone from what was a $10-$20 million business four years ago to a book of business that's now $125 million. We expect this book of business and these customers in this pipeline to generate 15%-20% growth on a go-forward basis, which is growing, we think, about twice the rate of the market. We have a fully vertically integrated offering here where the components, we oftentimes manufacture the components. We do the design development of the IPG and/or the lead system, and then we do the finished device assembly and support our customer from the early stage of development all the way through high-volume manufacturing launch. This is an exciting part of our business that has a very strong pipeline of continued growth. That's the organic story.
We want the bulk of our business and top-line growth to be organically driven, but we also have the capacity and capability to do inorganic strategic tuck-in acquisitions. We compete in a very fragmented marketplace. There are a lot of smaller, call it 10 to 20 to 50, $75 million companies that are oftentimes privately founder-led, founder-owned, or private equity-owned businesses that we work with. Oftentimes, we are either a customer or a supplier to many of these potential acquisition targets in the industry. When we look at our cash flow generation, we look at our EBITDA growth and the acquired EBITDA from an acquisition. We estimate we have $350-$400 million of annual acquisition capacity to do these strategic tuck-ins.
We've got very clear criteria that we evaluate that we've detailed out here, and we work to be very disciplined about how we execute on this tuck-in acquisition strategy. So, we've completed six acquisitions in a little more than three years. We did not do any substantive acquisitions from 2015 to 2021. I think I mentioned in 2017, when I joined as CEO, we were six times leveraged. So, we spent the next three to four years getting our leverage down. And now that we have leverage in that two and a half to three and a half target, we've been able to do these strategic tuck-ins and expect to continue being able to do that. What we expect to be able to deliver then is on a go-forward basis between the organic growth and the supplement of the organic growth with strategic tuck-ins.
We're driving for high single-digit to low double-digit total sales growth on a go-forward basis. Contrast this with before we started implementing this strategy where we were going at about the market, about mid-single digits. So, we want you to think of us as high single-digit, low double-digit, all in on a go-forward basis with expanding margins. So, let me summarize 2024. Since we're just a few weeks away from having reported our earnings release, we had reported sales for 2024 of 10% growth. That was 7.3% organic. So, we had strategic tuck-in acquisitions that got us to that double-digit. We had EBITDA and operating profit growth of 19% and 20%. So, we did hit our operating profit growing twice as fast as sales, 20% compared to 10%. I wish we were so good we could land on that every year. That's our strategy and what we're driving towards.
You see Adjusted Net Income up 18%. We feel like we're executing our strategy quite effectively, and we've got a great growth trajectory, which leads me to the 2025 outlook. We guided to, and I'm reiterating, 2025 guidance of 8-10% sales growth. That's reported 6-8% organic sales growth, operating income at 11-16%. We felt like this was the right place to start the year with Adjusted Net Income growing 13-20%. This is also a good time to maybe provide an update on the impact of tariffs. I checked the news before we started. I hadn't seen any changes. Now that the 25% tariffs have been implemented on Canada and Mexico, I mentioned earlier we have three manufacturing facilities in Mexico. We do not have any operations in Canada.
When you consider the import tariffs, I'm talking import tariffs on China and Canada, negligible. Mexico with three manufacturing facilities. We have two in Tijuana. They're side-by-side buildings run by the same manufacturing leadership team. We have one in Juarez, Mexico. These are maquiladora structures. Historically, the way those work, you bring material from the U.S. to Mexico, you process it, you ship it back into the U.S. If there were tariffs or duties or taxes, you only pay on the value add. The recent executive orders said that does not apply. Anything you bring back will be subject to the 25% tariff. The first thing we've done is we've made operational and logistics changes so that anything coming out of Mexico is now either being shipped directly to non-U.S. locations or it's flowing through the U.S.
in a structure that avoids the tariff while it's in transit and then leaves the U.S. So, that's been fully implemented. That mitigated a substantial portion of the potential tariff impact. The next thing we've done is we've gone through and analyzed the impact of the tariffs and what's dutiable or non-dutiable, what's subject to the tariff and what's not. Our estimate of the impact for 2025 is in the $1-$5 million range for the 25% import tariff into Mexico with a negligible amount of the impact coming from Canada and China for those tariffs. So, we're estimating $1-$5 million of 2025 impact. The range of AOI guidance we have on the slide here is $315-$331 million. We feel that that $1-$5 million is covered by this range of operating income for the year.
Reiterating full-year guidance with more clarity on the potential or the impact of tariffs coming from imports from Canada, China, and Mexico. I'm going to wrap up with cash flow. We continue to increase and generate strong cash flow from operations. On the far left, we're increasing our free cash flow. We're investing in the business. From here forward, we would expect to grow CapEx and the range of sales growth as we continue to add new programs, new products. We invest in the capacity and equipment to do so. We've given you a target range for our net debt combined with where we've guided you to EBITDA growth and net debt. You can do a calculation on where our debt leverage range is at the end of the year. That math puts you towards the lower end of the range by the end of 2025.
Andrew, I'm happy to field any questions.
Perfect. Yeah, we've got a few minutes. We can sit up here and go through a couple of things. You took my first one. I was going to have to ask about tariffs. So, I feel like you laid that out pretty well. I'll maybe skip that. I think the other kind of very topical piece, you had another player in the OEM landscape talk about some inventory dynamics affecting their portfolio and their business. So, just would love any comments from you. Is that something you're seeing in terms of your customers more aggressively managing inventory or anything like that as we think about 2025?
Sure. So, on inventory, I think we've had three competitors who are industrial companies with divisions in medical that have all had some form of commentary on inventory impact.
And what I'll say is we feel like we have really strong visibility to the demand from our customers. We have almost $800 million of orders on hand. We call it backlog, but think of it as orders, specific SKU, specific quantity, specific ship date. That combined with our customers continually giving us a rolling 12-month view of what the demand is for their manufacturing plants for what we supply to them, we feel gives us really good visibility. We have factored all of that into our guidance. What I will say is I commented back in the second half of 2023, we saw customers sending out letters to all their suppliers about inventory adjustments. That was incorporated into the information customers were giving us about their demand. We saw those kinds of things continue throughout 2024. We consider inventory management to just be something customers are always doing.
We incorporate the visibility they're giving us into our guidance, and we're very comfortable with our guidance for 2025.
Perfect. Maybe now with that out of the way and the tariffs piece out of the way, diving into a little bit higher-level questions. The thing that stands out to me, I think, is the 270% growth in the development work and kind of trying to be skating to where the puck is going. What ending of that journey do you think we're in, knowing that a PMA process is a multi-year process? So, what work you think you put in motion in 2021 probably isn't necessarily bearing fruit yet. So, where are we in that journey?
Yeah, it's a great question.
So, in 2018, when we launched this strategy, we knew it was going to take three, four, five, six years to start seeing manufacturing revenues from the development work. We have a slide in that we oftentimes show that talks about the cycle times from winning a development work, when's it become manufacturing revenue? So, we knew back in 2018 this was going to take a while. We also had confidence that once you get that pipeline built, you now have a pipeline that can deliver sustained growth. And we are now in the phase where we are seeing those early years, 2018, 2019, 2020 wins where we started development work, we're seeing that turn into manufacturing revenue. And so, I would say we're five or six years into execution of getting designed in as our strategy.
Every time we do an acquisition, we are either compounding differentiated capability we already have, or like the two most recent acquisitions, we're adding new capabilities that help us to get designed into even more products or further vertically integrate. So, I would say we're five or six years into the execution of our strategy, which we believe is enduring and the right strategy for the long term. We are in the very early innings of seeing that development growth start to translate into manufacturing revenues. And we think we're now on the trajectory of strong pipeline that's been built over five or six years that can continue to deliver sustained above-market organic growth.
Perfect.
Just to make sure it's clear, because I think there was a little noise around 4Q, the product development work shows up where on the P&L and how do we think about kind of what that does in a given period, knowing it can be a little bit lumpy?
Sure. I'll answer this way, and then I'll give you the specifics. When we do more development work that customers pay us for, the R&D expense line in the income statement gets lower. It ends up being reported as sales for what they pay us. And then we move some of that R&D work into cost of goods sold. That may sound confusing. That's accounting. Sometimes it is confusing. Think of it this way. The R&D line going down probably means we got paid to do more development work.
And I can tell you in 2024 actuals, you'll see our R&D expense line went down. That's because we grew the development sales. The slide I showed you said 270%. Last year, that slide said 230%. So, you see we grew it significantly still, and the R&D expense line went down. That's how to think about those two.
Perfect. And one of the questions we get, and just kind of would love to give you the venue to address a little bit, is the customer concentration one. I'm sure you get it in a lot of meetings as well. Help frame that for us. We know how big the top customers are overall, but how many projects? And maybe what's the biggest kind of single product or bill of goods exposure for you when you think about that concentration risk in your brain?
Yep. This is a common question.
So, our top three customers in alphabetical order, Abbott, Boston Scientific, Medtronic, all three of them are 10% or more sales. So, we have to publicly disclose those three. It's about 47% of our sales in 2024. As a % of sales, they look like they're significant. We think that because we serve the whole industry, we think that's representative of their position in the industry as the three biggest players in med tech. Way to think about it is we have hundreds of different programs with each of those customers. We serve each of those customers in the business unit and the markets that we serve. So, we have relationships at the C-suite and at the corporate level, but the actual day-to-day decision-making is made by their individual business units.
So, when you take any of those customers and you think about how they're making decisions, they're making decisions at a much more granular level. And it's engineer to engineer. It's technology offering to what they need. And it's spread across many end markets. It's spread across hundreds of different programs. And so, although it looks like concentration, it's actually very diversified. And there's no single program that's a meaningful driver of the entire company. We've talked about that a lot, and I think that diversification is a strength of ours.
Perfect.