Globus Medical

Phase A — Understand the business

Company Overview

Globus Medical develops and sells implantable devices and the instruments/disposables/capital equipment around them to treat musculoskeletal disorders — primarily spine (degenerative, deformity, MIS), plus orthopedic trauma, hip/knee/extremity recon, biologics, intra-operative neuromonitoring (IONM), and spinal-cord stimulation (SCS). HQ Audubon, PA; incorporated Delaware 2003; NYSE: GMED; auditor Deloitte (since 2017); CIK 0001237831.

How it actually makes money. Two disclosed operating segments, aggregated into one reportable segment:

• Musculoskeletal Solutions — $2,797.9M FY2025 (95.2% of revenue). The razor blades: implants + disposables consumed per surgery, recognized at the point the device is implanted (consignment model — inventory sits in hospitals/with reps, revenue books on use).
• Enabling Technologies — $141.0M FY2025 (4.8%). The razor: ExcelsiusGPS robots, navigation, imaging. Capital sale + multi-element (maintenance/support) contracts, revenue recognized as each obligation is fulfilled.

Customers: hospitals and ambulatory surgery centers, sold through a directly-employed + independent-distributor US sales force and a mix of direct/distributor/third-party channels internationally (~64 countries). No customer was ≥10% of sales in FY2023–25 — customer concentration is low; the real concentration is surgeon-level (the implant chosen is the surgeon's preference, won set-by-set).

• Contract structure: point-in-time product revenue, no take-or-pay, modest recurring (deferred revenue only $36.9M — the maintenance tail on robots). This is a transactional, surgeon-relationship business, not a contracted-backlog business.
• Suppliers: in-house manufacturing + third-party suppliers, "substantially all" US-based. Supply-chain fragility was the proximate cause of the 2025 stock collapse (see Lens 8).

The strategy in one line: consolidate the spine/ortho mid-tier via M&A (NuVasive 2023, Nevro 2025), cross-sell the combined bag through one enlarged sales force, and use the robot + navigation as the differentiator that locks the surgeon into the Globus implant ecosystem.

Supply Chain

Map: raw materials (titanium, PEEK, biologics, electronic components) → Globus in-house plants + third-party contract manufacturers (substantially all US) → consigned surgical sets held by reps/hospitals → surgeon implants device → revenue.

Named/material stakeholders and chokepoints:

• In-house manufacturing is a deliberate moat — Globus assembles its INR (robot) systems in-house and makes a large share of implants itself, which is unusual in spine (many peers are asset-light/outsourced). This is the company's identity ("engineering-driven").
• The consignment surgical-set model is the working-capital engine and the chokepoint. Inventory is $759.3M (14.3% of total assets). Sets must be physically present at every account in every size — fewer than all components are used per surgery, so structural excess/obsolescence risk is permanent (it is the critical audit matter Deloitte flagged).
• Integration as a supply-chain event. Management explicitly attributed the Q1 2025 miss to "supply chain disruptions from the NuVasive integration". Merging two implant catalogs means rationalizing two ERP/manufacturing/distribution stacks — the chain is the integration risk.
• FX-exposed nodes: operations in Puerto Rico, Brazil, Argentina (currency-control markets); functional-currency exposure to AUD, BRL, GBP, COP, EUR, JPY, SGD. FY2024 ate a $43.3M FX transaction loss; FY2025 only $3.0M.
• No single-source upstream dependency is disclosed as material; the contractual purchase obligations total only $36.1M — i.e., the company is not locked into large take-or-pay input contracts.

Competitive Advantages (moats)

Where the moat is real:

1. Surgeon switching costs + the enabling-tech lock-in. Once a surgeon trains on ExcelsiusGPS and its navigation, the implants that snap into that workflow are Globus implants. ~500 Excelsius systems installed globally (YE2024) each act as an annuity that pulls implant volume. Reviewers rate ExcelsiusGPS as more mature in spine than Stryker Mako Spine or J&J VELYS, and more imaging-flexible / cheaper than Medtronic Mazor X. In spine specifically, it is a co-leader.
2. In-house engineering velocity. Globus's brand identity is rapid product cadence — "continuous AI-driven workflow updates without replacing the system". Vertical integration lets it iterate implants + robot together.
3. Scale post-merger. NuVasive + Globus made the clear #2 pure-play in spine behind Medtronic; combined the bag spans the whole spine procedure. Scale buys sales-force density and R&D absorption.

Where the moat is thin:

• Bargaining power is weak on both sides. Hospitals are consolidating into GPO-driven buyers squeezing implant ASPs; surgeons hold the demand-side power (they choose the implant). Globus is the price-taker in the middle. No customer ≥10%, but that cuts both ways — no anchor, all share won surgeon-by-surgeon.
• The robot is not a durable moat by itself. Medtronic (Mazor), Stryker (Mako Spine, launched 2025), J&J (VELYS, 2025) are all funding spine robotics; ISRG/MDT/SYK already own 83.9% of the broader digital-surgery market. The hardware advantage is a 1–2 year lead, not a 10-year castle.
• IP is contested, not pristine — multiple active patent suits (Moskowitz NPE, 4WEB) and a just-lost legacy NuVasive case (Pimenta, $43.1M) show the spine-implant IP estate is a brawl, not a fortress.

Net: a genuine but narrow and time-limited moat — surgeon lock-in via an installed robot base, defended by engineering cadence and in-house manufacturing, in a category where three giants are now pointing R&D directly at it.

Segments

Globus reports one reportable segment, so segment-level operating income is not separately disclosed; revenue is disaggregated by product category and geography.

By product category (FY, $K):

The single most important trend in this table: the robot line shrank. Enabling Tech fell 8.4% in 2025 — the 10-KForm 10-KA company’s audited annual report to the US regulator. The most complete thing it publishes. attributes the US piece to "lower unit placement" of robots (−$17.3M domestic). Capital-equipment budgets are cyclical and the spine-robot market is "still in its infancy" by the company's own words. The growth is all in implants (organic + Nevro's SCS), not in the robot.

By geography (FY, $K):

US = 80.6% of revenue; international 19.4% across ~64 countries — a clear US-skewed franchise with international as the under-penetrated long-tail growth optionality.

The number that matters most — organic vs. acquired. Of the $419.6M FY2025 revenue increase, ~$293.6M was Nevro ($254.2M US + $39.4M intl). That leaves ~$126M of organic growth on a ~$2,519M base ≈ ~5% organic for FY2025. The headline 16.7% is M&A; the underlying engine grew mid-single-digits while it digested NuVasive. The Q1 2026 print shows that engine re-accelerating — US organic Musculoskeletal +$53.7M on $483.9M ≈ ~11%, with spine implantables +$38.9M and neuromonitoring +$10.1M. That acceleration is the whole bull case (Lens 12).

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Phase B — Measure performance

Earnings Result (latest print: Q1 2026, period ended 2026-03-31)

Headline:

• Net sales $759.9M, +27.0% YoY (vs $598.1M Q1 2025 — but Q1 2025 was pre-Nevro; Nevro closed Apr 3, 2025, so this is the first clean full-Nevro quarter).
• Operating income $150.4M (19.8% margin), up from $97.0M (16.2%) — real operating leverage.
• Net income $124.3M; GAAP diluted EPS $0.90 (vs $0.54).
• vs consensus: revenue $759.9M beat the $739.8M estimate (+2.7%); adjusted EPS $1.12 vs $0.92 est — a ~22% beat.

Drivers: US +$121.0M (Nevro $67.2M + organic Musculoskeletal $53.7M, of which spine implantables +$38.9M, IONM +$10.1M); International +$40.7M / +35.6% (mostly organic Musculoskeletal +$20.7M + Nevro $15.5M). International outgrew the US (+35.6% vs +25.0%) — early evidence the under-penetrated geography lever is live.

Margins. Q1 2026 gross margin ≈ 69.2%. Operating margin expanded ~360bp YoY as NuVasive inventory step-up amortization rolled off.

Guidance / tone change — this is the real news. Management reaffirmed FY2026 revenue of $3.18–$3.22B and RAISED non-GAAP EPS to $4.70–$4.80 from $4.40–$4.50. A guidance raise one quarter after a CEO change signals the new operator (Pfeil) is setting beatable numbers and the integration drag is fading. Stock +5.8% after-hours.

Balance-sheet flags (FY2025 year-end ):

• Effectively debt-free — senior convertible notes fully repaid ($450M paid off in 2025); $0 drawn on the $400M revolver; cash $526.2M + marketable securities $102.9M.
• FY2025 operating cash flow $753.4M (vs $520.6M) — robust and rising. CapexCapital expenditureMoney spent on long-lived things — buildings, machines, servers — rather than on running costs. $164.7M (mostly surgical sets) → FCF ≈ $588.8M.
• Watch items: AR $678.9M (+21.7% vs revenue +16.7% — receivables outran sales); inventory $759.3M (+15.2%); AR allowance jumped to $33.4M from $15.5M. Goodwill $1,435.0M + intangibles $745.1M = 41.1% of total assets — a roll-up balance sheet.

Earnings Calls (sentiment trend)

No transcripts on disk (transcripts=0); reconstructed from web coverage — label ``.

• Q1 2025 call (May 2025): crisis tone. Revenue −1.4% YoY miss; management owned NuVasive supply-chain disruption + soft enabling-tech + distributor-order timing; stock −24.8%. The recurring phrase that quarter was "integration."
• Q2 2025 (Jul 2025): leadership-transition call — Scavilla out (to Dentsply Sirona), Pfeil in; company simultaneously pre-announced improving Q2 sales to steady the ship. Tone shifts from "we stumbled" to "we're stabilizing and changing the operator."
• Q4/FY2025 (Feb 2026): recovery tone — record FY revenue, raised 2026 outlook.
• Q1 2026 (May 2026): confidence — big EPS beat, EPS guide raised.

Arc: crisis (Q1'25) → reset/leadership change (Q2'25) → recovery (Q4'25) → confidence (Q1'26). The thing management stopped saying is "integration disruption"; the thing they started saying is "operating leverage / raised EPS." This is a textbook self-help turnaround narrative — the question is whether it's durable or a Nevro-fueled sugar high (Lens 13).

Comps

Surgical-device / spine peer set (GMED is mis-bucketed as "robotics" — true comps are med-tech, surgical robotics, and spine/ortho). All multiples `` unless noted; market caps USD.

Read. GMED at 16.5x forward / 10.7x EV-EBITDA sits in the value med-tech tier — cheaper than ISRG (38x, deserved: 20%+ compounder, ~70% GM), cheaper than SYK (19.7x) and ATEC (23.9x, growth premium for a 22% grower the market believes is taking spine share), and a slight premium to the two troubled names ZBH (10.4x, earnings shrinking) and MDT (13.3x, low-single-digit grower). The multiple is honest: the market prices Globus as a high-single-digit grower with merger-integration overhang and mediocre ROE (12.6%), not as a robotics compounder. The re-rate case rests entirely on organic growth durably re-accelerating into low-double-digits (Q1'26 hinted at 11%). ROE 12.6% is the tell — two big goodwill-laden mergers diluted returns on capital; until that goodwill earns its keep, GMED can't claim an ISRG-style multiple.

Stock-Price Catalysts (moves >5%, last ~2 yrs)

The tape teaches what the market actually reacts to for GMED:

• May 2025: −24.8% in a day on the Q1 2025 revenue miss (rev −1.4%, NuVasive supply-chain disruption). The single biggest signal: this stock is priced for integration execution, and the market savagely punishes any organic-growth wobble. 52-week low $51.79 traces here.
• Jul 21, 2025: leadership transition + Q2 pre-announcement — CEO swap is a sentiment event; the pre-announced sales beat cushioned it.
• Feb 2026: Q4/FY2025 beat + raised 2026 outlook — positive re-rate leg.
• May 2026: +5.8% after-hours on the Q1 2026 EPS beat + raised EPS guide. 52-week high $101.40.

Pattern: GMED moves almost entirely on organic revenue trajectory and guidance credibility, secondarily on integration/leadership execution — not on the robot, not on macro. Earnings days are the variance events. The stock round-tripped from ~$52 to ~$101 and back to ~$79 inside a year — a high-beta "show me the organic growth" name.

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Phase C — Judge people & books

Management

• Founder & Executive Chairman: David C. Paul — co-founded Globus 2003, was initial CEO, Exec Chairman since Aug 2017. Controls ~70% of voting power via Class B super-voting stock (22.43M Class B shares × 10 votes vs 1 vote/Class A) despite a low/mid-single-digit economic stake. Founder-controlled company — Paul sets strategy and the board answers to him. He took a 100,000-option grant at $94.15 strike in Jan 2026 — i.e., he's incentivized above the current ~$79 price.
• CEO: Keith Pfeil — appointed July 18, 2025; joined Globus 2019 as CFO, added COO in 2024, so he ran finance + ops through both mega-mergers before taking the top job. A finance/ops operator, not a clinical founder-visionary — fitting for a company whose next three years are an integration-and-margin story, not a new-category story.
• Predecessor: Daniel Scavilla — CFO 2015, CEO 2022–Jul 2025, left to run Dentsply Sirona. A sitting CEO leaving mid-integration for a lateral is a yellow flag on something (board friction? the Paul control dynamic? a better seat?) — the market treated it as a sentiment negative but the pre-announced beat blunted it.
• CFO: Kyle Kline — promoted from SVP Finance to backfill Pfeil. Continuity hire.
• Capital allocation: (1) M&A-led — NuVasive ($2.6B all-stock, 2023), Nevro ($252.5M cash, 2025, bought below book → $117.7M bargain-purchase gain, a value-buy); (2) buybacks — $302.7M repurchased in 2025, new $500M authorization May 15, 2025; (3) debt paydown — cleared ~$900M of NuVasive-inherited debt, now net-cash; (4) no dividend. ROE ~12.6% / ROIC depressed by the goodwill load — the scorecard on capital allocation is incomplete: the Nevro buy looks shrewd (bargain price), the NuVasive buy is still unproven (it caused the 2025 disruption and ROE dilutionDilutionIssuing new shares, so each existing share owns a smaller slice of the same company.; the jury is out on whether cross-sell synergies materialize).
• Archetype: founder-chairman (Paul) + professional finance-operator CEO (Pfeil). Implication: disciplined integration and shareholder returns are likely; bold category reinvention is not the house style.

Forensic Red Flags

Forensic lens — every figure labeled.

Accounting-quality flags:

1. FY2025 net income is flattered by non-operating one-offs. Of $537.9M net income, $117.7M was a non-cash bargain-purchase gain (Nevro) and the effective tax rate fell to 11.1% (from 14.7%) partly via a $46.3M valuation-allowance release. Strip the bargain gain and the VA release and "clean" pre-tax income is ~$487M, not $605M. GAAP EPS $3.92 overstates run-rate earnings power; the TTM net income +216% is an artifact. Use non-GAAP EPS (FY2026 guide $4.70–$4.80) for valuation, not trailing GAAP.
2. Receivables outrunning revenue. AR +21.7% vs revenue +16.7%; AR allowance more than doubled ($15.5M→$33.4M). Partly Nevro consolidation, but worth tracking — DSO creep is the classic spine-company soft spot.
3. Inventory & the consignment model = perpetual obsolescence risk. Inventory $759.3M; provision for excess/obsolete $22.1M in 2025; Deloitte named inventory valuation a critical audit matter. Structural, not fraud — but a permanent drag and an earnings-management surface (write-down timing).
4. Goodwill/intangibles = 41% of assets, none impaired in 2025. If NuVasive cross-sell underperforms, this is where the write-down lands. No impairment yet is good but the bar is the next downturn.
5. SBC modest and not flattering non-GAAP egregiously — $49.8M SBC on $2.94B revenue (1.7%). Clean by tech standards; this is a real-economics medtech, not an SBC-inflated software name.
6. Cash flow > earnings quality is GOOD — operating cash flow $753.4M > net income $537.9M, and net income itself contains a $117.7M non-cash gain that cash flow correctly backs out. Earnings are cash-backed, which materially de-risks flags 1–4. This is the reassuring counter-signal.

Regulatory findings (required sub-section):

• SEC Litigation Releases: none. SEC AAERs: none. Verified via EDGAR EFTS (LR + AAER) for 2021-06-22 → 2026-06-22.
• Non-SEC (web search "Globus Medical (FTC OR DOJ OR FDA OR consent decree OR settlement OR penalty)"): no material agency enforcement action surfaced. Standard FDA device-regulatory exposure (510(k)/PMA pathway risk) is disclosed as ordinary-course, not an enforcement finding.
• Item 3 / Note 15 Legal Proceedings (company's own disclosure):
• Pimenta Litigation — MATERIAL, NOW ACCRUED. Legacy NuVasive case; Nov 4, 2025 jury verdict of $28.7M against NuVasive (breach of a clinical-advisor royalty agreement); post-trial interest/costs ruled Jan 28, 2026 → $43.1M liability accrued in SG&A. This is the single biggest driver of the FY2025 SG&A jump and the $37.7M litigation provision. Globus intends to appeal.
• Moskowitz Family LLC (NPE, 6 patents): jury defense verdict for Globus Dec 2023; Moskowitz appealed Sep 2024. No liability accrued beyond counsel fees.
• 4WEB LLC (11 patents, Modulus line): ongoing, outcome/range not estimable, no liability accrued.
• Conclusion: No SEC accounting/enforcement issues. The material legal item is the inherited NuVasive Pimenta verdict ($43.1M, appealing) plus ordinary spine-IP patent litigation — characteristic of the category, contained, and already reserved. Clean accounting, messy-but-normal IP docket.

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Phase D — Project & stress-test

Forward Projection (FY2026–FY2028, non-GAAP EPS)

Built bottom-up from the latest actuals + company guidance. Anchor: management FY2026 non-GAAP EPS guide $4.70–$4.80; revenue $3.18–$3.22B; Q1 2026 already printed $1.12 non-GAAP.

Input assumptions (every line labeled):

• Revenue: FY2026 ~$3.20B (guide midpoint). FY2027 +7% / FY2028 +7% → ~$3.42B / ~$3.66B.
• Non-GAAP operating margin: ~21% FY2026 rising to ~23% by FY2028.
• Share count: ~138M diluted, declining ~1.5%/yr on the $500M buyback net of SBC.
• Tax: normalize to ~16–18% (FY2025's 11.1% was VA-release-aided and not repeatable).

Output (non-GAAP diluted EPS):

Valuation cross-check: at ~$79 and base FY2026 $4.75 → ~16.6x forward, consistent with the market quote (16.5x). Base FY2028 $5.85 at a held 16–17x → ~$94–$99; the sell-side $108.64 average PT implies ~21–22x on FY2026 or mid-teens on a FY2027 bull number. The stock is roughly fairly-to-slightly-cheaply valued on the base case; the upside is a re-rate (multiple expansion if organic growth proves durable), not just EPS compounding.

Brier forecast — NOT logged. (Per --watchlist rules, no our model create in the unattended sweep.) Were one logged, the scoreable claim would be: "GMED FY2026 non-GAAP diluted EPS ≥ $4.75, p=0.62, resolves 2026-12-31" — base case slightly above guide midpoint, given the Q1 beat-and-raise pattern.

Bull vs Bear

Bull case. Globus is a self-help margin-and-growth story trading at a value multiple. The 2025 NuVasive-integration disruption — the thing that broke the stock — is visibly healing: US organic Musculoskeletal re-accelerated to ~11% in Q1 2026, international grew 35.6%, operating margin expanded 360bp, and the new operator-CEO raised EPS guidance one quarter in. It owns a co-leading spine-robot installed base (~500 systems) that annuitizes implant pull-through, it's net-cash with $588M+ FCF, it's buying back stock ($500M auth), and it bought Nevro below book. If organic settles into high-single/low-double digits and the goodwill starts earning its keep, a 16.5x forward multiple re-rates toward the low-20s (SYK/ATEC tier) — that's the path to the ~$108 sell-side target. Contrarian kicker the market is underrating: the "robotics decline" everyone frowns at is a ~5%-of-revenue capital line whose whole job is to drag implants along — and implants are growing double-digits. The market is mis-framing a razor-blade compounding story as a stalling-hardware story.

Bear case (permanent-impairment risks).

1. The organic engine is structurally mid-single-digit, and Q1'26 is a Nevro-aided optical illusion. Spine is a low-growth, ASP-pressured, hospital-consolidation category; strip M&A and Globus has grown ~5%. If the Q1'26 "acceleration" is just easy comps + Nevro's first full quarter, the re-rate thesis collapses and you own a 5%-grower at 16.5x.
2. Three giants are now pointing R&D at the one differentiator. Medtronic (Mazor, ~32% spine share), Stryker (Mako Spine, 2025), J&J (VELYS, 2025) — the robot lead is a 1–2 year window, and ISRG/MDT/SYK already own 84% of digital surgery. Erode the enabling-tech edge and the implant pull-through moat erodes with it.
3. Goodwill/intangible impairment latent in 41% of the balance sheet if NuVasive cross-sell underperforms — a non-cash but confidence-shattering event.
4. Founder super-voting control (~70%) means minority holders can't force a sale or governance change; the mid-cycle CEO exit (Scavilla → Dentsply) hints at the friction that structure can create.

Pre-mortem (it's late 2027, the thesis broke — what happened?): organic growth faded back to ~4% as Stryker/J&J spine robots took capital-equipment placements and hospitals squeezed implant ASPs; the NuVasive cross-sell synergies never showed; a goodwill write-down landed; and the stock de-rated from 16.5x to ~12x (ZBH/MDT tier) on ~$5 EPS → ~$60, a ~25% loss from $79.

Are multiples too high? No — 16.5x forward / 10.7x EV-EBITDA is defensible-to-cheap for the cash generation. The risk isn't a bubble multiple; it's EPS-and-multiple both fading if organic growth disappoints. This is a "prove the growth" name, not an "overvalued" name.

Contrarian view (what the market refuses to see): the consensus frown is "robot sales are declining, integration was a mess, CEO left." The thing being missed: this is a cash-gushing, net-cash, founder-aligned spine consolidator whose core implant business just re-accelerated to double-digits and whose new CFO-CEO is engineering margin expansion — priced like a no-growth value-trap. If the next two prints confirm Q1'26's organic trajectory, the gap between the narrative ("stalling hardware") and the reality ("compounding razor-blades") closes upward.

Devil's Advocate (short-seller)

Dismantling the bull case.

• The growth is bought, not earned. Two-thirds of FY2025's "growth" was Nevro; the organic business is a ~5% spine grower in a category with structural ASP deflation and hospital-GPO buying power. The Q1'26 11% organic print is one quarter against a disrupted prior-year comp — show me four.
• FY2025 GAAP earnings are a mirage: $117.7M bargain-purchase gain + a $46.3M valuation-allowance release inflated net income and crushed the tax rate to 11.1%. +216% TTM net income is noise. Normalize and the real earnings power is the ~$4.70–4.80 non-GAAP — i.e., the stock is not cheap on clean numbers, it's ~16.5x a high-single-digit grower.
• The moat is renting, not owning. ExcelsiusGPS's lead is a software/hardware cadence advantage that Medtronic, Stryker, and J&J are explicitly funding to erase in 2025–27. The enabling-tech line already declined 8.4% — the leading indicator of the moat eroding is in the 10-K.
• Most dangerous competitor bulls underrate: not Medtronic (slow), but Alphatec — growing 22%+, taking spine surgeons with a focused MIS/"informed-consent" sales motion, and Stryker bringing Mako's 1,600-system hospital relationships into spine. Globus is squeezed between a faster disruptor and a bigger-installed-base entrant.
• Worst capital-allocation reality: ROE ~12.6% after two big mergers — capital is trapped in goodwill. If the NuVasive synergies were real, ROIC would be climbing, not stuck. The mid-integration CEO departure to a competitor-adjacent seat is exactly what you'd expect if the board/founder and the CEO disagreed on whether the roll-up was working.
• What must hold for $79: ~7%+ revenue growth, ~150bp/yr margin expansion, no goodwill write-down, robot line stabilizing. If organic growth disappoints 20–30% (i.e., 3–4% not 7%), base EPS flattens near $4.70 and the multiple compresses to ~12x → ~$56 (back to the 52-week low).
• The single scenario that permanently impairs: spine-robot commoditization (Stryker + J&J + Medtronic flood the market, robot becomes table-stakes giveaway hardware) collapses the implant pull-through premium → Globus becomes a commodity implant vendor competing on price against larger-scale diversified players, ROE structurally <10%, multiple <12x. Plausibility: medium — it's the slow-burn category risk, not a 2026 event, but it's the real one.

Management Questions (ordered by information value)

1. Of Q1 2026's ~11% US organic Musculoskeletal growth, how much is durable share gain vs. easy comps against the 2025 integration disruption — and what's the underlying organic growth rate you're actually steering to for FY2026–28?
2. Enabling Technologies revenue declined 8.4% in 2025 on "lower unit placement." With Stryker Mako Spine and J&J VELYS now in the market, what's your installed-base and placement trajectory, and at what point does robot pull-through stop being accretive to implant share?
3. What is the quantified NuVasive cross-sell synergy realized to date vs. the deal model — and how do we see it in ROIC, not just revenue?
4. Capital allocation: with $588M+ FCF, net-cash, and a $500M buyback — what's the hurdle that tips you toward the next acquisition vs. returning more capital, and is large M&A on or off the table for the next 24 months?
5. ROE is ~12.6% after NuVasive + Nevro. What's the path and timeline to a mid-to-high-teens ROIC, and what happens to the $1.4B goodwill if cross-sell underperforms?
6. Why did Dan Scavilla leave mid-integration, and what — if anything — does the dual-class structure (Mr. Paul's ~70% vote) imply for CEO autonomy and strategic flexibility?
7. International is 19.4% of revenue and grew 35.6% in Q1'26 — what's the realistic ceiling, and what investment does capturing it require vs. defending the US?
8. The Pimenta verdict cost $43.1M. What's the residual legacy-NuVasive litigation/IP liability tail, and how do you think about the appeal's probability-weighted outcome?
9. Hospital/GPO ASP pressure in spine: what's your pricing trajectory assumption, and how much of "growth" is volume vs. mix vs. price?
10. What's the right normalized tax rate post the FY2025 valuation-allowance release, and the bridge from GAAP to the non-GAAP EPS you guide to?
11. Where are you on in-house manufacturing capacity vs. third-party supply after the integration — and is supply-chain disruption risk (the 2025 problem) structurally fixed?
12. What's the R&D allocation between next-gen robotics/navigation, implant innovation, and biologics — and how do you defend the engineering-cadence moat against three larger R&D budgets?
13. Receivables grew faster than revenue and the allowance doubled — what's driving DSO and credit-loss trends, and is any of it Nevro-channel or distributor-timing?
14. Nevro (SCS/chronic pain) was bought below book at a bargain price — is that a sign the asset is structurally challenged, and what's your turnaround plan for it inside Globus?
15. Five years out, is Globus a spine/ortho implant consolidator that happens to sell robots, or a surgical-enabling-technology platform — and what does that imply for where you invest the next $1B?

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