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GOODWILL AND INTANGIBLE ASSETS | 9 Months Ended
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Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract] |
GOODWILL AND INTANGIBLE ASSETS | GOODWILL AND INTANGIBLE ASSETS Acquisitions in 2021 There were no material acquisitions for the three and nine months ended September 30, 2021. Acquisitions in 2020 Orpheus Medical In February 2020, the Company acquired Orpheus Medical Ltd. and its wholly owned subsidiaries (“Orpheus Medical”) to deepen and expand our integrated informatics platform (the “Orpheus Medical Acquisition”). Orpheus Medical provides hospitals with information technology connectivity, as well as expertise in capturing, processing, and archiving clinical videos across the hospital. The Orpheus Medical Acquisition did not have a material impact on the financial statements. Goodwill The following table summarizes the changes in the carrying amount of goodwill (in millions):
| Amount
Balance at December 31, 2020 | $ | 336.7 |
Acquisition activity | 8.0 |
Translation and other | (0.4) |
Balance at September 30, 2021 | $ | 344.3 |
Intangible Assets The following table summarizes the components of gross intangible assets, accumulated amortization, and net intangible asset balances as of September 30, 2021, and December 31, 2020 (in millions):
|  | September 30, 2021 |  | December 31, 2020
|  | Gross Carrying Amount |  | Accumulated Amortization |  | Net Carrying Amount |  | Gross Carrying Amount |  | Accumulated Amortization |  | Net Carrying Amount
Patents and developed technology |  | $ | 219.3 |  |  | $ | (169.3) |  |  | $ | 50.0 |  |  | $ | 198.4 |  |  | $ | (158.7) |  |  | $ | 39.7 |
Distribution rights and others |  | 26.3 |  |  | (17.8) |  |  | 8.5 |  |  | 91.9 |  |  | (77.4) |  |  | 14.5 |
Customer relationships |  | 31.8 |  |  | (13.1) |  |  | 18.7 |  |  | 59.0 |  |  | (35.8) |  |  | 23.2 |
Total intangible assets |  | $ | 277.4 |  |  | $ | (200.2) |  |  | $ | 77.2 |  |  | $ | 349.3 |  |  | $ | (271.9) |  |  | $ | 77.4 |
Amortization expense related to intangible assets was $6.3 million and $12.6 million for the three months ended September 30, 2021, and 2020, respectively. Amortization expense related to intangible assets was $20.8 million and $37.3 million for the nine months ended September 30, 2021, and 2020, respectively. The estimated future amortization expense related to intangible assets as of September 30, 2021, is as follows (in millions):
Fiscal Year | Amount
Remainder of 2021 | $ | 6.1 |
2022 | 23.6 |
2023 | 19.0 |
2024 | 14.5 |
2025 | 9.7 |
2026 and thereafter | 4.3 |
Total | $ | 77.2 |
The preceding expected amortization expense is an estimate. Actual amounts of amortization expense may differ from estimated amounts due to additional intangible asset acquisitions, measurement-period adjustments to intangible assets, changes in foreign currency exchange rates, impairments of intangible assets, accelerated amortization of intangible assets, and other events.

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- Definition The entire disclosure for goodwill and intangible assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 350 -URI http://asc.fasb.org/topic&trid=2144416 + Details
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