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Goodwill and Intangible Assets
3 Months Ended
Mar. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Intangible Assets
Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the three-month period ended March 31, 2018 were as follows (in thousands):
 
2018
Goodwill balance at January 1
$
238,147

Effect of foreign exchange
591

Additions as the result of acquisitions
5,387

Goodwill balance at March 31
$
244,125



As of March 31, 2018, we had recorded $8.3 million of accumulated goodwill impairment charges. All of the goodwill balance as of March 31, 2018 and December 31, 2017, is related to our cardiovascular segment.

Other intangible assets at March 31, 2018 and December 31, 2017, consisted of the following (in thousands):
 
March 31, 2018
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
17,356

 
$
(4,023
)
 
$
13,333

Distribution agreements
7,262

 
(4,966
)
 
2,296

License agreements
23,920

 
(6,077
)
 
17,843

Trademarks
20,935

 
(5,079
)
 
15,856

Covenants not to compete
1,028

 
(976
)
 
52

Customer lists
35,297

 
(19,397
)
 
15,900

In-process technology
920

 

 
920

 
 
 
 
 
 
Total
$
106,718

 
$
(40,518
)
 
$
66,200


 
December 31, 2017
 
Gross Carrying
Amount
 
Accumulated
Amortization
 
Net Carrying
Amount
Patents
$
16,528

 
$
(3,737
)
 
$
12,791

Distribution agreements
7,262

 
(4,686
)
 
2,576

License agreements
23,783

 
(5,568
)
 
18,215

Trademarks
16,224

 
(4,686
)
 
11,538

Covenants not to compete
1,028

 
(968
)
 
60

Customer lists
31,935

 
(18,482
)
 
13,453

In-process technology
920

 

 
920

 
 
 
 
 
 
Total
$
97,680

 
$
(38,127
)
 
$
59,553



Aggregate amortization expense for the three-month periods ended March 31, 2018 and 2017 was approximately $8.5 million and $6.2 million, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of March 31, 2018 (in thousands):

Year Ending December 31
 
Remaining 2018
$
36,644

2019
41,215

2020
38,160

2021
30,525

2022
28,879