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Geographic and Segment Information
 9 Months Ended
Sep. 30, 2020
Segment Reporting [Abstract]  
Geographic and Segment Information
Note 15. Geographic and Segment Information
We identify operating segments based on the way we manage, evaluate and internally report our business activities for purposes of allocating resources, developing and executing our strategy, and assessing performance. We have two reportable segments: Cardiovascular and Neuromodulation.
The Cardiovascular segment generates its revenue from the development, production and sale of cardiopulmonary products, heart valves and related products and advanced circulatory support. Cardiopulmonary products include oxygenators, heart-lung machines, autotransfusion systems, perfusion tubing systems, cannulae and other related accessories. Heart valves include mechanical heart valves, tissue heart valves, related repair products and minimally invasive surgical instruments. Advanced circulatory support includes temporary life support controllers and product kits that can include a combination of pumps, oxygenators, and cannulae.
Our Neuromodulation segment generates its revenue from the design, development and marketing of neuromodulation therapy systems for the treatment of drug-resistant epilepsy, difficult-to-treat depression (“DTD”) and obstructive sleep apnea. Neuromodulation products include the VNS Therapy System, which consists of an implantable pulse generator, a lead that connects the generator to the vagus nerve, and other accessories.
“Other” includes corporate shared service expenses for finance, legal, human resources, information technology and corporate business development.
Net sales of our reportable segments include revenues from the sale of products they each develop and manufacture or distribute. We define segment income as operating income before merger and integration, restructuring and amortization of intangibles.
We operate under three geographic regions: U.S., Europe, and Rest of World. The table below presents net sales by operating segment and geographic region (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Cardiopulmonary
United States$33,549 $39,054 $96,223 $119,580 
Europe29,947 30,052 87,475 99,933 
Rest of World43,704 50,908 140,925 152,650 
107,200 120,014 324,623 372,163 
Heart Valves
United States3,129 4,626 8,990 13,660 
Europe7,945 9,572 22,822 30,757 
Rest of World10,062 14,679 32,001 43,484 
21,136 28,877 63,813 87,901 
Advanced Circulatory Support
United States12,331 6,313 28,075 22,290 
Europe162 186 835 497 
Rest of World49 36 136 310 
12,542 6,535 29,046 23,097 
Cardiovascular
United States49,009 49,993 133,288 155,530 
Europe38,054 39,810 111,132 131,187 
Rest of World53,815 65,623 173,062 196,444 
140,878 155,426 417,482 483,161 
Neuromodulation
United States79,854 88,433 197,345 245,870 
Europe10,475 10,425 27,474 34,080 
Rest of World8,079 13,685 20,458 31,511 
98,408 112,543 245,277 311,461 
Other797 641 1,927 1,958 
Totals
United States128,863 138,426 330,633 401,400 
Europe (1)
48,529 50,235 138,606 165,267 
Rest of World62,691 79,949 195,447 229,913 
Total (2)
$240,083 $268,610 $664,686 $796,580 
(1)Europe sales include those countries in which we have a direct sales presence, whereas European countries in which we sell through distributors are included in Rest of World.
(2)No single customer represented over 10% of our consolidated net sales. No country’s net sales exceeded 10% of our consolidated sales except for the U.S.
The table below presents a reconciliation of segment income from continuing operations to consolidated (loss) income from continuing operations before tax (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Cardiovascular $(7,311)$36,180 $(8,037)$47,289 
Neuromodulation 21,154 30,010 82,294 52,260 
Other(10,921)(21,869)(58,407)(75,845)
Total reportable segment income from continuing operations2,922 44,321 15,850 23,704 
Merger and integration expenses1,094 6,716 6,616 14,345 
Restructuring expenses(349)698 2,025 4,563 
Amortization of intangibles9,685 11,146 29,346 29,690 
Operating (loss) income from continuing operations(7,508)25,761 (22,137)(24,894)
Interest income47 151 482 624 
Interest expense(14,673)(4,774)(25,237)(10,490)
Foreign exchange and other gains (losses)3,420 327 507 (795)
(Loss) income from continuing operations before tax$(18,714)$21,465 $(46,385)$(35,555)
Assets by segment are as follows (in thousands):
September 30, 2020December 31, 2019
Cardiovascular$1,463,523 $1,546,520 
Neuromodulation 668,899 749,069 
Other389,326 116,208 
Total assets$2,521,748 $2,411,797 
Capital expenditures by segment are as follows (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Cardiovascular$7,040 $5,178 $17,777 $13,564 
Neuromodulation 1,210 136 7,285 666 
Other967 691 3,174 2,571 
Total$9,217 $6,005 $28,236 $16,801 
The changes in the carrying amount of goodwill by segment for the nine months ended September 30, 2020 were as follows (in thousands):
NeuromodulationCardiovascularTotal
December 31, 2019$398,754 $517,040 $915,794 
Foreign currency adjustments— 2,684 2,684 
September 30, 2020$398,754 $519,724 $918,478 
Property, plant and equipment, net by geography are as follows (in thousands):
September 30, 2020December 31, 2019
United States$64,620 $61,410 
Europe116,746 110,270 
Rest of World9,143 9,674 
Total$190,509 $181,354