7. Goodwill and Intangible Assets:

Goodwill was $4.4 billion and $4.3 billion at December 31, 2018 and 2017, respectively. The change in the carrying amount of goodwill of $99.0 million during the year ended December 31, 2018 is primarily related to the Company’s 2018 acquisitions. The Company expects that $63.0 million of the goodwill recorded during the year ended December 31, 2018 will be deductible for tax purposes.

The Company’s management services reporting unit has experienced lower operating results than previously forecasted primarily due to a slower rate of new customer bookings and an increase in customer termination activity. The Company continues to believe that the fair value of the reporting unit exceeds the carrying value, and accordingly the goodwill assigned to the management services reporting unit is not impaired. Although the Company believes that the current assumptions and estimates used in its goodwill analysis are reasonable, supportable and appropriate, continued efforts to maintain or improve the performance of this business could be impacted by unfavorable or unforeseen changes which could impact the existing assumptions used in the impairment analysis. Various factors could reasonably be expected to unfavorably impact existing assumptions, primarily delays in new customer bookings and the related delay in revenue from new customers, increases in customer termination activity or increases in operating costs. Accordingly, there can be no assurance that the estimates and assumptions made for the purposes of the goodwill impairment analysis will prove to be accurate predictions of future performance. The carrying value of the Company’s management services reporting unit included goodwill of $321.6 million as of December 31, 2018. The Company will continue to closely monitor the performance of the management services reporting unit. If an impairment loss is required in a future period, it could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of the Company’s securities.

Intangible assets, net, consist of the following (in thousands):


	December 31, 2018
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	376,871	$	(223,589)		$	153,282
Customer relationships		443,300		(71,870	)		371,430
Trade names		43,156		(4,630	)		38,526
Patented and other technology		47,561		(22,487	)		25,074

	$	910,888	$	(322,576)		$	588,312


	December 31, 2017
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	381,635	$	(203,915)		$	177,720
Customer relationships		443,300		(48,837	)		394,463
Trade names		43,156		(2,933	)		40,223
Patented and other technology		38,590		(11,068	)		27,522

	$	906,681	$	(266,753)		$	639,928

During the year ended December 31, 2018, the Company recorded intangible assets related to acquisitions totaling $17.2 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately nine years.

Amortization expense for intangible assets was $72.8 million, $68.9 million and $60.3 million for the years ended December 31, 2018, 2017 and 2016, respectively.

Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):


2019	$	66,532
2020		59,969
2021		53,771
2022		46,249
2023		40,448