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Goodwill and Intangible Assets | 12 Months Ended
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Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets |
7. | Goodwill and Intangible Assets:
Goodwill was $ 2.7 billion and $4.1 billion at December 31, 2019 and 2018, respectively. Goodwill is tested for impairment at a reporting unit level on at least an annual basis, in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. Consistent with prior years, the Company performed its annual impairment test in the third quarter of 2019 , specifically as of July 31, 2019. The Company changed its management structure during the third quarter of 2019 to combine its two historical operating segments into a single unified physician services operating segment. However, for goodwill testing purposes, the Company determined that its reporting units would be represented by the components that underly the unified physician services operating segment. The reporting units represent the service line medical groups of Women’s and Children’s, anesthesiology and radiology. The Company used a combination of income and market-based valuation approaches to determine the fair value of its reporting units. Significant assumptions used in these valuations included the weighted average cost of capital discount factor, revenue growth rate, and revenue and EBITDA multiples. Based on the analysis performed, the Company recorded a non-cash impairment charge of $1.30 billion during the three months ended September 30, 2019, nearly all of which related to its anesthesiology reporting unit. Recognition of the non-cash charge against goodwill resulted in a tax benefit which generated an additional deferred tax asset of $147.2 million that increased the fair value of the reporting units. An incremental non-cash charge is then required to reduce the reporting units to their previously determined fair value. Accordingly, the Company recorded the i ncremental non-cash charge of $ 147.2 million for a total non-cash charge of $ 1.45 billion. The primary factors driving the non-cash impairment charge were (i) the change in management structure effective during the third quarter resulting in reporting units one level below the Company’s single physician services operating segment, which is also its single reportable segment, (ii) the decrease in the Company’s share price used in the market capitalization reconciliation and (iii) changes in the assumptions used in the valuation analysis, specifically the discount rate used in the cash flow analysis which included a company-specific risk premium. Intangible assets, net, consist of the following (in thousands):
|  | December 31, 2019 |
|  | Gross Carrying Value |  |  | Accumulated Amortization |  |  | Net Carrying Value |
Physician and hospital agreements |  | $ | 384,059 |  |  | $ | (269,889 | ) |  | $ | 114,170 |
Customer relationships |  |  | 156,530 |  |  |  | (29,595 | ) |  |  | 126,935 |
Trade names |  |  | 19,990 |  |  |  | (2,326 | ) |  |  | 17,664 |
Patented and other technology |  |  | 34,528 |  |  |  | (18,890 | ) |  |  | 15,638 |
|  | $ | 595,107 |  |  | $ | (320,700 | ) |  | $ | 274,407 |
|  | December 31, 2018 |
|  | Gross Carrying Value |  |  | Accumulated Amortization |  |  | Net Carrying Value |
Physician and hospital agreements |  | $ | 375,344 |  |  | $ | (222,818 | ) |  | $ | 152,526 |
Customer relationships |  |  | 156,530 |  |  |  | (29,595 | ) |  |  | 126,935 |
Trade names |  |  | 19,990 |  |  |  | (2,326 | ) |  |  | 17,664 |
Patented and other technology |  |  | 33,129 |  |  |  | (17,089 | ) |  |  | 16,040 |
|  | $ | 584,993 |  |  | $ | (271,828 | ) |  | $ | 313,165 |
During the year ended December 31, 2019, the Company recorded intangible assets related to acquisitions totaling $14.0 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately eight years . Amortization expense for intangible assets was $48.9 million, $54.5 million and $52.5 million for the years ended December 31, 2019, 2018 and 2017, respectively. Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):
2020 |  | $ | 42,502 |
2021 |  |  | 36,502 |
2022 |  |  | 29,482 |
2023 |  |  | 24,482 |
2024 |  |  | 10,590 |

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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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