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Goodwill | 12 Months Ended
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Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill | (11) Goodwill The following table reflects the changes in the carrying amount of goodwill by reporting unit for the year ended December 31, 2022:
| Year Ended December 31, 2022
| Healthcare |  | Industrial |  | Consolidated
(in thousands) | Gross Goodwill |  | Impairments |  | Net Goodwill |  | Gross Goodwill |  | Impairments |  | Net Goodwill |  | Gross Goodwill |  | Impairments |  | Net Goodwill
Balance at beginning of year | $121,970 |  | $(32,055) |  | $89,915 |  | $298,002 |  | $(42,329) |  | $255,673 |  | $419,972 |  | $(74,384) |  | $345,588
Acquisitions | 25,378 |  | — |  | 25,378 |  | 23,433 |  | — |  | 23,433 |  | 48,811 |  | — |  | 48,811
Foreign currency translation adjustments | (3,917) |  | — |  | (3,917) |  | (5,170) |  | — |  | (5,170) |  | (9,087) |  | — |  | (9,087)
Balance at end of year | $143,431 |  | $(32,055) |  | $111,376 |  | $316,265 |  | $(42,329) |  | $273,936 |  | $459,696 |  | $(74,384) |  | $385,312
The effect of foreign currency exchange in the table above reflects the impact on goodwill of amounts recorded in currencies other than the U.S. dollar on the financial statements of foreign subsidiaries and the resulting effect of foreign currency translation between the applicable functional currency and the U.S. dollar. Our reporting units are Healthcare Solutions and Industrial Solutions. We completed the required annual goodwill impairment tests as of November 30, 2022 and 2021. The goodwill impairment tests compared the fair value of each reporting unit to its carrying value. We estimated the fair value of our reporting units based primarily on projections of future revenues, expenses, and cash flows discounted to their present value, and a market approach. The valuation methodology and underlying financial information included in the Company's determination of fair value required significant judgment by management. The principal assumptions used in the Company's discounted cash flow analysis consisted of (a) the long-term projections of future financial performance and (b) the weighted-average cost of capital of market participants, adjusted for the risk attributable to the Company and the industry in which it operates. Under the market approach, the principal assumptions included estimates of multiples for various financial metrics of comparable companies. The estimated fair value for each of our reporting units was in excess of their respective carrying values as of November 30, 2022 and 2021. Goodwill Impairment Prior to Change in Segments Prior to identifying Healthcare Solutions and Industrial Solutions as the Company's reportable segments, which took effect as of January 1, 2021, the reporting units at which goodwill was tested for impairment were based upon geographic regions. As of September 30, 2020, we experienced a goodwill valuation triggering event due to a drop in our stock price, which was negatively impacted by the business environment as a result of the COVID-19 pandemic. Accordingly, we performed a quantitative analysis for potential impairment of our goodwill and long-lived asset balances. Based on available information and analysis as of September 30, 2020, we determined the carrying value of the EMEA reporting unit exceeded its fair value and recorded a non-cash goodwill impairment charge of $48,300. We also determined that, as of September 30, 2020, the fair values of the Americas and APAC reporting units exceeded their carrying values, and the carrying values of our long-lived assets were recoverable for all reporting units.

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