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GOODWILL AND OTHER INTANGIBLE ASSETS
12 Months Ended
Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets GOODWILL AND OTHER INTANGIBLE ASSETS
Goodwill is not amortized, but is evaluated for impairment annually in the fourth quarter of the fiscal year, or more frequently if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying value.
Circumstances that could trigger an interim impairment test include: a significant adverse change in the business climate or legal factors; an adverse action or assessment by a regulator; unanticipated competition; the loss of key personnel; a change in reporting units; the likelihood that a reporting unit or significant portion of a reporting unit will be sold or otherwise disposed of; and the results of testing for recoverability of a significant asset group within a reporting unit.
A qualitative impairment analysis was performed in the fourth quarter of 2020 and 2019 to assess whether it is more likely than not that the fair value of the Company’s reporting unit is less than its carrying value. The Company assessed relevant events and circumstances including macroeconomic conditions, industry and market considerations, overall financial performance, entity-specific events, and changes in the Company’s stock price. The Company determined that there was no goodwill impairment in 2020 or 2019.
A quantitative impairment analysis was performed in the fourth quarter of 2018, and the Company estimated the fair value of its reporting unit using an income approach. The income approach requires management to estimate a number of factors for its reporting unit, including projected future operating results, economic projections, anticipated future cash flows, and discount rates. The fair value determined using the income approach was then compared to marketplace fair value data from within a comparable industry grouping for reasonableness. The Company determined that there was no goodwill impairment in 2018.
The determination of fair value and the allocation of that value to individual assets and liabilities within the reporting unit requires the Company to make significant estimates and assumptions. These estimates and assumptions primarily include, but are not limited to, the selection of appropriate peer group companies; control premiums appropriate for acquisitions in the industries in which the Company competes; the discount rate; terminal growth rates; and forecasts of revenue, operating income, depreciation and amortization, and capital expenditures. Actual financial results could differ from those estimates due to the inherent uncertainty involved in making such estimates. Changes in assumptions concerning future financial results or other underlying assumptions could have a significant impact on either the fair value of the reporting unit, the amount of the goodwill impairment charge, or both.
Changes in the carrying amount of goodwill consist of the following activity for the years ended December 31, 2020, 2019 and 2018 (in thousands):
Balance at December 31, 2017$627,392 
Acquisitions5,077 
Balance at December 31, 2018$632,469 
Acquisitions793,073 
Balance at December 31, 2019$1,425,542 
Purchase accounting adjustments3,068 
Balance at December 31, 2020$1,428,610 
The carrying amount and accumulated amortization of intangible assets consists of the following as of December 31, 2020 and 2019 (in thousands):
December 31, 2020December 31, 2019
Gross intangible assets:
Referral sources$438,121 $438,121 
Trademarks/names44,536 44,536 
Other amortizable intangible assets402 402 
Total gross intangible assets483,059 483,059 
Accumulated amortization:
Referral sources(110,498)(84,295)
Trademarks/names(21,146)(12,748)
Other amortizable intangible assets(363)(106)
Total accumulated amortization(132,007)(97,149)
Total intangible assets, net$351,052 $385,910 
Amortization expense for intangible assets was $35.1 million, $26.1 million and $19.6 million for the years ended December 31, 2020, 2019 and 2018, respectively.
Expected future amortization expense for intangible assets recorded at December 31, 2020, is as follows (in thousands):
2021$32,015 
202228,338 
202328,338 
202428,338 
202528,338 
2026 and beyond205,685 
Total$351,052