The changes in the carrying amount of goodwill and intangible assets during the six months ended June 30, 2022 are as follows:


	Goodwill			Intangible Assets
Balance at December 31, 2021	$	15,300		$	4,398
Impairment charges		(14,701	)		(4,036	)
Amortization		-			(298	)
Foreign currency exchange rate changes		(60	)		(9	)
Balance at June 30, 2022	$	539		$	55

The following table presents a summary of acquired intangible assets:


	As of June 30, 2022
	Weighted Average Amortization Period in Years		Gross Carrying Amount		Accumulated Amortization
Customer agreements		3.83	$	456	$	(401	)

During the three months ended June 30, 2022, a substantial decline in the Company’s stock price and other factors such as leadership changes in the Vapotherm Access reporting unit, represented indicators of long-lived asset impairment for the Vapotherm Access asset group, which triggered an interim impairment assessment. The Company determined that the carrying value of Vapotherm Access intangible assets was not recoverable based on the excess of the carrying value of the asset group over the undiscounted future cash flows. The decrease in the undiscounted future cash flows from the asset group was primarily attributable to a significant decrease in future forecasted revenues, which reflects the notification of non-renewal of certain HGE customer relationships during the three months ended June 30, 2022, as well as uncertainty related to the Company’s ability to scale its remote patient monitoring business given slower than expected patient enrollment. As a result, the Company recognized an impairment charge of $4.0 million to write down HGE customer relationships and developed technology to their estimated fair value during the three and six months ended June 30, 2022. The fair value of the intangible assets was estimated using discounted cash flows under the income approach, which the Company considers to be a Level 3 measurement. There were no impairments of intangible assets during the three or six months ended June 30, 2021.

The factors listed above, along with the long-lived asset impairment, also represented indicators of goodwill impairment which triggered an interim impairment assessment. Based on the results of the optional qualitative assessment, the Company determined that there were no indicators of impairment for the Vapotherm UK reporting unit, but the fair value of the Vapotherm Access reporting unit was more likely than not less than its carrying value. There is no goodwill allocated to the Vapotherm reporting unit.

To perform the quantitative assessment for the Vapotherm Access reporting unit, the Company determined the fair value using the income approach. The Company utilized a discounted cash flow analysis, which involves estimating the expected after-tax cash flows that will be generated by the reporting unit and then discounting those cash flows to present value, reflecting the relevant risks associated with the reporting unit and the time value of money. This approach requires the use of significant estimates and assumptions, including forecasted revenue growth rates, forecasted earnings before interest, taxes, depreciation and amortization (“EBITDA”) margins, and discount rates. The Company’s forecasts are based on historical experience, expected market demand, and other industry information. The Company determined that the carrying value of the Vapotherm Access reporting unit exceeded the fair value, with the decrease in the fair value being primarily attributable to a significant decrease in future forecasted revenues, as discussed above. As a result, during the three months ended June 30, 2022, the Company recognized an impairment charge of $14.7 million to write down the goodwill of the Vapotherm Access reporting unit to its estimated fair value. There was no impairment of goodwill during the three or six months ended June 30, 2021.

The Company recognized $0.1 million of amortization expense within sales and marketing expenses related to the intangible assets during each of the three months ended June 30, 2022 and 2021, and recognized $0.2 million of amortization expense within sales and marketing expenses related to the intangible assets during each of the six months ended June 30, 2022 and 2021. The Company also recognized $0.1 million of amortization expense within general and administrative expenses related to intangible assets during each of the three months ended June 30, 2022 and 2021, and recognized $0.1 million of amortization expense within general and administrative expenses related to intangible assets during each of the six months ended June 30, 2022 and 2021.