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Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

5.GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2020 and 2019, are as follows (in thousands):


	2020		2019
Goodwill balance at January 1	$	353,193	$	335,433
Effect of foreign exchange		1,941		(199)
Additions and adjustments as the result of acquisitions		8,399		17,959
Goodwill balance at December 31	$	363,533	$	353,193

Total accumulated goodwill impairment losses aggregated to $8.3 million as of December 31, 2020 and 2019. We did not have any goodwill impairments for the years ended December 31, 2020, 2019 and 2018. The total goodwill balance as of December 31, 2020 and 2019 is related to our cardiovascular segment.

Other intangible assets at December 31, 2020 and 2019, consisted of the following (in thousands):


	December 31, 2020
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	23,669	$	(6,460)	$	17,209
Distribution agreements		3,250		(2,319)		931
License agreements		14,453		(6,647)		7,806
Trademarks		30,273		(12,414)		17,859
Customer lists		35,154		(29,103)		6,051
Total	$	106,799	$	(56,943)	$	49,856


	December 31, 2019
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	22,703	$	(6,863)	$	15,840
Distribution agreements		8,012		(6,794)		1,218
License agreements		26,987		(12,746)		14,241
Trademarks		30,240		(9,477)		20,763
Covenants not to compete		964		(964)		—
Customer lists		39,984		(28,763)		11,221
In-process technology		2,500		—		2,500
Total	$	131,390	$	(65,607)	$	65,783

Aggregate amortization expense for the years ended December 31, 2020, 2019 and 2018 was approximately $58.6 million, $60.7 million and $41.2 million, respectively.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of December 31, 2020 (in thousands):


Year Ending December 31,	Estimated Amortization Expense
2021	$	49,701
2022		48,496
2023		47,323
2024		44,313
2025		42,503

During the years ended December 31, 2020, 2019, and 2018, we identified indicators of impairment associated with certain acquired intangible assets based on our qualitative assessment, which required us to then complete a quantitative impairment assessment. The primary indicators of impairment were slower-than-anticipated sales growth in the acquired products, planned closure and restructuring activities, uncertainty about future product development and commercialization associated with certain acquired technologies, and in 2020 economic uncertainties associated with the COVID-19 pandemic.

During the year ended December 31, 2020, we recorded total impairment charges related to our intangible assets of approximately $28.7 million which included a partial impairment charge of $8.2 million of intangible assets from our acquisition of STD Pharmaceutical, a partial impairment charge of $8.0 million of intangible assets from our acquisition of certain assets from Laurane Medical S.A.S, a partial impairment charge of $4.8 million related to our license agreements with ArraVasc Limited, and other intangible asset impairments charges of $7.7 million related to intangible assets from our acquisition of certain assets from DirectACCESS Medical, LLC, in-process technology intangible assets of Sontina Medical LLC acquired in connection with our acquisition of certain divested assets from Becton, Dickinson and Company,

and a customer list intangible asset from our acquisition of ITL Healthcare Pty Ltd (“ITL”). During the year ended December 31, 2019, we recorded impairment charges related to our amortizing intangible assets from our acquisitions of certain assets from Distal Access, LLC, Lazarus Medical Technologies, LLC, and Pleuratech ApS for a total of approximately $3.3 million. During the year ended December 31, 2018, we recorded impairment charges of $657,000 related to our acquisition of certain assets from Quellent, LLC. The impairment charges recorded in 2020, 2019, and 2018 all pertained to our cardiovascular segment and are reflected within impairment charges in our consolidated statements of income (loss).