Goodwill and Intangible Assets

9 Months Ended

Sep. 30, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

13.   Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the nine-month period ended September 30, 2019 were as follows (in thousands):

	2019
Goodwill balance at January 1	$	335,433
Effect of foreign exchange		(1,069)
Additions and adjustments as the result of acquisitions		17,794
Goodwill balance at September 30	$	352,158

Total accumulated goodwill impairment losses aggregated to approximately $8.3 million as of September 30, 2019 and December 31, 2018. We did not have any goodwill impairments for the nine-month periods ended September 30, 2019 and 2018. The total goodwill balance as of September 30, 2019 and December 31, 2018, was related to our cardiovascular segment.

Other intangible assets at September 30, 2019 and December 31, 2018, consisted of the following (in thousands):

	September 30, 2019
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	21,938	$	(6,449)	$	15,489
Distribution agreements		8,012		(6,537)		1,475
License agreements		26,975		(12,226)		14,749
Trademarks		30,232		(8,743)		21,489
Covenants not to compete		1,029		(1,023)		6
Customer lists		39,803		(27,400)		12,403
In-process technology		2,500		—		2,500
Total	$	130,489	$	(62,378)	$	68,111

	December 31, 2018
	Gross Carrying		Accumulated		Net Carrying
	Amount		Amortization		Amount
Patents	$	19,378	$	(5,012)	$	14,366
Distribution agreements		8,012		(5,766)		2,246
License agreements		26,930		(7,411)		19,519
Trademarks		29,998		(6,586)		23,412
Covenants not to compete		1,028		(1,000)		28
Customer lists		39,936		(23,361)		16,575
In-process technology		3,420		—		3,420
Total	$	128,702	$	(49,136)	$	79,566

Aggregate amortization expense for the three and nine-month periods ended September 30, 2019 was approximately $15.5 million and $45.2 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2018 was approximately $10.5 million and $29.4 million, respectively.

We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows is largely independent of the cash flows of other assets and liabilities. We compare the carrying value of the amortizing intangible assets acquired to the undiscounted cash flows expected to result from the asset group and determine whether the carrying amount is recoverable. We determine the fair value of our amortizing assets based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. We identified indicators of impairment associated with certain acquired intangible assets in our cardiovascular segment based on our qualitative assessment, which required us to complete an interim quantitative impairment assessment. The primary indicator of impairment was slower than anticipated sales growth in the acquired products and uncertainty about future product development and commercialization associated with the acquired technologies.

During the nine months ended September 30, 2019, we recorded impairment charges related to our amortizing intangible assets of approximately $869,000 from our July 2015 acquisition of certain assets from Distal Access, LLC, $548,000 from our June 2016 acquisition of certain assets from Lazarus Medical Technologies, LLC, and $1.8 million from our July 2017 acquisition of certain assets from Pleuratech ApS. Total impairment charges for the three and nine-month periods ended September 30, 2019 were approximately $2.7 million and $3.3 million, respectively.

During the three months ended September 30, 2018, we compared the carrying value of the amortizing intangible assets acquired in our July 2015 acquisition of certain assets from Quellent, LLC, all of which pertained to our cardiovascular segment, to the undiscounted cash flows expected to result from the asset group and determined that the carrying amount was not recoverable. We recorded an impairment charge for Quellent of approximately $657,000 during the three months ended September 30, 2018.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of September 30, 2019 (in thousands):

Year Ending December 31,	Estimated Amortization Expense
Remaining 2019	$	15,435
2020		59,265
2021		51,916
2022		50,504
2023		49,297
2024		46,360