10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

 FORM 10-Q

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 For the quarterly period ended: September 30, 2023

 or

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from:              to

Commission File No.: 001-34634

 ICU MEDICAL, INC.

(Exact name of registrant as specified in its charter)

Delaware	33-0022692
(State or other jurisdiction of	(I.R.S. Employer
incorporation or organization)	Identification No.)

951 Calle Amanecer	,	San Clemente	,	California	92673
(Address of principal executive offices)					(Zip Code)

 (949) 366-2183

(Registrant’s telephone number including area code)

N/A

(Former name, former address and former fiscal year, if changed since last report)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class	Trading Symbol	Name of each exchange on which registered
Common stock, par value $0.10 per share	ICUI	The Nasdaq Stock Market LLC
		(Global Select Market)

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes x  No o

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).  Yes x  No o

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the Exchange Act.

Large accelerated filer	x	Accelerated filer	☐
Non-accelerated filer	☐	Smaller reporting company	☐
		Emerging growth company	☐

 If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.    o

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act):  Yes ☐ No x

Indicate the number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date:

Class	Outstanding at October 31, 2023
Common	24,140,076

ICU MEDICAL, INC. AND SUBSIDIARIES

Form 10-Q

September 30, 2023

Table of Contents

		Page Number
	Forward Looking Statements	1
PART I.	Financial Information
Item 1.	Financial Statements (Unaudited)
	Condensed Consolidated Balance Sheets at September 30, 2023 and December 31, 2022	4
	Condensed Consolidated Statements of Operations for the Three and Nine Months Ended September 30, 2023 and 2022	5
	Condensed Consolidated Statements of Comprehensive Income (Loss) for the Three and Nine Months Ended September 30, 2023 and 2022	6
	Condensed Consolidated Statements of Stockholders' Equity for the Three and Nine Months Ended September 30, 2023 and 2022	7
	Condensed Consolidated Statements of Cash Flows for the Three and Nine Months Ended September 30, 2023 and 2022	9
	Notes to Condensed Consolidated Financial Statements	11
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	42
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	54
Item 4.	Controls and Procedures	55
PART II.	Other Information
Item 1.	Legal Proceedings	56
Item1A.	Risk Factors	56
Item 2.	Unregistered Sales of Equity Securities, Use of Proceeds, and Issuer Purchases of Equity Securities	56
Item 5.	Other Information	57
Item 6.	Exhibits	57
	Signature	58

Forward-Looking Statements

Various portions of this Quarterly Report on Form 10-Q, including Part 1. Item 2 “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” describe trends in our business and finances that we perceive and state some of our expectations and beliefs about our future. These statements about the future are “forward-looking statements,” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and we may identify them by using words such as “anticipate,” “believe,” “expect,” “estimate,” “intend,” “plan,” “will,” “continue,” “could,” “may,” and by similar expressions and statements about aims, goals and plans. The forward-looking statements are based on the information currently available to us and assumptions that we believe are reasonable, but we do not intend the statements to be representations as to future results. They include, without limitation, statements about:

•our future growth; future operating results and financial condition (including, among other things, anticipated sales; accruals for restructuring charges, production costs; gross margins; litigation expense; future SG&A and R&D expenses; manufacturing expenses; our expectations regarding liquidity and capital resources over the next twelve months; capital expenditures; source of funds for capital purchases and operations; future tax rates; alternative sources of capital or financing; changes in working capital items such as receivables and inventory; use of treasury stock; realizable value of our investment securities; future investment alternatives; foreign currency denominated financial instruments; and income taxes;

•factors affecting operating results, such as the impact of an increase in shipping costs; loss of a strategic relationship; change in demand for our products; domestic and international sales; expansion in international markets, future increases or decreases in sales of certain products and in certain markets and distribution channels; maintaining strategic relationships and securing long-term and multi-product contracts with large healthcare providers and major buying organizations; increases in systems capabilities; introduction, development and sales of new products, benefits of our products over competing systems; qualification of our new products for the expedited Section 510(k) clearance procedure; possibility of lengthier clearance process for new products; planned increases in marketing; warranty claims; rebates; product returns; bad debt expense; amortization expense; inventory requirements; lives of property and equipment; manufacturing efficiencies and cost savings; unit manufacturing costs; establishment or expansion of production facilities inside or outside of the United States; planned new orders for semi-automated or fully automated assembly machines for new products; adequacy of production capacity; results of R&D; our plans to repurchase shares of our common stock; asset impairment losses; relocation of manufacturing facilities and personnel; effect of expansion of manufacturing facilities on production efficiencies and resolution of production inefficiencies; the effect of costs to customers and delivery times; business seasonality and fluctuations in quarterly results; customer ordering patterns and the effects of new accounting pronouncements;

•new or extended contracts with manufacturers and buying organizations; dependence on a small number of customers; loss of larger distributors and the ability to locate other distributors; the outcome of our strategic initiatives; regulatory approvals and compliance; including the work necessary to achieve regulatory compliance with respect to the Smiths Medical Warning Letter; outcome of litigation; patent protection and intellectual property landscape; patent infringement claims and the impact of newly issued patents on other medical devices; competitive and market factors, including continuing development of competing products by other manufacturers; improved production processes and higher volume production; innovation requirements; consolidation of the healthcare provider market and downward pressure on selling prices; distribution or financial capabilities of competitors; healthcare reform legislation; foreign exchange risk; commodity price risk; plans to convert existing space; acquisitions of other businesses or product lines, and

•the impact of acquisitions and the integration of acquired businesses and product lines (including the Smiths Medical business).

The forward looking statements in this Quarterly Report on Form 10-Q are only predictions and are based largely on our current expectations and projections about future events and financial trends that we believe may affect our business, financial condition and results of operations. These forward-looking statements are subject to a number of known and unknown risks, uncertainties and assumptions, including without limitation, the following:

•our dependence on single and limited source third-party suppliers, which subjects our business and results of operations to risks of supplier business interruptions, and a loss or degradation in performance in our suppliers;

1

•damage to any of our manufacturing facilities or disruption to our supply chain network;

•prolonged periods of inflation, rising interest rates and the impact of foreign currency exchange rates as a result of the current global macroeconomic and geopolitical conditions, for example,armed conflicts between Ukraine and Russia and in Israel;

•the impact of the COVID-19 pandemic on the way we, our suppliers and our customers operate and the duration, and the extent to which this will impact our business, future results of operations, liquidity and overall financial performance;

•significant sales through our distributors;

•our failure to achieve expected operating efficiencies or expense reductions associated with cost reduction and restructuring efforts;

•our failure to compete successfully with our competitors and maintain market share;

•our inability to fund substantial investment in product development and recover such investment through commercial product sales;

•significant decline in demand for our products;

•continuing pressures to reduce healthcare costs and inadequate coverage and reimbursement;

•failure to protect our information technology systems against security breaches, service interruptions, or misappropriation of data;

•disruptions at the FDA, other government agencies or notified bodies caused by funding shortages or global health concerns;

•actual or perceived failures to comply with foreign, federal, and state data privacy and security laws, regulations and standards, or certain fraud and abuse and transparency laws;

•our failure to defend and enforce our patents or other proprietary rights and the cost of enforcing and of defending patent claims or claims of other proprietary rights; and expiration of our patents;

•our exposure to risks related to foreign currency exchange rates;

•any significant changes in U.S. trade, tax or other policies that restrict imports or increase import tariffs;

•additional risks from international sales, related to competition with larger international companies and established local companies and our possibly higher cost structure;

•our failure to effectively manage our growth and change to our business resulting from the Smiths Medical acquisition or any other future acquisitions;

•the actual impact of the Smiths Medical acquisition on our financial results and our use of a significant portion of our cash on hand and incurrence of a substantial amount of debt to finance the Smiths Medical acquisition, which could adversely affect our business, including by restricting our ability to engage in additional transactions or incur additional indebtedness.

For a more detailed discussion of these factors, see the information under the sections entitled “Summary Risk Factors,” Part I. Item 1A. “Risk Factors” and Part II. Item 7 “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our Annual Report on Form 10-K for the year ended December 31, 2022 (the “2022 Annual Report on Form 10-K”) filed with the Securities and Exchange Commission (the “SEC”), and the sections in this Quarterly Report on Form 10-Q entitled Part II. Item 1A “Risk Factors” and Part I. Item 2 “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” in each case as updated by our periodic filings with the SEC.

2

Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified and some of which are beyond our control, you should not rely on these forward-looking statements as predictions of future events. The events and circumstances reflected in our forward-looking statements may not be achieved or occur and actual results could differ materially from those projected in the forward-looking statements. Moreover, we operate in an evolving environment. New risk factors and uncertainties may emerge from time to time, and it is not possible for management to predict all risk factors and uncertainties. Except as required by applicable law, we do not plan to publicly update or revise any forward-looking statements contained herein, whether as a result of any new information, future events, changed circumstances or otherwise.

3

PART I - FINANCIAL INFORMATION

Item1.Financial Statements (Unaudited)

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(In thousands, except par value data and treasury shares) 

	September 30, 2023		December 31, 2022
	(Unaudited)		(1)
ASSETS
CURRENT ASSETS:
Cash and cash equivalents	$	197,192	$	208,784
Short-term investment securities	1,806		4,224
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	198,998		213,008
Accounts receivable, net of allowance for doubtful accounts $10,556 at September 30, 2023 and $8,530 at December 31, 2022	161,797		221,719
Inventories	759,622		696,009
Prepaid income taxes	14,579		15,528
Prepaid expenses and other current assets	84,412		88,932
TOTAL CURRENT ASSETS	1,219,408		1,235,196
PROPERTY, PLANT AND EQUIPMENT, net	608,762		636,113
OPERATING LEASE RIGHT-OF-USE ASSETS	73,767		74,864
LONG-TERM INVESTMENT SECURITIES	—		516
GOODWILL	1,444,456		1,449,258
INTANGIBLE ASSETS, net	891,280		982,766
DEFERRED INCOME TAXES	31,466		31,466
OTHER ASSETS	107,725		105,462
TOTAL ASSETS	$	4,376,864	$	4,515,641
LIABILITIES AND STOCKHOLDERS’ EQUITY
CURRENT LIABILITIES:
Accounts payable	$	149,288	$	215,902
Accrued liabilities	251,324		242,769
Current portion of long-term debt	45,688		29,688
Income tax payable	11,443		6,200
Contingent earn-out liability	6,300		—
TOTAL CURRENT LIABILITIES	464,043		494,559
CONTINGENT EARN-OUT LIABILITY	7,061		25,572
LONG-TERM DEBT	1,589,244		1,623,675
OTHER LONG-TERM LIABILITIES	100,005		114,104
DEFERRED INCOME TAXES	77,845		126,007
INCOME TAX LIABILITY	40,310		41,796
COMMITMENTS AND CONTINGENCIES (Note 19)	—		—
STOCKHOLDERS’ EQUITY:
Convertible preferred stock, $1.00 par value; Authorized — 500 shares; Issued and outstanding — none	—		—
Common stock, $0.10 par value; Authorized — 80,000 shares; Issued — 24,144 shares at September 30, 2023 and 23,995 shares at December 31, 2022; and outstanding — 24,139 shares at September 30, 2023 and 23,993 shares at December 31, 2022	2,414		2,399
Additional paid-in capital	1,356,348		1,331,249
Treasury stock, at cost (4,638 and 1,633 shares, respectively)	(672)		(243)
Retained earnings	824,993		837,501
Accumulated other comprehensive loss	(84,727)		(80,978)
TOTAL STOCKHOLDERS' EQUITY	2,098,356		2,089,928
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$	4,376,864	$	4,515,641

______________________________________________________

(1) December 31, 2022 balances were derived from audited consolidated financial statements.

The accompanying notes are an integral part of these condensed consolidated financial statements.

4

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited)

(In thousands, except per share data)

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
TOTAL REVENUES	$	553,311	$	597,857	$	1,671,270	$	1,701,983
COST OF GOODS SOLD	369,391		411,461		1,102,982		1,179,167
GROSS PROFIT	183,920		186,396		568,288		522,816
OPERATING EXPENSES:
Selling, general and administrative	148,609		153,452		452,076		465,412
Research and development	20,870		23,105		62,933		69,538
Restructuring, strategic transaction and integration	7,160		14,365		30,527		61,795
Change in fair value of contingent earn-out	(15,572)		(4,059)		(12,256)		(31,253)
TOTAL OPERATING EXPENSES	161,067		186,863		533,280		565,492
INCOME (LOSS) FROM OPERATIONS	22,853		(467)		35,008		(42,676)
INTEREST EXPENSE, net	(24,175)		(17,808)		(70,811)		(46,303)
OTHER EXPENSE, net	(4,044)		(3,032)		(5,815)		(3,983)
LOSS BEFORE INCOME TAXES	(5,366)		(21,307)		(41,618)		(92,962)
BENEFIT FOR INCOME TAXES	12,604		8,099		29,110		34,212
NET INCOME (LOSS)	$	7,238	$	(13,208)	$	(12,508)	$	(58,750)
NET INCOME (LOSS) PER SHARE
Basic	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)
Diluted	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)
WEIGHTED AVERAGE NUMBER OF SHARES
Basic	24,132		23,908		24,075		23,828
Diluted	24,368		23,908		24,075		23,828

The accompanying notes are an integral part of these condensed consolidated financial statements.

5

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Unaudited)

(In thousands)

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
NET INCOME (LOSS)	$	7,238	$	(13,208)	$	(12,508)	$	(58,750)
Other comprehensive income (loss), net of tax:
Cash flow hedge adjustments, net of tax of $(514) and $(3,676) for the three months ended September 30, 2023 and 2022, respectively, and $(457) and $(15,357) for the nine months ended September 30, 2023 and 2022, respectively.	1,659		16,915		1,356		48,631
Foreign currency translation adjustment, net of tax of $0 for all periods	(37,557)		(90,549)		(5,005)		(195,300)
Other adjustments, net of tax of $0 for all periods	(35)		227		(100)		256
Other comprehensive loss, net of tax	(35,933)		(73,407)		(3,749)		(146,413)
COMPREHENSIVE LOSS	$	(28,695)	$	(86,615)	$	(16,257)	$	(205,163)

The accompanying notes are an integral part of these condensed consolidated financial statements.

6

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (Unaudited)

(Amounts in thousands)

	Common Stock			Additional Paid-in Capital		Treasury Stock		Retained Earnings		Accumulated Other Comprehensive (Loss) Income
	Shares	Amount										Total
Balance, January 1, 2023	23,995	$	2,399	$	1,331,249	$	(243)	$	837,501	$	(80,978)	$	2,089,928
Issuance of restricted stock and exercise of stock options	172	12		(503)		662		—		—		171
Tax withholding payments related to net share settlement of equity awards	(53)	—		—		(8,425)		—		—		(8,425)
Stock compensation	—	—		9,158		—		—		—		9,158
Other comprehensive income, net of tax	—	—		4		—		—		19,375		19,379
Net loss	—	—		—		—		(9,812)		—		(9,812)
Balance, March 31, 2023	24,114	$	2,411	$	1,339,908	$	(8,006)	$	827,689	$	(61,603)	$	2,100,399
Issuance of restricted stock and exercise of stock options	2	—		(4,626)		6,688		—		—		2,062
Tax withholding payments related to net share settlement of equity awards	(2)	—		—		(293)		—		—		(293)
Stock compensation	—	—		9,773		—		—		—		9,773
Other comprehensive income, net of tax	—	—		2		—		—		12,809		12,811
Net loss	—	—		—		—		(9,934)		—		(9,934)
Balance, June 30, 2023	24,114	$	2,411	$	1,345,057	$	(1,611)	$	817,755	$	(48,794)	$	2,114,818
Issuance of restricted stock and exercise of stock options	34	3		344		1,442		—		—		1,789
Tax withholding payments related to net share settlement of equity awards	(4)	—		—		(503)		—		—		(503)
Stock compensation	—	—		10,947		—		—		—		10,947
Other comprehensive loss, net of tax	—	—		—		—		—		(35,933)		(35,933)
Net income	—	—		—		—		7,238		—		7,238
Balance, September 30, 2023	24,144	$	2,414	$	1,356,348	$	(672)	$	824,993	$	(84,727)	$	2,098,356

7

	Common Stock			Additional Paid-in Capital		Treasury Stock		Retained Earnings		Accumulated Other Comprehensive (Loss) Income
	Shares	Amount										Total
Balance, January 1, 2022	21,280	$	2,128	$	721,412	$	(27)	$	911,787	$	(19,269)	$	1,616,031
Issuance of restricted stock and exercise of stock options	154	12		(2,965)		5,927		—		—		2,974
Tax withholding payments related to net share settlement of equity awards	(37)	—		—		(8,743)		—		—		(8,743)
Issuance of common stock for acquisitions	2,500	250		575,725		—		—		—		575,975
Stock compensation	—	—		12,092		—		—		—		12,092
Other comprehensive income, net of tax	—	—		—		—		—		18,641		18,641
Net loss	—	—		—		—		(38,068)		—		(38,068)
Balance, March 31, 2022	23,897	$	2,390	$	1,306,264	$	(2,843)	$	873,719	$	(628)	$	2,178,902
Issuance of restricted stock and exercise of stock options	10	—		(4,428)		4,446		—		—		18
Tax withholding payments related to net share settlement of equity awards	(8)	—		—		(1,695)		—		—		(1,695)
Stock compensation	—	—		7,762		—		—		—		7,762
Other comprehensive loss, net of tax	—	—		—		—		—		(91,647)		(91,647)
Net loss	—	—		—		—		(7,474)		—		(7,474)
Balance, June 30, 2022	23,899	$	2,390	$	1,309,598	$	(92)	$	866,245	$	(92,275)	$	2,085,866
Issuance of restricted stock and exercise of stock options	82	8		4,837		69		—		—		4,914
Tax withholding payments related to net share settlement of equity awards	(2)	—		—		(103)		—		—		(103)
Stock compensation	—	—		8,743		—		—		—		8,743
Other comprehensive loss, net of tax	—	—		—		—		—		(73,407)		(73,407)
Net loss	—	—		—		—		(13,208)		—		(13,208)
Balance, September 30, 2022	23,979	$	2,398	$	1,323,178	$	(126)	$	853,037	$	(165,682)	$	2,012,805

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ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited)

(In thousands) 

	Nine months ended September 30,
	2023		2022
CASH FLOWS FROM OPERATING ACTIVITIES:
Net loss	$	(12,508)	$	(58,750)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	171,615		178,338
Amortization of inventory step-up	—		22,676
Noncash lease expense	16,543		17,382
Provision for doubtful accounts	865		214
Provision for warranty, returns and field action	5,597		3,439
Stock compensation	29,878		28,597
Loss on disposal of property, plant and equipment and other assets	1,757		2,391
Bond premium amortization	14		254
Debt issuance costs amortization	5,108		5,254
Change in fair value of contingent earn-out liability	(12,256)		(31,253)
Usage of spare parts	13,587		7,915
Other	4,393		(2,855)
Changes in operating assets and liabilities, net of amounts acquired:
Accounts receivable	43,086		(8,956)
Inventories	(66,662)		(151,840)
Prepaid expenses and other current assets	11,295		20,074
Other assets	(18,860)		(22,594)
Accounts payable	(65,049)		30,413
Accrued liabilities	(10,532)		(38,070)
Income taxes, including excess tax benefits and deferred income taxes	(42,939)		(63,047)
Net cash provided by (used in) operating activities	74,932		(60,418)
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property, plant and equipment	(53,956)		(68,715)
Proceeds from sale of assets	1,481		933
Business acquisitions, net of cash acquired	—		(1,844,164)
Intangible asset additions	(7,742)		(6,560)
Purchases of investment securities	—		(3,397)
Proceeds from sale and maturities of investment securities	2,920		36,433
Net cash used in investing activities	(57,297)		(1,885,470)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of long-term debt, net of lender debt issuance costs	—		1,672,631
Principal repayments of long-term debt	(22,250)		(20,250)
Payment of third-party debt issuance costs	—		(1,852)
Proceeds from exercise of stock options	4,022		7,906
Payments on finance leases	(681)		(477)
Tax withholding payments related to net share settlement of equity awards	(9,221)		(10,541)
Net cash (used in) provided by financing activities	(28,130)		1,647,417
Effect of exchange rate changes on cash	(1,097)		(10,477)
NET DECREASE IN CASH AND CASH EQUIVALENTS	(11,592)		(308,948)
CASH AND CASH EQUIVALENTS, beginning of period	208,784		552,827
CASH AND CASH EQUIVALENTS, end of period	$	197,192	$	243,879

The accompanying notes are an integral part of these condensed consolidated financial statements.

9

ICU MEDICAL, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - CONTINUED

(In thousands)

	Nine months ended September 30,
	2023		2022
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION:
Accounts payable for property, plant and equipment	$	3,712	$	2,757
SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING ACTIVITIES:
Detail of assets acquired and liabilities assumed in acquisitions:
Fair value of assets acquired			$	1,658,937
Cash paid for acquisitions, net of cash acquired			(1,844,164)
Issuance of common stock for acquisitions			(575,975)
Contingent consideration			(55,158)
Goodwill, acquired/adjusted during period			1,442,849
Liabilities assumed/Adjustments to liabilities assumed			$	(626,489)

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited)

Note 1:Basis of Presentation

The accompanying unaudited interim condensed consolidated financial statements of ICU Medical, Inc., ("ICU" or the "Company"), a Delaware corporation, have been prepared in accordance with accounting principles generally accepted in the United States of America ("U.S.") and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments, consisting of only normal recurring adjustments, which are, in the opinion of management, necessary for a fair statement of the consolidated results for the interim periods presented. Results for the interim period are not necessarily indicative of results for the full year. Certain information and footnote disclosures normally included in annual consolidated financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations. The condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K of ICU for the year ended December 31, 2022.

We develop, manufacture and sell innovative medical products used in infusion therapy, vascular access, and vital care applications. ICU's product portfolio includes ambulatory, syringe, and large volume IV pumps and safety software; dedicated and non-dedicated IV sets, needlefree IV connectors, peripheral IV catheters, and sterile IV solutions; closed system transfer devices and pharmacy compounding systems; as well as a range of respiratory, anesthesia, patient monitoring, and temperature management products. We sell the majority of our products through our direct sales force and through independent distributors throughout the U.S. and internationally. We also sell certain products on an original equipment manufacturer basis to other medical device manufacturers. All subsidiaries are wholly owned and are included in the condensed consolidated financial statements. All intercompany balances and transactions have been eliminated.

Certain reclassifications have been made to the prior year financial statements and footnotes to conform to the presentation used in the current year. In the statements of operations we reclassified interest income to interest expense, net from other expense, net and in Note 5: Revenues, certain reclassifications were made to revenues disaggregated by product line and by geography. Also, in Note 9: Fair Value Measurements the table indicating the Level inputs for the assets and liabilities measured at fair value on a recurring basis was updated to correct the Level input identified for the hedge assets and liabilities. These reclassifications had no impact on total revenues, net loss, shareholder's equity or cash flows as previously reported.

Note 2:    New Accounting Pronouncements

Recently Issued Accounting Standards

    In March 2020, the Financial Accounting Standards Board issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction-based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a de-designation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. ASU No. 2022-06, Reference Rate Reform: Deferral of the Sunset Date of Topic 848 deferred the sunset date to December 31, 2024. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap referenced LIBOR. These swaps were amended in early 2022 to transition to an alternative reference rate (see Note 8: Derivatives and Hedging Activities). The amendments in this ASU allow for certain expedients that will allow us to assume that our hedged interest payments are probable of occurring regardless of any expected modification in their terms related to reference rate reform and will allow us to continue hedge accounting for a cash flow hedge for which the hedged interest rate risk changes if the hedge is highly effective under ASC 815, Derivatives and Hedging, or the optional expedient under this ASU is elected. The impact of this ASU on our contracts has not been and is not expected to be material.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Note 3:    Acquisitions

2022 Acquisition

On January 6, 2022, we acquired 100.0% of the equity interests in Smiths Medical, the holding company of Smiths Group plc's global medical device business, from Smiths Group International Holdings Limited (“Smiths”). Consistent with our strategic growth plans, the acquisition of Smiths Medical enabled us to broaden our product offerings to include syringe and ambulatory infusion devices, vascular access, and vital care products and to strengthen and expand our global market reach.

Total cash consideration for the acquisition was $1.9 billion, which was financed with existing cash balances and proceeds from the credit agreement entered into on January 6, 2022 (see Note 17: Long-Term Debt). We also issued share consideration to Smiths of 2.5 million shares of our common stock. The fair value of the common shares issued to Smiths was determined based on the opening market price of our common stock on the acquisition date. Smiths may be entitled to an additional $100.0 million in cash consideration contingent on our common stock achieving certain price targets for certain periods after closing in accordance with the terms of the Share Sale and Purchase Agreement (the "Purchase Agreement"). In the event that (a) on or prior to the third anniversary of closing the 30-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share or (b) on or prior to the fourth anniversary of closing the 45-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share (each a "Price Target"), and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved, then Smiths will be entitled to receive the additional $100.0 million in cash consideration. The fair value of the contingent consideration was determined using an option pricing model, specifically the Monte Carlo Simulation. In the analysis, the determinants of payout are simulated in a risk neutral framework over a large number of simulation paths. The fair value of the contingent consideration is then calculated as the average present value across all simulated paths.

Smiths became a related party to us when we issued 2.5 million shares of our common stock as partial consideration for the acquisition of Smiths Medical. Additionally, we entered into a transition services agreement ("TSA") with certain members of Smiths Group, plc. The TSA includes certain information technology, human resource and tax support services for an initial term of twelve months with the option to extend up to 24 months. During the three and nine months ended September 30, 2023, we expensed $0.3 million and $8.3 million, respectively, for services provided under the TSA. As of September 30, 2023, we have no open payables related to the services received under the TSA.

Final Purchase Price Allocation

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets acquired and liabilities assumed (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Cash consideration for acquired assets	$	1,922,955
Fair value of contingent consideration payable to Smiths	53,520
Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Smiths	2,500
Price per share (ICU's opening market price on the acquisition date)	$	230.39
Fair value of ICU shares issued to Smiths	$	575,975
Total Consideration	$	2,552,450
Purchase Price Allocation:
Cash and cash equivalents	$	78,791
Accounts receivable	106,132
Inventories	228,919
Prepaid expenses and other current assets	53,554
Property, plant and equipment	206,333
Operating lease right-of-use assets	55,161
Intangible assets(1)	945,000
Other assets	379
Accounts payable	(105,291)
Accrued liabilities(2)	(173,151)
Income tax payable	(40,312)
Other long-term liabilities	(85,490)
Deferred income taxes	(187,455)
Total identifiable net assets acquired	$	1,082,570
Goodwill - not tax deductible	1,469,880
Estimated Purchase Consideration	$	2,552,450

_______________________________

(1)    Identifiable intangible assets include $510.0 million of customer relationships, $400.0 million of developed technology, $30.0 million of internally developed software, and $5.0 million of trademark. The estimated weighted-average amortization period for the total identifiable intangible assets is approximately nine years, and, for each identifiable intangible asset is estimated as follows: eight years for customer relationships, ten years for developed technology, five years for internally developed software, and six months for the trademark.

(2)    Accrued liabilities includes, among other things, accrued warranty reserves, accrued restructuring initiatives, accrued salaries and related benefits, deferred revenue and accrued sales and use taxes.

The identifiable intangible assets and other long-lived assets acquired have been valued utilizing Level 3 inputs as defined in Note 9: Fair Value Measurements. The fair value of identifiable intangible assets was generally developed using the income approach and are based on critical estimates, judgments and assumptions derived from: analysis of market conditions; discount rate; discounted cash flows; royalty rates; customer retention rates; and/or estimated useful lives. Certain other intangible assets were valued using a cost to replace method, estimating the labor and non-labor costs required to replace the asset under the premise that it was not part of the transaction. Property, plant and equipment was valued with the consideration of remaining economic lives. The raw materials inventory was valued at historical cost and adjusted for any obsolescence which we estimate to approximate replacement cost, the work in process inventory was valued at estimated sales proceeds less costs to complete and costs to sell, and finished goods inventory was valued at estimated sales proceeds less costs to sell. The prepaid expenses and other current assets and assumed liabilities were recorded at their carrying values as of the date of the acquisition, as their carrying values approximated their fair values due to their short-term nature.

Unaudited Pro Forma Information

Smiths Medical is included in our consolidated results beginning on January 7, 2022. Total revenues and net loss attributable to Smiths Medical for the period from January 7, 2022 to September 30, 2022 were estimated to be $699.1 million

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

and $79.0 million, respectively, and for the three months ended September 30, 2022 were estimated to be $261.4 million and $13.6 million, respectively. The following unaudited pro forma financial information presents the combined results of operations of ICU and Smiths Medical as if the acquisition had occurred on January 1, 2021. The pro forma financial information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisition had taken place on the date indicated or of results that may occur in the future.

(In thousands)	Three months ended September 30, 2022		Nine months ended September 30, 2022
Revenues	$	597,857	$	1,722,357
Net Loss	$	(13,208)	$	(54,840)

The unaudited pro forma results presented above include the impact of the following adjustments: incremental amortization expense on intangible assets acquired of $1.9 million for the nine months ended September 30, 2022, incremental interest expense, including amortization of debt discount and debt issuance costs on the Senior Secured Credit Facilities (as defined in Note 17: Long-Term Debt) of $1.4 million for the nine months ended September 30, 2022 and a $27.4 million expense adjustment related to the increase in fair value of inventory to remove the expense for the nine months ended September 30, 2022. The unaudited pro forma results include IFRS to U.S. GAAP adjustments for Smiths Medical's historical results and adjustments for accounting policy alignment, which were materially similar to the Company. Any differences in accounting policies were adjusted to reflect the accounting policies of the Company in the unaudited pro forma results presented.

Note 4: Restructuring, Strategic Transaction and Integration

    Restructuring, strategic transaction and integration expenses were $7.2 million and $14.4 million for the three months ended September 30, 2023 and 2022, respectively and $30.5 million and $61.8 million for the nine months ended September 30, 2023 and 2022 respectively.

Restructuring

    During the three and nine months ended September 30, 2023, restructuring charges were $1.1 million and $5.1 million, respectively, as compared to $2.4 million and $7.3 million, respectively, for the three and nine months ended September 30, 2022 and were primarily related to severance costs for all periods. The restructuring charges for the three and nine months ended September 30, 2023 are net of $0.2 million of facility closures costs that were reversed in the current periods.    

The following table summarizes the activity in our restructuring-related accrual by major type of cost (in thousands):

	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2023	$	4,416	$	1,507	$	5,923
Charges incurred	2,732		—		2,732
Payments	(1,284)		—		(1,284)
Other(1)	(291)		(620)		(911)
Currency translation	70		16		86
Accrued balance, March 31, 2023	$	5,643	$	903	$	6,546
Charges incurred	1,290		20		1,310
Payments	(3,302)		(27)		(3,329)
Currency translation	227		17		244
Accrued balance, June 30, 2023	$	3,858	$	913	$	4,771
Charges incurred	583		522		1,105
Payments	(802)		(495)		(1,297)
Other(2)	—		(165)		(165)
Currency translation	(52)		(27)		(79)
Accrued balance, September 30, 2023	$	3,587	$	748	$	4,335

__________________________

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

(1) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended March 31, 2023.

(2) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended September 30, 2023.

Strategic Transaction and Integration Expenses

    We incurred and expensed $6.1 million and $12.0 million in strategic transaction and integration expenses during the three months ended September 30, 2023 and 2022, respectively, and we incurred and expensed $25.4 million and $54.5 million in strategic transaction and integration expenses during the nine months ended September 30, 2023 and 2022, respectively, which are included in restructuring, strategic transaction and integration expenses in our condensed consolidated statements of operations. The strategic transaction and integration expenses during the three and nine months ended September 30, 2023 were primarily related to consulting expenses and employee costs incurred to integrate our Smiths Medical business acquired in 2022. The strategic transaction and integration expenses for the three and nine months ended September 30, 2022 were primarily related to transaction and integration expenses associated with our acquisition of Smiths Medical on January 6, 2022 (see Note 3: Acquisitions) which primarily included legal expenses, bank fees, and employee costs. The nine months ended September 30, 2022 also included a United Kingdom stamp tax.

Note 5: Revenue

Revenue Recognition

    As part of the integration of our acquisition of Smiths Medical, we have now migrated to our new business unit structure of Consumables, Infusion Systems and Vital Care. The vast majority of our sales of products within these business units are made on a stand-alone basis to hospitals and distributors. Our revenues are recorded at the net sales price, which includes an estimate for variable consideration related to rebates, chargebacks and product returns. Revenue is typically recognized upon transfer of control of the products, which we deem to be at point of shipment. However, for purposes of revenue recognition for our software licenses and renewals, we consider the control of these products to be transferred to a customer at a certain point in time; therefore, we recognize revenue at the start of the applicable license term.

    Payment is typically due in full within 30 days of delivery or the start of the contract term. Revenue is recorded in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services. We offer certain volume-based rebates to our distribution customers, which we record as variable consideration when calculating the transaction price. Rebates are offered on both a fixed and tiered/variable basis. In both cases, we use information available at the time and our historical experience with each customer to estimate the most likely rebate amount. We also provide chargebacks to distributors that sell to end customers at prices determined under a contract between us and the end customer. Chargebacks are the difference between the prices we charge our distribution customers and the contracted prices we have with the end customer which are processed as credits to our distribution customers. In estimating the expected value of chargeback amounts in order to determine the transaction price, we use information available at the time, including our historical experience.

    We also warranty products against defects and have a policy permitting the return of defective products, for which we accrue and expense at the time of sale using information available at that time and our historical experience. We also provide extended service-type warranties, which we consider to be separate performance obligations. We allocate a portion of the transaction price to the extended service-type warranty based on its estimated relative stand-alone selling price, and recognize revenue over the period the warranty service is provided.

Revenue Disaggregated

The following table represents our revenues disaggregated by product line (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Three months ended September 30,				Nine months ended September 30,
Product line	2023		2022		2023		2022
Consumables	242,010		251,572		715,108		732,756
Infusion Systems	148,981		161,555		463,836		448,426
Vital Care	162,320		184,730		492,326		520,801
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

For the three and nine months ended September 30, 2023, net sales to Medline made up approximately 18% and 16% of total revenues, respectively. For the three and nine months ended September 30, 2022, net sales to Medline made up approximately 16% and 15% of total revenues, respectively.

The following table represents our revenues disaggregated by geography (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Geography	2023		2022		2023		2022
United States	$	355,984	$	376,691	$	1,063,037	$	1,088,348
Europe, the Middle East and Africa	88,014		101,869		276,994		275,488
APAC	59,064		66,569		177,719		191,847
Other Foreign	50,249		52,728		153,520		146,300
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

Contract Balances

    The following table presents the changes in our contract balances for the nine months ended September 30, 2023 and 2022 (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Contract Liabilities
Beginning balance, January 1, 2023	$	(45,866)
Equipment revenue recognized	24,872
Equipment revenue deferred	(25,620)
Software revenue recognized	13,546
Software revenue deferred	(12,797)
Government grant deferred income*	(944)
Government grant recognized	3,164
Other deferred revenue	(1,674)
Other deferred revenue recognized	4,748
Ending balance, September 30, 2023	$	(40,571)
Beginning balance, January 1, 2022	$	(7,461)
Fair value of acquired deferred revenue	(51,245)
Equipment revenue recognized	22,757
Equipment revenue deferred	(13,420)
Software revenue recognized	12,761
Software revenue deferred	(12,978)
Government grant deferred income*	(3,434)
Government grant recognized	178
Other deferred revenue	(1,285)
Other deferred revenue recognized	3,488
Ending balance, September 30, 2022	$	(50,639)

____________________________

*The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

Our contract liabilities are included in accrued liabilities or other long-term liabilities in our condensed consolidated balance sheet based on the expected timing of revenue recognition.    

As of September 30, 2023, revenue from remaining performance obligations is as follows:

	Recognition Timing
(in millions)	< 12 Months		> 12 Months
Equipment deferred revenue	$	(16,448)	$	(12)
Software deferred revenue	(8,261)		(707)
Government grant deferred income*	(1,451)		(10,548)
Other deferred revenue**	(2,575)		(569)
Total	$	(28,735)	$	(11,836)

_________________________________

*The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

**Other deferred revenue includes pump development programs, purchased training and extended warranty.

Note 6: Leases

    We determine if an arrangement is a lease at inception. Our operating lease assets are separately stated in operating lease right-of-use ("ROU") assets and our financing lease assets are included in other assets on our condensed consolidated

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

balance sheets. Our lease liabilities are included in accrued liabilities and other long-term liabilities on our condensed consolidated balance sheets. We have elected not to recognize an ROU asset and lease liability for leases with terms of twelve months or less.

    Lease ROU assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. Most of our leases do not provide an implicit rate, therefore we use our incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a similar term based on the information available at commencement date. Our lease ROU assets exclude lease incentives and initial direct costs incurred. Our lease terms include options to extend when it is reasonably certain that we will exercise that option. All of our leases have stated lease payments, which may include fixed rental increases. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

    Our leases are for corporate, research and development and sales and support offices, distribution facilities, device service centers and certain equipment. Our leases have original lease terms of one year to fifteen years, some of which include options to extend the leases for up to an additional five years. For all of our leases, we do not include optional periods of extension in our current lease terms because we determine the exercise of options to extend is not reasonably certain.

The following table presents the components of our lease cost (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Operating lease cost	$	5,968	$	5,819	$	18,162	$	16,472
Finance lease cost — interest	32		25		91		82
Finance lease cost — reduction of ROU asset	279		176		757		516
Short-term lease cost	3		1		29		7
Total lease cost	$	6,282	$	6,021	$	19,039	$	17,077

Interest expense on our finance leases is included in interest expense, net in our condensed consolidated statements of operations. The reduction of the operating and finance ROU assets is included as noncash lease expense in selling, general and administrative expenses in our condensed consolidated statements of operations.    

The following table presents the supplemental cash flow information related to our leases (in thousands):

	Nine months ended September 30,
	2023		2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	18,477	$	18,886
Operating cash flows from finance leases	$	91	$	25
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	14,423	$	4,771
Finance leases	$	932	$	266

The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	As of
	September 30, 2023			December 31, 2022
Operating leases
Operating lease right-of-use assets	$	73,767		$	74,864
Accrued liabilities	$	19,850		$	18,169
Other long-term liabilities	57,277			60,916
Total operating lease liabilities	$	77,127		$	79,085
Weighted-Average Remaining Lease Term
Operating leases	5.7 years			6.1 years
Weighted-Average Discount Rate
Operating leases	4.23		%	4.34		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of
	September 30, 2023			December 31, 2022
Finance leases
Finance lease right-of-use assets	$	2,814		$	2,598
Accrued liabilities	$	897		$	816
Other long-term liabilities	2,018			1,855
Total finance lease liabilities	$	2,915		$	2,671
Weighted-Average Remaining Lease Term
Finance leases	4.2 years			4.8 years
Weighted-Average Discount Rate
Finance leases	4.85		%	4.23		%

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

As of September 30, 2023, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2023	$	5,866	$	301
2024	21,457		919
2025	16,108		711
2026	14,179		590
2027	10,316		266
2028	5,684		189
Thereafter	12,570		236
Total Lease Payments	86,180		3,212
Less imputed interest	(9,053)		(297)
Total	$	77,127	$	2,915

Note 7:    Net Income (Loss) Per Share

Basic earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options and restricted stock units that are anti-dilutive are not included in the treasury stock method calculation. Due to the net loss for the nine months ended September 30, 2023 and for the three and nine months ended September 30, 2022, any potentially dilutive common shares were not included in the computation of diluted earnings per share as they would have had an anti-dilutive effect; therefore, basic and diluted net loss per share are equal for each of these periods. There were 247,530 anti-dilutive securities for the three months ended September 30, 2023.

    The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Net income (loss)	$	7,238	$	(13,208)	$	(12,508)	$	(58,750)
Weighted-average number of common shares outstanding (basic)	24,132		23,908		24,075		23,828
Dilutive securities(1)	236		—		—		—
Weighted-average common and common equivalent shares outstanding (diluted)	24,368		23,908		24,075		23,828
EPS — basic	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)
EPS — diluted	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)

_______________________________

(1)    Due to the net loss for the nine months ended September 30, 2023 and the three and nine months ended September 30, 2022, there are no potentially dilutive common shares included in the computation of diluted earnings per share.

Note 8:    Derivatives and Hedging Activities

Hedge Accounting and Hedging Program

     The purposes of our cash flow hedging programs are to manage the foreign currency exchange rate risk on forecasted revenues and expenses denominated in currencies other than the functional currency of the operating unit, and to manage floating interest rate risk associated with future interest payments on the variable-rate term loans issued in January 2022. We do not issue derivatives for trading or speculative purposes.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

    To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The derivative instruments we utilize, including various foreign exchange contracts and interest rate swaps, are designated and qualify as cash flow hedges. Our derivative instruments are recorded at fair value on the condensed consolidated balance sheets and are classified based on the instrument's maturity date. We record gains or losses from changes in the fair values of the derivative instruments as a component of other comprehensive income (loss) and we reclassify those gains or losses into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings. If the underlying forecasted transaction does not occur, or it becomes probable that it will not occur, we reclassify the gain or loss on the related derivative instrument from accumulated other comprehensive loss into earnings immediately.

Foreign Currency Exchange Rate Risk

Foreign Exchange Forward Contracts

We enter into foreign exchange forward contracts to hedge a portion of our forecasted foreign currency-denominated revenues and expenses to minimize the effect of foreign exchange rate movements on the related cash flows. These contracts are agreements to buy or sell a quantity of a currency at a predetermined future date and at a predetermined exchange rate. Our foreign exchange forward contracts hedge exposures principally denominated in Mexican Pesos ("MXN"), Euros, Czech Koruna ("CZK"), Japanese Yen ("JPY"), Swedish Krona ("SEK"), Danish Krone ("DKK"), Chinese Renminbi ("CNH"), Canadian Dollar ("CAD"), U.S. Dollar ("USD") and Australian Dollar ("AUD") and have varying maturities with an average term of approximately eleven months. The total notional amount of these outstanding derivative contracts as of September 30, 2023 was $152.7 million, which included the notional equivalent of $44.1 million in MXN, $25.5 million in Euros, $14.4 million in JPY, $6.4 million in CNH, $13.8 million in CAD, $10.3 million in AUD, $30.8 million in USD and $7.4 million in other foreign currencies, with terms currently through January 2025.

Cross-currency Par Forward Contracts

We have entered into cross-currency par forward contracts to hedge a portion of our Mexico forecasted expenses denominated in MXN. These contracts are agreements to exchange cash flows from one currency to another at specified intervals over the contract term with all exchanges occurring at the same predetermined rate. In November 2021, we entered into a one-year cross-currency par forward contract with a term from December 1, 2021 to December 1, 2022. The total notional amount of this outstanding derivative as of September 30, 2022 was approximately 103.8 million MXN. This derivative instrument matured in equal monthly amounts at a fixed forward rate of 21.60 MXN/USD.

Floating Interest Rate Risk

In November 2021, in anticipation of entering into the new senior secured credit facilities in January 2022, which includes a variable-rate term loan A and a variable-rate term loan B (see Note 17: Long-Term Debt), we entered into two forward-starting interest rate swaps. In February 2022, certain terms under the agreements were amended to reflect the transition from LIBOR to the Secured Overnight Financing Rate ("SOFR"), an alternative reference rate. Under the interest rate swap agreements, we exchange, at specified intervals, the difference between fixed and floating interest amounts calculated by reference to an agreed-upon notional amount. Effective March 30, 2022, the term loan A swap, as amended, has an initial notional amount of $300.0 million, reducing to $150.0 million evenly on a quarterly basis excluding its final maturity on March 30, 2027. We will pay a fixed rate of 1.32% and will receive the greater of 3-months USD SOFR or (0.15)%. Effective March 30, 2022, the term loan B swap, as amended, has an initial notional amount of $750.0 million, reducing to $46.9 million evenly on a quarterly basis excluding its final maturity on March 30, 2026. We will pay a fixed rate of 1.17% and will receive the greater of 3-months USD SOFR or 0.35%.

In June 2023, we entered into an additional interest rate swap that hedges both term loan A and term loan B interest payments. The total notional amount of the swap is $300 million. The hedge matures on June 30, 2028. We will pay a fixed rate of 3.88% and will receive 3-months USD SOFR.

These swaps effectively convert the relevant portion of the floating-rate term loans to fixed rates.

The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Derivatives Designated as Cash Flow Hedging Instruments
Condensed Consolidated Balance Sheet Location	Foreign Exchange Contracts		Interest Rate Swaps		Gross Derivatives
As of September 30, 2023
Prepaid expenses and other current assets	$	8,630	$	30,447	$	39,077
Other assets	542		22,167		22,709
Total assets	$	9,172	$	52,614	$	61,786
Accrued liabilities	$	1,890	$	—	$	1,890
Other long-term liabilities	91		—		91
Total liabilities	$	1,981	$	—	$	1,981
As of December 31, 2022
Prepaid expenses and other current assets	$	4,860	$	28,431	$	33,291
Other assets	94		26,753		26,847
Total assets	$	4,954	$	55,184	$	60,138
Accrued liabilities	$	1,847	$	—	$	1,847
Other long-term liabilities	167		—		167
Total liabilities	$	2,014	$	—	$	2,014

We recognized the following gains on our derivative instruments designated as cash flow hedges in other comprehensive income before reclassifications to net loss (in thousands):

	Gain Recognized in Other Comprehensive Income
	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	$	1,757	$	3,383	$	10,260	$	11,720
Interest rate swaps	12,496		21,201		21,236		60,398
Total derivatives designated as cash flow hedging instruments	$	14,253	$	24,584	$	31,496	$	72,118

The following table presents the effects of our derivative instruments designated as cash flow hedges on the Condensed Consolidated Statements of Operations (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Gain (Loss) Reclassified From Accumulated Other Comprehensive Loss into Income
			Three months ended September 30,				Nine months ended September 30,
	Location of Gain (Loss) Recognized in Income		2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	Total revenues		$	1,019	$	(1,690)	$	(429)	$	2,666
Foreign exchange contracts	Cost of goods sold		2,247		3,090		6,063		4,140
Foreign exchange contracts	Other expense, net	(1)	—		—		229		—
Foreign exchange contracts	Interest expense	(2)	—		462		13		717
Interest rate swaps	Interest expense		8,813		2,133		23,807		608
Total derivatives designated as cash flow hedging instruments			$	12,079	$	3,995	$	29,683	$	8,131

_______________________________

(1)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of ineffectiveness.

(2)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of forecasted transactions no longer probable of occurring.

As of September 30, 2023, we expect an estimated $6.7 million in deferred gains on the outstanding foreign exchange contracts and an estimated $31.6 million in deferred gains on the interest rate swaps will be reclassified from accumulated other comprehensive loss to net income during the next 12 months concurrent with the underlying hedged transactions also being reported in net income.    

Note 9:    Fair Value Measurements

    Fair value is the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. There are three levels of inputs that may be used to measure fair value:

•Level 1: quoted prices in active markets for identical assets or liabilities;

•Level 2: inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices in active markets for similar assets or liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities; or

•Level 3: unobservable inputs that are supported by little or no market activity and that are significant to the fair values of the assets or liabilities.

Contingent Earn-out Liabilities

On January 6, 2022, we acquired Smiths Medical with a combination of cash consideration and share consideration issued at closing. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving certain Price Targets from the closing date to either the third or fourth anniversary of closing (see Note 3: Acquisitions for additional information) and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved. The initial estimated fair value of the earn-out was determined to be $53.5 million. The initial fair value of the earn-out was determined using a Monte Carlo simulation model. The model utilized several assumptions including volatility and the risk-free interest rate. The assumed volatility is based on the average of the historical volatility of our common stock price and the implied volatility of certain at-the-money traded options. The risk-free interest rate is equal to the yield on U.S. Treasury securities at constant maturity for the period commensurate with the term of the earn-out. At each reporting date subsequent to the acquisition, we remeasure the earn-out liability and recognize any changes in its fair value in our consolidated statements of operations. If the probability of achieving the Price Targets during their respective measurement periods is significantly greater than initially anticipated, the realization of an additional liability and related expense will have a significant impact on our consolidated financial statements in the period recognized. As of September 30, 2023, the estimated fair value of the contingent earn-out is $7.1 million.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. As of December 31, 2022, the measurement period related to (i) above ended, and based on the actual revenue achieved during the measurement period we determined that the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2023, the estimated fair value for the contingent earn-out related to certain product-related regulatory certifications was estimated to be $1.5 million.

In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out payment shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of September 30, 2023, the estimated fair value of the contingent earn-out is $4.3 million. The estimated fair value of the contingent earn-out is calculated using a probability-weighted cash flow model based on historical revenue streams and the likelihood that the revenue targets will be met.

    Our contingent earn-out liabilities are separately stated on our condensed consolidated balance sheets.

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Earn-out Liability
Accrued balance, January 1, 2023	$	25,572
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(700)
Currency translation	33
Accrued balance, March 31, 2023	24,905
Change in fair value of earn-out (included in income from operations as a separate line item)(2)	4,016
Other	11
Currency translation	1
Accrued balance, June 30, 2023	28,933
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(15,572)
Other	58
Currency translation	(58)
Accrued balance, September 30, 2023	$	13,361

	Earn-out Liability
Accrued balance, January 1, 2022	$	2,589
Acquisition date fair value estimate of earn-out(3)	55,158
Currency translation	(46)
Accrued balance, March 31, 2022	57,701
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(27,194)
Currency translation	(98)
Accrued balance, June 30, 2022	30,409
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(4,059)
Currency translation	(108)
Accrued balance, September 30, 2022	$	26,242

_______________________________

(1) Primarily relates to the change in fair value of our Smiths Medical earn-out.

(2) Primarily relates to the change in fair value of our Smiths Medical earn-out and the earnout with one of our international distributors.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

(3) $53.5 million of the change in fair value of earn-out relates to our acquisition of Smiths Medical, and $1.6 million of the change in fair value of earn-out relates to our acquisition of a small foreign infusions systems supplier in the fourth quarter of 2021 (see Note 3: Acquisitions).

The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities related to Smiths Medical:

Smiths Medical Earn-out Liability

Simulation Input	As of September 30, 2023		As of December 31, 2022
Volatility	41.00	%	38.00	%
Risk-Free Rate	4.91	%	4.17	%

Investments, Foreign Exchange Contracts and Interest Rate Contracts    

    Our investments consist of corporate and government bonds and U.S. treasury securities. The fair value of our corporate and government bonds is estimated using observable market-based inputs such as quoted prices, interest rates and yield curves or Level 2 inputs. The fair value of our U.S. treasury securities are based on quoted market prices in active markets and are included in the Level 1 fair value hierarchy.

    The fair value of our Level 2 foreign exchange contracts, including forward contracts and cross-currency par forward contracts, is estimated using observable market inputs such as known notional value amounts, spot and forward exchange rates. These inputs relate to liquid, heavily traded currencies with active markets which are available for the full term of the derivative.

The fair value of our Level 2 interest rate swaps is estimated using a pricing model that reflects the terms of the contracts, including the period to maturity, and relies on observable market inputs such as known notional value amounts and USD interest rate curves.

Our assets and liabilities measured at fair value on a recurring basis consisted of the following Level 1, 2 and 3 inputs as defined above (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Fair value measurements as of September 30, 2023
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	1,306	$	—	$	1,306	$	—
Short-term government bonds	500		—		500		—
Foreign exchange contracts:
Prepaid expenses and other current assets	8,630		—		8,630		—
Other assets	542		—		542		—
Interest rate contracts:
Prepaid expenses and other current assets	30,446		—		$	30,446	—
Other assets	22,167		—		$	22,167	—
Total Assets	$	63,591	$	—	$	63,591	$	—
Liabilities:
Contingent earn-out liability - ST	$	6,300	$	—			$	6,300
Contingent earn-out liability - LT	7,061		—				$	7,061
Foreign exchange contracts:
Accrued liabilities	1,890		—		$	1,890	—
Other long-term liabilities	91		—		$	91	—
Total Liabilities	$	15,342	$	—	$	1,981	$	13,361

26

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Fair value measurements as of December 31, 2022
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	2,314	$	—	$	2,314	$	—
Short-term U.S. treasury securities	1,412		1,412		—		—
Short-term government bonds	498		—		$	498	—
Long-term corporate bonds	516		—		$	516	—
Foreign exchange forwards:
Prepaid expenses and other current assets	4,860		—		$	4,860	—
Other assets	94		—		$	94	—
Interest rate contracts:
Prepaid expenses and other current assets	28,431		—		$	28,431	—
Other assets	26,753		—		$	26,753	—
Total Assets	$	64,878	$	1,412	$	63,466	$	—
Liabilities:
Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities	1,847		—		1,847		—
Other long-term liabilities	167		—		167		—
Total Liabilities	$	27,586	$	—	$	2,014	$	25,572

Note 10: Investment Securities

Investments in Available-for-sale Securities

    Our available-for-sale investment securities currently consist of short-term corporate bonds and short-term government bonds and are considered “investment grade” and are carried at fair value. We assess our investment in available-for-sale debt securities for impairment each reporting period. If an unrealized loss exists, we determine whether any portion of the decline in fair value below the amortized cost basis is credit-related by reviewing several factors, including, but not limited to, the extent of the fair value decline and changes in the financial condition of the issuer. We record an impairment for credit-related losses through an allowance, limited to the amount of the unrealized loss. If we either intend to sell or it is more likely than not we will be required to sell the debt security before its anticipated recovery, any allowance is written off and the amortized cost basis is written down to fair value through a charge against net earnings. Unrealized gains and non-credit-related unrealized losses are recorded, net of tax, in other comprehensive income (loss). We did not have any investments in available-for-sale debt securities in unrealized loss positions as of September 30, 2023 or December 31, 2022.

The amortized cost of the debt securities are adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in interest expense, net in our condensed consolidated statements of operations. Realized gains and losses are accounted for on the specific identification method. There have been no realized gains or losses on the disposal of these investments. The scheduled maturities of the outstanding debt securities are between 2023 and 2024. All short-term investment securities are callable within one year.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Our short-term and long-term investments in available-for-sale securities consist of the following (in thousands):

	As of September 30, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	1,306		$	—	$	1,306
Short-term government bonds	500		—		500
Total investment securities	$	1,806	$	—	$	1,806
	As of December 31, 2022
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	2,314	$	—	$	2,314
Short-term U.S. treasury securities	1,412		—		1,412
Short-term government bonds	498		—		498
Long-term corporate bonds	516		—		516
Total investment securities	$	4,740	$	—	$	4,740

Investments in Non-Marketable Equity Securities

During the third quarter of 2021, we acquired an approximate 20% non-marketable equity interest in a nonpublic company and entered into a three-year distribution agreement where we have the exclusive rights to market, sell and distribute the company's products in exchange for a cash payment of $3.3 million. In addition, we were granted an exclusive license for all of the seller's intellectual property. At the expiration of the distribution agreement we have the right but not the obligation to acquire the remaining interest in the business.

We apply the equity method of accounting for investments when we determine we have a significant influence, but not a controlling interest in the investee. We determine whether we have significant influence by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. Our equity method investment is reported at cost and adjusted each period for our share of the investee's income or (loss) and dividend paid, if any. We eliminate any intra-entity profits to the extent of our beneficial interest. We record our share of the investee's income or (loss) on a one quarter lag. We report our proportionate share of the investee's income or (loss) resulting from this investment in other income, net in our condensed consolidated statements of operations. The carrying value of our equity method investment is reported in other assets on our condensed consolidated balance sheets (see Note 11: Prepaid Expenses and Other Current Assets and Other Assets). We assess our equity method investments for impairment on an annual basis or whenever events or circumstances indicate that the carrying value of the investment may not be recoverable. Our recorded share of the investee's loss was not material for the three and nine months ended September 30, 2023 and 2022. We did not receive any dividend distributions from this investment during the three and nine months ended September 30, 2023 and 2022.

Our non-marketable equity method investment consists of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Equity method investment	$	3,145	$	3,178

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Note 11:     Prepaid Expenses and Other Current Assets and Other Assets

Prepaid expenses and other current assets consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Other prepaid expenses and receivables	$	21,880	$	21,635
Prepaid vendor expenses	1,657		3,052
Deferred costs	5,676		2,395
Prepaid insurance and property taxes	4,245		16,322
VAT/GST receivable	2,390		3,546
Deferred tax charge	4,935		3,830
Foreign exchange contracts	8,630		4,860
Interest rate contracts	30,446		28,431
Deposits	1,227		1,329
Other	3,326		3,532
	$	84,412	$	88,932

Other assets consist of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Pump lease receivables	$	29,070	$	27,086
Spare parts	44,076		38,498
Equity method investment	3,145		3,178
Deferred debt issuance costs	3,867		5,156
Finance lease right-of-use assets	2,814		2,598
Interest rate contracts	22,167		26,753
Other	2,586		2,193
	$	107,725	$	105,462

Note 12: Inventories

    Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. Inventory costs include material, labor and overhead related to the manufacturing of our products.

Inventories consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Raw materials	$	298,753	$	286,964
Work in process	75,935		73,795
Finished goods	384,934		335,250
Total inventories	$	759,622	$	696,009

During the three and nine months ended September 30, 2023, we recorded a $6.3 million reserve to inventory related to certain product at the end of its life cycle due to the integration of acquired product with similar functionality. This adjustment was recorded to cost of goods sold in our condensed consolidated statement of operations.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Note 13:     Property, Plant and Equipment

Property, plant and equipment consists of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Machinery and equipment	$	477,444	$	414,811
Land, building and building improvements	275,997		274,063
Molds	87,757		77,203
Computer equipment and software	120,743		115,214
Furniture and fixtures	30,311		29,876
Instruments placed with customers(1)	107,673		98,481
Construction in progress	106,051		152,909
Total property, plant and equipment, cost	1,205,976		1,162,557
Accumulated depreciation	(597,214)		(526,444)
Property, plant and equipment, net	$	608,762	$	636,113

______________________________

(1)    Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers under operating leases.

Depreciation expense was $25.0 million and $72.8 million for the three and nine months ended September 30, 2023, respectively, and $23.0 million and $69.4 million for the three and nine months ended September 30, 2022, respectively.

Note 14: Goodwill and Intangible Assets, Net

Goodwill

    The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2023	$	1,449,258
Currency translation	(4,802)
Balance as of September 30, 2023	$	1,444,456

Intangible Assets, Net

    Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Weighted-Average Amortization Life in Years	September 30, 2023
		Cost		Accumulated Amortization		Net
Patents	10	$	32,741	$	20,107	$	12,634
Customer contracts	12	9,860		6,631		3,229
Non-contractual customer relationships	8	545,192		151,573		393,619
Trademarks	1	5,425		5,425		—
Trade name	15	18,243		6,852		11,391
Developed technology	10	583,845		152,444		431,401
Non-compete	3	9,100		6,900		2,200
Total amortized intangible assets		$	1,204,406	$	349,932	$	854,474
Internally developed software*		$	36,806			$	36,806
Total intangible assets		$	1,241,212	$	349,932	$	891,280

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted-Average Amortization Life in Years	December 31, 2022
		Cost		Accumulated Amortization		Net
Patents	10	$	29,998	$	18,610	$	11,388
Customer contracts	12	10,026		6,443		3,583
Non-contractual customer relationships	8	546,935		101,556		445,379
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		5,959		12,292
Developed technology	10	583,176		108,708		474,468
Non-compete	3	9,100		5,250		3,850
Total amortized intangible assets		$	1,202,911	$	251,951	$	950,960
Internally developed software*		$	31,806			$	31,806
Total intangible assets		$	1,234,717	$	251,951	$	982,766

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

Intangible assets with definite lives are amortized on a straight-line basis over their estimated useful lives. Intangible asset amortization expense was $33.4 million and $98.8 million during the three and nine months ended September 30, 2023, respectively, and $35.6 million and $108.9 million during the three and nine months ended September 30, 2022, respectively.

As of September 30, 2023 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Remainder of 2023	$	32,407
2024	131,060
2025	123,490
2026	122,832
2027	112,782
2028	112,184
Thereafter	219,719
Total	$	854,474

Note 15:     Accrued Liabilities and Other Long-Term Liabilities

    Accrued liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Salaries and benefits	$	53,763	$	44,304
Incentive compensation	25,853		30,254
Operating lease liability-ST	19,850		18,169
Accrued sales taxes	6,440		5,844
Restructuring accrual	4,335		5,923
Deferred revenue	28,768		30,838
Accrued other taxes	5,657		5,794
Accrued professional fees	3,194		5,317
Italy medical device payback provision(1)	22,754		7,900
Legal accrual	1,601		3,137
Distribution fees	12,500		17,063
Warranties and returns	3,576		3,097
Field service corrective action(2)	26,382		24,517
Accrued freight	17,544		17,988
Foreign exchange contracts	1,890		1,847
Accrued research and development	—		3,538
Accrued audit fees	6,362		6,279
Defined benefit plan	2,064		2,928
Accrued interest	1,083		1,033
Other	7,708		6,999
	$	251,324	$	242,769

___________________________

(1)     As of December 31, 2022, there was $12.1 million in payback provision recorded as a reduction to accounts receivable, net. The Company reclassified such amount to accrued liabilities as of September 30, 2023. This amount was not reclassified as of December 31, 2022 to conform to the current year presentation.

(2)    Relates to field service corrective actions associated with certain products in connection with a 2021 Warning Letter received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility, see Note 19: Commitments and Contingencies for further detail.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Other long-term liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Operating lease liability-LT	$	57,277	$	60,916
Benefits	4,999		5,314
Accrued rent	864		997
Finance lease liability-LT	2,018		1,855
Deferred revenue	11,836		16,239
Field service corrective action(1)	19,470		25,294
Other	3,541		3,489
	$	100,005	$	114,104

______________________________

(1)    Relates to field service corrective actions associated with certain products in connection with a 2021 Warning Letter received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility, see Note 19: Commitments and Contingencies for further detail.

Note 16:     Income Taxes

Income taxes were accrued at an estimated effective tax rate of 235% and 70% for the three and nine months ended September 30, 2023, respectively, as compared to 38% and 37% for the three and nine months ended September 30, 2022, respectively.

    The effective tax rate for the three and nine months ended September 30, 2023 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, foreign-derived intangible income ("FDII") and tax credits and the following discrete items recognized during the interim period:

•Net unrecognized tax benefits resulting primarily from the expiration of statute of limitations during the three and nine months ended September 30, 2023 of $0.0 million and $6.0 million, respectively.

•Excess tax benefit recognized on stock option exercises and the vesting of restricted stock units during the three and nine months ended September 30, 2023 of $0.6 million and $0.8 million, respectively.

•U.S. federal return-to-provision adjustments net of related tax reserves for the year ended December 31, 2022 resulted in a tax benefit of $7.5 million during the three and nine months ended September 30, 2023. The adjustments related primarily to changes in estimates for the research and development credit and foreign tax credits.

•The revaluation of the contingent consideration during the three and nine months ended September 30, 2023 of $15.6 million and $12.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

    The effective tax rate for the three and nine months ended September 30, 2022 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, FDII and tax credits. The effective tax rate during the three and nine months ended September 30, 2022 included a discrete tax benefit of $1.5 million and $4.1 million, respectively, related to excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period. The revaluation of the contingent consideration during the three and nine months ended September 30, 2022 of $4.1 million and $31.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

Note 17:     Long-Term Debt

2022 Credit Agreement

On January 6, 2022, in connection with the acquisition of Smiths Medical, we entered into a Credit Agreement (the "Credit Agreement") with Wells Fargo Bank, National Association, Wells Fargo Securities, LLC, Barclays Bank PLC and certain other financial institutions (the “Lenders”) for $2.2 billion of senior secured credit facilities. The senior secured credit facilities include (i) a five-year Tranche A term loan of $850.0 million (the "Term Loan A"), (ii) a seven-year Tranche B term loan of $850.0 million (the "Term Loan B") and (iii) a five-year revolving credit facility of $500.0 million (the "Revolving

33

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Credit Facility"), with separate sub-limits of $50.0 million for letters of credit and swingline loans (collectively, the "Senior Secured Credit Facilities"). We used the proceeds from borrowings under the Term Loan A and the Term Loan B (collectively, the "Term Loans") to fund a portion of the cash consideration for the purchase of Smiths Medical and the related fees and expenses incurred in connection with the acquisition. We did not incur borrowings under the Revolving Credit Facility on the closing date of the acquisition. The proceeds from any future borrowings under the Revolving Credit Facility may be used for working capital and other general corporate purposes.

In connection with entering into the Credit Agreement, during the period ended March 31, 2022, we incurred $37.8 million in debt discount and issuance costs, which were allocated to the Term Loan A, the Term Loan B and the Revolving Credit Facility based on lender commitment amounts relative to each type of fees paid. The lender and third-party discount and issuance costs allocated to the Term Loan A and the Term Loan B were $15.8 million and $13.4 million, respectively, and are reflected as a direct deduction from the face amount of the corresponding term loans on the condensed consolidated balance sheet. These costs are being amortized to interest expense over the respective terms of the loans using the effective interest method. The issuance costs allocated to the Revolving Credit Facility were $8.6 million, which are capitalized and included in prepaid expenses and other current assets and other assets on our condensed consolidated balance sheets. These costs are being amortized to interest expense over the term of the Revolving Credit Facility using the straight-line method.

The net funds received from the Term Loan A and the Term Loan B, after deducting debt issuance costs, were $834.2 million and $836.6 million, respectively.

Maturity Dates

The maturity date for the Term Loan A and the Revolving Credit Facility is January 6, 2027, and the maturity date for the Term Loan B is January 6, 2029. Pursuant to the terms and conditions of the Credit Agreement, the maturity dates of the Term Loans and the Revolving Credit Facility may be extended upon our request, subject to the consent of the Lenders.

Interest Rate Terms

In general, the Term Loans and borrowings under the Revolving Credit Facility denominated in U.S. dollars bear interest, at our option, on either: (1) the Base Rate, as defined below, plus the applicable margin, as indicated below ("Base Rate Loans") or (2) the Adjusted Term Secured Overnight Financing Rate ("Adjusted Term SOFR"), as defined below, plus the applicable margin, as indicated below ("Term SOFR Loans").

The Base Rate is defined as the highest of (a) the Prime Rate, (b) the Federal Funds Rate plus 0.50% and (c) Adjusted Term SOFR (as defined below) for a one-month period plus, in each case, 1.00%.

Adjusted Term SOFR is the rate per annum equal to (a) the Term SOFR plus (b) the Term SOFR Adjustment. Term SOFR is the forward-looking term rate based on SOFR and is calculated separately for Term SOFR Loans and Base Rate Loans, as specified in the Credit Agreement. The Term SOFR Adjustment is a percentage per annum of 0.10% for Base Rate Loans and between 0.10% to 0.25% for Term SOFR Loans based on the applicable interest period.

Revolving Credit Facility Commitment Fee

The Revolving Credit Facility has a per annum commitment fee at an initial rate of 0.25% which is applied to the available amount of the Revolving Credit Facility. Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the commitment fee will be determined by reference to the leverage ratio in effect from time to time as set forth in the table below.

Applicable Interest Margins

The Term Loan A and borrowings under the Revolving Credit Facility have an initial applicable margin of 0.75% per annum for Base Rate Loans and 1.75% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the applicable margin for the Term Loan A and borrowings under the Revolving Credit Facility will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
Greater than 4.00 to 1.0	2.25%	1.25%	0.35%
Less than or equal to 4.00 to 1.0 but greater than 3.00 to 1.0	2.00%	1.00%	0.30%
Less than or equal to 3.00 to 1.0 but greater than 2.50 to 1.0	1.75%	0.75%	0.25%
Less than or equal to 2.50 to 1.0 but greater than 2.00 to 1.0	1.50%	0.50%	0.20%
Less than or equal to 2.00 to 1.0	1.25%	0.25%	0.15%

The Term Loan B has an initial applicable margin of 1.5% per annum for Base Rate Loans and 2.5% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the applicable margin for the Term Loan B will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:

Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans
Greater than 2.75 to 1.0	2.50%	1.50%
Less than 2.75 to 1.0	2.25%	1.25%

Principal Payments

Principal payments on the Term Loans are due on the last day of each calendar quarter commencing on June 30, 2022.

The Term Loan A will amortize in nineteen consecutive quarterly installments in an amount equal to 2.50% of the original principal amount in each of the first two years, 5.00% in each of the third and fourth years and 7.50% in the fifth year, with a final payment of the remaining outstanding principal balance due on the maturity date.

The Term Loan B matures in twenty-seven consecutive quarterly installments in an amount equal to 0.25% of the original principal amount, with a final payment of the remaining outstanding principal balance due on the maturity date.

We may borrow, prepay and re-borrow amounts under the Revolving Credit Facility, in accordance with the terms and conditions of the Credit Agreement, with all outstanding amounts due at maturity.

During March 2022, we prepaid $16.0 million in principal payments on the Term Loan A principal balance. For the nine months ended September 30, 2023 and 2022 total principal payments on both Term Loans were $22.3 million and $20.3 million, respectively.

Interest Payments

Interest payments on Base Rate Loans are payable quarterly in arrears on the last business day of each calendar quarter and the applicable maturity date. Interest periods on Term SOFR Loans will be determined, at our option, as either one, three or six months and will be payable on the last day of each interest period and the applicable maturity date. In the case of any interest periods of more than three months' duration, the interest payment will be payable on each day prior to the last day of such interest period that occurs at three-month intervals.

The commitment fee on the Revolving Credit Facility is payable quarterly in arrears on the third business day following the last day of each calendar quarter and at the maturity date. The commitment fee is included in interest expense in our condensed consolidated statements of operations.

Guarantors and Collateral

35

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Our obligations under the Credit Agreement are unconditionally guaranteed, on a joint and several basis, by ICU Medical, Inc. and certain of our existing subsidiaries.

Debt Covenants

The Credit Agreement contains affirmative and negative covenants, including certain financial covenants. The negative covenants include restrictions regarding the incurrence of liens and indebtedness, certain merger and acquisition transactions, asset sales and other dispositions, other investments, dividends, share purchases and payments affecting subsidiaries, changes in nature of business, fiscal year or organizational documents, prepayments and redemptions of subordinated and other junior debt, transactions with affiliates, and other matters.

The financial covenants include the Senior Secured Leverage Ratio and the Interest Coverage Ratio, both defined below, and pertain to the Term Loan A and the Revolving Credit Facility.

The Senior Secured Leverage Ratio is defined, at any measurement date, as the ratio of: (a) all Funded Debt, as defined in the Credit Agreement, that is secured by a lien on any asset or property minus the lesser of (i) all unrestricted cash and cash equivalents and (ii) $500.0 million, to (b) Consolidated EBITDA, as defined in the Credit Agreement, for the most recently completed four fiscal quarters, calculated on a pro forma basis. The maximum Senior Secured Leverage Ratio is 4.50 to 1.00 until June 30, 2024. Thereafter, the maximum Senior Secured Leverage Ratio is 4.00 to 1.00, with limited permitted exception.

The Interest Coverage ratio is defined, at any measurement date, as the ratio of Consolidated EBITDA, as defined in the Credit Agreement, to Consolidated Interest Expense, as defined in the Credit Agreement, paid or payable in cash, for the most recently completed four fiscal quarters. The minimum Interest Coverage ratio is 3.00 to 1.00.

We were in compliance with all financial covenants as of September 30, 2023.

The Credit Agreement contains customary events of default, including, among others: non-payments of principal and interest; breach of representations and warranties; covenant defaults; cross-defaults and cross-acceleration to certain other material indebtedness; the existence of bankruptcy or insolvency proceedings; certain events under ERISA; material judgments; and a change of control. If an event of default occurs and is not cured within any applicable grace period or is not waived, the administrative agent and the Lenders are entitled to take various actions, including, without limitation, the acceleration of all amounts due and the termination of commitments under the Senior Secured Credit Facilities.

2017 Credit Facility

    On November 8, 2017, we entered into a five-year senior secured revolving credit facility with various lenders for $150.0 million, with Wells Fargo Bank, National Association as the administrative agent, swingline lender and issuing lender (the "Prior Credit Facility"). The Prior Credit Facility, which was set to mature on November 8, 2022, was terminated in connection with entering into the Credit Agreement on January 6, 2022.

The carrying values of our long-term debt consist of the following (in thousands):

	Effective Interest Rate		As of September 30, 2023		Effective Interest Rate		As of December 31, 2022
Senior Secured Credit Facilities:
Term Loan A — principal	7.62	%	$	818,125	3.99	%	$	834,000
Term Loan B — principal	7.96	%	837,250		4.61	%	843,625
Revolving Credit Facility — principal	—	%	—		—	%	—
Less unamortized debt issuance costs(1)			(20,443)				(24,262)
Total carrying value of long-term debt			1,634,932				1,653,363
Less current portion of long-term debt			45,688				29,688
Long-term debt, net			$	1,589,244			$	1,623,675

_______________________________

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

(1)    Comprised of $10.1 million and $10.3 million relating to the Term Loan A and the Term Loan B, respectively, as of September 30, 2023.

As of September 30, 2023, the aggregate amount of principal repayments of our long-term debt (including any current portion) for each of the next five years is approximately (in thousands):

Remainder of 2023	$	7,437
2024	51,000
2025	51,000
2026	72,250
2027	672,563
2028	8,500
Thereafter	792,625
Total	$	1,655,375

The following table presents the total interest expense related to our long-term debt (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Contractual interest	$	32,494	$	19,228	$	92,593	$	41,868
Amortization of debt issuance costs	1,704		1,758		5,108		5,200
Commitment fee — Revolving Credit Facility	384		334		1,135		994
Total long-term debt-related interest expense	$	34,582	$	21,320	98,836		48,062

We currently hedge against the contractual interest expense on our long-term debt (see Note 8: Derivatives and Hedging Activities).

Note 18: Stockholders' Equity

Shareholders Agreement

At the completion of the Smiths Medical acquisition on January 6, 2022, Smiths owned approximately 10.5% of the total outstanding shares of our common stock (see Note 3: Acquisitions). At closing, in connection with the issuance of the share consideration, we entered into a Shareholders Agreement (the “Shareholders Agreement”) with Smiths. The Shareholders Agreement imposes certain restrictions on Smiths including prohibiting certain transfers of the shares of our common stock issued (i) for 6 months following the closing of the acquisition and (ii) to certain of our competitors and certain other parties, as well as customary standstill limitations. The Shareholders Agreement also permits Smiths to designate one individual for election to our Board of Directors (the "Board") so long as Smiths beneficially owns at least 5.0% of the total outstanding shares of our common stock. On February 1, 2022, our Board appointed a new director designated by Smiths pursuant to the Shareholders Agreement who was elected to the Board at the 2022 Annual Meeting of Stockholders held in May 2022. This appointment expanded the size of our Board from eight to nine members. See our Current Report on Form 8-K filed on February 1, 2022 for additional information.

Treasury Stock

    In August 2019, our Board approved a share purchase plan to purchase up to $100.0 million of our common stock. This plan has no expiration date. During the three months ended September 30, 2023, we did not purchase any shares of our common stock under our share purchase plan. As of September 30, 2023, all of the $100.0 million available for purchase was remaining under the plan. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Agreement (see Note 17: Long-Term Debt).

37

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

    For the nine months ended September 30, 2023, we withheld 58,089 shares of our common stock from employee vested restricted stock units in consideration for $9.2 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. For the nine months ended September 30, 2022, we withheld 45,370 shares of our common stock from employee vested restricted stock units in consideration for $10.5 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. Treasury stock is used to issue shares for stock option exercises and restricted stock grants.

Accumulated Other Comprehensive (Loss) Income ("AOCI")

    The components of AOCI, net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2023	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income (loss) before reclassifications	24,983		(113)		(31)		24,839
Amounts reclassified from AOCI	—		(5,464)		—		(5,464)
Other comprehensive income (loss)	24,983		(5,577)		(31)		19,375
Balance as of March 31, 2023	$	(97,990)	$	35,202	$	1,185	$	(61,603)
Other comprehensive (loss) income before reclassifications	7,569		13,175		(34)		20,710
Amounts reclassified from AOCI	—		(7,901)		—		(7,901)
Other comprehensive income (loss)	7,569		5,274		(34)		12,809
Balance as of June 30, 2023	$	(90,421)	$	40,476	$	1,151	$	(48,794)
Other comprehensive (loss) income before reclassifications	(37,557)		10,824		(35)		(26,768)
Amounts reclassified from AOCI	—		(9,165)		—		(9,165)
Other comprehensive (loss) income	(37,557)		1,659		(35)		(35,933)
Balance as of September 30, 2023	$	(127,978)	$	42,135	$	1,116	$	(84,727)

38

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2022	$	(19,045)	$	(237)	$	13	$	(19,269)
Other comprehensive (loss) income before reclassifications	(4,946)		25,782		15		20,851
Amounts reclassified from AOCI	—		(2,210)		—		(2,210)
Other comprehensive (loss) income	(4,946)		23,572		15		18,641
Balance as of March 31, 2022	$	(23,991)	$	23,335	$	28	$	(628)
Other comprehensive (loss) income before reclassifications	(99,805)		10,245		14		(89,546)
Amounts reclassified from AOCI	—		(2,101)		—		(2,101)
Other comprehensive (loss) income	(99,805)		8,144		14		(91,647)
Balance as of June 30, 2022	$	(123,796)	$	31,479	$	42	$	(92,275)
Other comprehensive (loss) income before reclassifications	(90,549)		18,784		227		(71,538)
Amounts reclassified from AOCI	—		(1,869)		—		(1,869)
Other comprehensive (loss) income	(90,549)		16,915		227		(73,407)
Balance as of September 30, 2022	$	(214,345)	$	48,394	$	269	$	(165,682)

Note 19: Commitments and Contingencies

Legal Proceedings

From time to time, we are involved in various legal proceedings, most of which are routine litigation, in the normal course of business. Our management does not believe that the resolution of the unsettled legal proceedings that we are involved with will have a material adverse impact on our financial position or results of operations.

Off-Balance Sheet Arrangements

    In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters or other matters related to sales of our products. There is no maximum limit on the indemnification that may be required under these agreements. 

Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification.

Contingencies

On January 6, 2022, we acquired Smiths Medical. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving a certain volume-weighted average price from the closing date to either the third or fourth anniversary of closing. As of September 30, 2023, the estimated fair value of the contingent earn-out is $7.1 million (see Note 9: Fair Value Measurements).

Prior to being acquired, during 2021, Smiths Medical received a Warning Letter from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility. The Warning Letter cited, among other things, failures to comply with FDA's medical device reporting requirements and failures to comply with applicable portions of the Quality System Regulation. A provision for the estimated costs related to the field service corrective action was recorded on the opening acquired balance sheet of Smiths Medical in the amount of $55.1 million. The initial estimate recorded was based on a probability-weighted estimate of the costs required to settle the obligation. The actual costs to be incurred are dependent upon the scope of the work necessary to achieve regulatory clearance and could differ from the original estimate. The estimated field service corrective action recorded at September 30, 2023 is $42.8 million.

39

ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. As of December 31, 2022, the measurement period related to (i) above ended and based on the actual revenue achieved during the measurement period we determined that the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2023, the estimated fair value of the contingent earn-out related to certain product-related regulatory certification was estimated to be $1.5 million (see Note 9: Fair Value Measurements).

In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of September 30, 2023, the estimated fair value of the contingent earn-out is $4.3 million (see Note 9: Fair Value Measurements).

Commitments

    We have non-cancelable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 6: Leases).

Note 20:     Collaborative and Other Arrangements

    On February 3, 2017, we entered into two Manufacturing and Supply Agreements ("MSAs") whereby (i) Pfizer will manufacture and supply us with certain agreed upon products for an initial five-year term with a one-time two-year option to extend and (ii) we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSAs provide each party with mutually beneficial interests and both of the MSAs are to be jointly managed by both Pfizer and ICU. The initial supply price, which is subject to an annual update, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On January 1, 2021, we amended our MSA with Pfizer, whereby we manufacture and supply certain agreed upon products to Pfizer. The amendments included a change to the term of the agreement to end on December 31, 2024 with Pfizer's unilateral election to extend through December 31, 2025. Other changes to the terms of the MSA included (i) amendments to our level of supply of products to Pfizer, (ii) certain changes to our manufacturing lines, (iii) updates to our supply price with added volume price tiers for annual periods and (iv) certain minimum purchase requirements for certain products. On February 1, 2022, effective as of January 1, 2022, upon our request, Pfizer executed a Product Addendum (the "Product Addendum") to our MSA, whereby Pfizer manufactures and supplies to us certain agreed upon products. The Product Addendum includes the supply of additional product to us subject to certain time and pricing terms and conditions. The Product Addendum includes a minimum purchase obligation of $29.6 million and expired on November 30, 2022. As of November 30, 2022, we had satisfied the minimum purchase obligations under the Product Addendum.

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ICU MEDICAL, INC. AND SUBSIDIARIES

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Note 21: Accounts Receivable Purchase Program

On January 19, 2023, we entered into a revolving $150 million uncommitted receivables purchase agreement with Bank of The West ("BOW") which provides for a less expensive form of capital. The discount rate applied to the sold receivables equals a rate per annum equal to the sum of (i) an applicable margin of 1.75%, plus (ii) Term SOFR for a period equal to the discount period which is calculated with respect to the payment terms of the specific receivable. The accounts receivable sold have payment terms ranging between 30 and 60 days, and are related to customer accounts with good credit history. The transfer of the purchased accounts receivable under the agreement is intended to be an absolute and irrevocable transfer constituting a true sale as the transferred receivables have been isolated beyond the reach of the Company and our creditors, even in bankruptcy or other receivership. We do not retain effective control over the sold receivables and BOW has the right upon purchase to pledge and/or exchange the transferred assets without restrictions. The Company acts as collection agent for BOW and collection services are undertaken by our accounts receivable personnel in their normal course of business and collected funds are remitted to BOW. We do not have any continuing involvement with the sold receivables other than the collection services which does not provide us with more than a trivial benefit. The discount rate has been negotiated net of consideration for the collection services, the cost of collection is immaterial to the Company; therefore, we did not separately record any related servicing assets or liabilities related to the sold receivables.

For the nine months ended September 30, 2023, the carrying value of trade receivables sold to BOW in connection with the purchase program was $452.6 million. In exchange for the sale of trade receivables, we received cash of $450.0 million. For the three and nine months ended September 30, 2023, the sale of the receivables resulted in a loss of $1.0 million and $2.7 million, respectively, recorded in other expense, net in our condensed consolidated statement of operations. For the nine months ended September 30, 2023, we have collected and remitted $390.2 million in cash to BOW. As of September 30, 2023, cash remaining to be collected on behalf of BOW was $62.4 million, which has been removed from our condensed consolidated balance sheet as of September 30, 2023 and is reflected as cash provided by operating activities in the condensed consolidated statement of cash flows. There were no such balances at December 31, 2022. The carrying value of the sold receivables approximated the fair value at September 30, 2023.

41

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

    You should read the following discussion and analysis of our financial condition and results of operations together with the condensed consolidated financial statements and accompanying notes in this Quarterly Report on Form 10-Q, as well as the audited consolidated financial statements and related notes thereto included in our 2022 Annual Report on Form 10-K. This discussion contains forward-looking statements based upon current plans, expectations and beliefs involving risks and uncertainties. Our actual results may differ materially from those anticipated in these forward-looking statements as a result of various factors, including those set forth under the caption entitled “Forward-Looking Statements” in this section and Part I, Item 1A. “Risk Factors” in our 2022 Annual Report on Form 10-K.

    When used in this report, the terms “we,” “us,” and “our” refer to ICU Medical, Inc. ("ICU") and its consolidated subsidiaries included in our condensed consolidated financial statements unless context requires otherwise.

Business Overview and Highlights

We develop, manufacture, and sell infusion systems, infusion consumables and high-value critical care products used in hospital, alternate site and home care settings. Our team is focused on providing quality, innovation and value to our clinical customers worldwide. Our product portfolio includes ambulatory, syringe, and large volume IV pumps and safety software; dedicated and non-dedicated IV sets, needlefree IV connectors, peripheral IV catheters, and sterile IV solutions; closed system transfer devices and pharmacy compounding systems; as well as a range of respiratory, anesthesia, patient monitoring, and temperature management products.

Products

In 2023, our primary product offerings have been classified into our new business units as listed below. We have presented our financial results in accordance with these product lines:

Consumables

Our Consumables business unit includes Infusion Therapy, Oncology, Vascular Access and Tracheostomy products.

Infusion Therapy

Our Infusion Therapy products include non-dedicated infusion sets, extension sets, needle-free connectors, and disinfection caps. Infusion sets used in hospitals and ambulatory clinics consist of flexible sterile tubing running from an IV bag or bottle containing a drug product or solution to a catheter inserted in a patient’s vein that may or may not be used with an infusion pump. Disinfection caps are used to actively disinfect access points into the infusion sets and catheters. Our primary Infusion Therapy products are:

•Clave™ needlefree products, including the MicroClave, MicroClave Clear, and NanoClave™ brand of connectors, accessories, extension and administration sets used for the administration of IV fluids and medications and the Neutron catheter patency device, used to help maintain patency of central venous catheters;

•Neutron™ catheter patency device, used to help maintain patency of central venous catheters;

•Tego™ needlefree connector utilized to access catheters for hemodialysis and apheresis applications; and

•ClearGuard™, SwabCap™ and SwabTip™ disinfection caps.

Oncology

Closed System Transfer Devices ("CSTD") and hazardous drug compounding systems are used to prepare and deliver hazardous IV medications such as those used in chemotherapy, which, if released, can have harmful effects on the healthcare worker and environment. Our primary Oncology products are:

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•ChemoLockTM CSTD, which utilizes a proprietary needlefree connection method, is used for the preparation and administration of hazardous drugs. ChemoLock is used to limit the escape of hazardous drug or vapor concentrations, block the transfer of environmental contaminants into the system, and eliminates the risk of needlestick injury;

•ChemoClaveTM, an ISO Connection standard and universally compatible CSTD used for the preparation and administration of hazardous drugs. ChemoClave utilizes standard ISO luer locking connections, making it compatible with all brands of needlefree connectors and pump delivery systems. ChemoClave also is used to limit the escape of hazardous drug or vapor concentrations, block the transfer of environmental contaminants into the system, and eliminate the risk of needlestick injury; and

•Deltec® GRIPPER® non-coring needles for portal access.

The preparation of hazardous drugs typically takes place in a pharmacy where drugs are removed from vials and prepared for delivery to a patient. Those prepared drugs are then transferred to a nursing unit where the chemotherapy is administered via an infusion pump set to a patient. Components of the ChemoClave and ChemoLock product lines are used both in pharmacies and on the nursing floors for the preparation and administration of hazardous drugs.

Vascular Access

Our vascular access products allow clinicians to safely access the patients' bloodstream to deliver fluids and medication or to obtain blood samples. Our primary Vascular Access products are:

•Jelco® safety and conventional peripheral IV catheters and sharps safety devices for hypodermic injection, designed to help prevent accidental needlestick injury;

•Safe-T Wing® venipuncture and blood collection devices;

•Port-A-Cath® implantable ports;

•Portex® arterial blood sampling syringes;

•PowerWand® midline catheters; and

•Cleo® subcutaneous infusion catheters and sets.

Tracheostomy

Our tracheostomy products enable placement of a secure airway using both surgical and percutaneous insertion techniques. Our primary Tracheostomy products includes:

•Portex BLUselect® PVC tracheostomy tubes feature an inner cannula as well as a Suctionaid option for above the cuff suctioning and vocalization capability;

•Portex Bivona® silicone tracheostomy tubes offer the added benefits of comfort and mobility and come in a variety of configurations suited to meet the clinical needs of neonatal through adult patients; and

•Portex BLUperc® percutaneous insertion kits allow for safe placement of the tracheostomy tube at the bedside.

Infusion Systems

    We offer a wide range of infusion pumps, dedicated IV sets, software and professional services. Our primary Infusion System products are:

Large Volume Pump ("LVP") Hardware and Dedicated IV Sets:

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•Plum 360™: The Plum 360™ infusion pump is an ICU Medical MedNet™ ready large volume infusion pump with an extensive drug library and wireless capability. The pumps work with dedicated IV sets. Plum 360 was named the 2018, 2019, 2020, and 2022 Best in KLAS winner as top-performing IV smart pump and was the first medical device to be awarded UL Cybersecurity Assurance Program Certification. Also, in 2021 2022 and 2023, the Plum 360 won the award as the top-performing Smart Pump EMR-Integrated.

Ambulatory Infusion Hardware:

•CADD® ambulatory infusion pumps and disposables, including administration sets and medication cassette reservoirs, support a variety of IV pain management therapies across clinical care areas from hospital to outpatient treatment.

Syringe Infusion Hardware:

•MedfusionTM syringe infusion pumps are designed for the administration of fluids and medication requiring precisely controlled infusion rates from a variety of syringe sizes in acute care settings.

    IV Medication Safety Software:

•ICU Medical MedNet™: ICU Medical MedNet is an enterprise-class medication management platform for any sized healthcare system that can help reduce medication errors, improve quality of care, streamline workflows and maximize revenue capture. ICU Medical MedNet connects our industry-leading smart pumps to a hospital’s EHR, asset tracking systems, and alarm notification platforms with the largest array of integration partners.

•PharmGuard® Medication Safety Software for MedfusionTM 4000 syringe and CADD™ Solis pumps allows for customized drug libraries to support the standardization of protocols for medication administration throughout the facility.

Professional Services:

•In addition to the products above, our teams of clinical, information technology, and professional services experts work with customers to develop and deliver safe and efficient infusion systems, providing customized and personalized configuration, implementation, and data analytics services to complement our infusion hardware and software.

Vital Care

Our Vital Care business unit includes IV Solutions, Critical Care, General Anesthesia and Respiratory, Temperature Management Solutions and Regional Anesthesia/Pain Management products.

IV Solutions

Our IV Solutions products include a broad portfolio of injection, irrigation, nutrition and specialty IV solutions including:

IV Therapy and Diluents:

•Including Sodium Chloride, Dextrose, Balanced Electrolyte Solutions, Lactated Ringer's, Ringer's, Mannitol, Sodium Chloride/Dextrose and Sterile Water.

Irrigation:

•Including Sodium Chloride Irrigation, Sterile Water Irrigation, Physiologic Solutions, Ringer's Irrigation, Acetic Acid Irrigation, Glycine Irrigation, Sorbitol-Mannitol Irrigation, Flexible Containers and Pour Bottle Options.

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Hemodynamic Monitoring

Our Hemodynamic Monitoring products help clinicians get accurate real-time access to patients’ hemodynamic and cardiac status with an extensive portfolio of monitoring systems and advanced sensors & catheters. Measurements provided by our systems help clinicians determine how well the heart is pumping blood and how efficiently oxygen from the blood is being used by the tissues. Our Hemodynamic Monitoring products include:

•Cogent™ 2-in-1 hemodynamic monitoring system;

•CardioFlo™ hemodynamic monitoring system;

•TDQ™ and OptiQ™ cardiac output monitoring catheters;

•TriOxTM venous oximetry catheters;

•Transpac™ blood pressure transducers; and

•SafeSet™ closed blood sampling and conservation system.

•MEDEX® LogiCal® Pressure Monitoring System and components.

    General Anesthesia & Respiratory

We offer a broad range of anesthesia systems and devices and breathing circuits, ventilation, respiratory and specialty airway products that maintain patients’ airways before, during and after surgery. Our primary Anesthesia & Respiratory products are:

•Portex® acapella® bronchial hygiene products used to mobilize pulmonary secretions to facilitate the opening of airways in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease, or COPD, asthma and cystic fibrosis.

    Temperature Management Solutions

Temperature Management solutions systems are used in perioperative and critical care settings to help monitor and regulate patient temperature. Our primary Temperature Management products include:

•Level 1® rapid infusion, fluid warming, routine blood and fluid warming, irrigation fluid warming, convective patient warming and temperature probes.

    Regional Anesthesia/Pain Management Trays

We offer a comprehensive range of Portex® regional anesthesia/pain management trays and components. Our primary products include:

•Epidural Trays;

•Spinal Trays;

•Combined (CSE) Trays;

•Peripheral Nerve Block Trays; and

•Specialty Trays (Lumbar Puncture, Amniocentesis, Myelogram).

In the U.S. a substantial amount of our products are sold to group purchasing organization member hospitals. We believe that as healthcare providers continue to either consolidate or join major buying organizations, the success of our products will depend, in part, on our ability, either independently or through strategic relationships, to secure long-term contracts with large healthcare providers and major buying organizations. 

Supply Constraints, Global Economic Conditions

We have experienced significant impacts to our business as a result of global economic challenges, resulting from the COVID-19 pandemic and the continuing conflict between Russia and Ukraine, such as rising inflation, especially with respect to freight costs driven by higher fuel prices, increased cost and shortages of raw materials, and supply chain disruptions which negatively impacted our gross profit margin during 2022. We expect the pressure on the supply chain to continue and freight costs to remain subject to volatility in the market. The rising interest rates and foreign currency impact due to the strengthening of the U.S. dollar have also impacted our results of operations during 2022 and the nine months ended September 30, 2023.

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These challenges arising from global economic conditions could worsen as a result of the current armed conflict in the Middle East, which is highly uncertain at this time.

Our business operations expose us to risks associated with public health crises and epidemics/pandemics, such as COVID-19. COVID 19 caused lower hospital admissions and medical procedure volumes, and any resurgence of the pandemic or any new public health crisis could again shift healthcare priorities and cause volatility in the demand for our products, thereby adversely affecting our business operations.

While we continually monitor the ongoing and evolving impact of the above events on our operations, the overall impact remains uncertain and may not be fully reflected until future periods. The overall impact to our results of operations will depend on factors such as the duration and extent of the current global economic challenges, including any impact from conflicts in Eastern Europe and the Middle East more generally, and the resurgence of the pandemic or the emergence of a new public health crisis, none of which can be fully predicted at this time. See “Part I. Item 1A. Risk Factors” in our 2022 Annual Report on Form 10-K for a discussion of risks and uncertainties.

Consolidated Results of Operations

    We present income statement data in Part I, Item 1. "Financial Statements." The following table shows, for the three and nine months ended September 30, 2023 and 2022, the percentages of each income statement caption in relation to total revenue: 

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Total revenues	100	%	100	%	100	%	100	%
Gross profit	33	%	31	%	34	%	31	%
Selling, general and administrative expenses	27	%	26	%	27	%	27	%
Research and development expenses	4	%	4	%	4	%	4	%
Restructuring, strategic transaction and integration expenses	1	%	2	%	2	%	4	%
Change in fair value of contingent earn-out	(3)	%	(1)	%	(1)	%	(2)	%
Total operating expenses	29	%	31	%	32	%	33	%
Income (loss) from operations	4	%	—	%	2	%	(2)	%
Interest expense, net	(4)	%	(3)	%	(4)	%	(3)	%
Other (expense) income, net	(1)	%	(1)	%	—	%	—	%
Loss before income taxes	(1)	%	(4)	%	(2)	%	(5)	%
Benefit for income taxes	2	%	1	%	2	%	2	%
Net income (loss)	1	%	(3)	%	—	%	(3)	%

Seasonality/Quarterly Results

There are no significant seasonal aspects to our business. We can experience fluctuations in net sales as a result of variations in the ordering patterns of our largest customers, which may be driven more by production scheduling and customer inventory levels, and less by seasonality. Our expenses often do not fluctuate in the same manner as net sales, which may cause fluctuations in operating income that are disproportionate to fluctuations in our revenue.

Non-GAAP Financial Measures

In addition to comparing changes in revenue on a U.S. GAAP basis, we also compare the changes in revenue from one period to another using constant currency. The presentation of revenues on a constant currency basis is a non-GAAP financial measure that excludes the impact of fluctuations in foreign currency exchange rates that occurred between the comparative periods. We provide constant currency information to enhance the visibility of underlying business trends, excluding the effects of changes in foreign currency translation rates. We believe this information is useful to investors to facilitate comparisons and better identify trends in our business. Our constant currency revenues reflect current period local currency revenues at prior

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period's average exchange rates. We consistently apply this approach to revenues for all currencies where the functional currency is not the U.S. dollar. These results should be considered in addition to, not as a substitute for, results reported in accordance with GAAP. Results on a constant currency basis, as we present them, may not be comparable to similarly titled measures used by other companies and are not measures of performance presented in accordance with GAAP.

Consumables

    The following table summarizes our total Consumables revenue (in millions):

	Three months ended September 30,								Nine months ended September 30,
	2023		2022		$ Change		% Change		2023		2022		$ Change		% Change
Consumables revenue (GAAP)	$	242.0	$	251.6	$	(9.6)	(3.8)	%	$	715.1	$	732.8	$	(17.7)	(2.4)	%
Impact of foreign exchange rate changes	(1.9)								5.8
Consumables revenue on a constant currency basis (non-GAAP)	$	240.1	$	251.6	$	(11.5)	(4.6)	%	$	720.9	$	732.8	$	(11.9)	(1.6)	%

Consumables revenue decreased for the three and nine months ended September 30, 2023, as compared to the same periods in the prior year, primarily due to a decrease in our Vascular Access revenues. For the three months ended September 30, 2023, the revenue decrease was partially offset by an increase in Infusion Therapy revenue and the impact of having six less billing days in the current year period for the products acquired from Smiths Group as compared to the same prior year period. For the nine months ended September 30, 2023, the revenue decrease was partially offset by an increase in Infusion Therapy and Tracheostomy revenues.

Infusion Systems

    The following table summarizes our total Infusion Systems revenue (in millions):

	Three months ended September 30,								Nine months ended September 30,
	2023		2022		$ Change		% Change		2023		2022		$ Change		% Change
Infusion Systems (GAAP)	$	149.0	$	161.6	$	(12.6)	(7.8)	%	$	463.9	$	448.4	$	15.5	3.5	%
Impact of foreign exchange rate changes	1.0								8.9
Infusion Systems on a constant currency basis (non-GAAP)	$	150.0	$	161.6	$	(11.6)	(7.2)	%	$	472.8	$	448.4	$	24.4	5.4	%

Infusion Systems revenue decreased for the three months ended September 30, 2023, as compared to the same period in the prior year, primarily due to the impact of having six less billing days in the current year period for the products acquired from Smiths Group as compared to the same prior year period and our backorder recovery in the prior year period. Infusion Systems revenue increased for the nine months ended September 30, 2023, as compared to the same period in the prior year, primarily due to higher sales of our syringe pump products and LVP dedicated sets.

Vital Care

    The following table summarizes our total Vital Care revenue (in millions):

	Three months ended September 30,								Nine months ended September 30,
	2023		2022		$ Change		% Change		2023		2022		$ Change		% Change
Vital Care (GAAP)	$	162.3	$	184.7	$	(22.4)	(12.1)	%	$	492.3	$	520.8	$	(28.5)	(5.5)	%
Impact of foreign exchange rate changes	(0.3)								5.0
Vital Care on a constant currency basis (non-GAAP)	$	162.0	$	184.7	$	(22.7)	(12.3)	%	$	497.3	$	520.8	$	(23.5)	(4.5)	%

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Vital Care revenue decreased for the three and nine months ended September 30, 2023, as compared to the same periods in the prior year, primarily due to lower sales of IV Solutions in the current year period and backorder recovery in the prior year period. Additionally, revenue for the three months ended September 30, 2023 included the impact of six less billing days for the products acquired from Smiths Group as compared to the same period in the prior year.

Gross Margins

    For the three and nine months ended September 30, 2023, gross margins were 33.2% and 34.0%, respectively, as compared to 31.2% and 30.7% for the three and nine months ended September 30, 2022, respectively. The increase in gross margin for the three months ended September 30, 2023, as compared to the same period in the prior year, was primarily driven by lower freight costs and lower quality remediation costs partially offset by lower manufacturing absorption from lower volumes and scheduled plant shutdowns, the impact of foreign exchange rate changes and higher product reserves related to product-line integration. The increase in gross margin for the nine months ended September 30, 2023, as compared to the same period in the prior year, was primarily driven by lower freight costs and the cost recognition of a purchase accounting write-up of inventory in 2022.

Selling, General and Administrative (“SG&A”) Expenses

    The following table summarizes our total SG&A Expenses (in millions):

	Three months ended September 30,								Nine months ended September 30,
	2023		2022		$ Change		% Change		2023		2022		$ Change		% Change
SG&A	$	148.6	$	153.5	$	(4.9)	(3.2)	%	$	452.1	$	465.4	$	(13.3)	(2.9)	%

SG&A expenses decreased for the three months ended September 30, 2023, as compared to the same period in the prior year primarily due to decreases of $5.2 million in depreciation and amortization, $3.0 million in compensation costs, and $1.8 million of IT expenses. These decreases were partially offset by an increase of $4.2 million in dealer fees and $1.8 million in stock based compensation. Depreciation and amortization decreased as the fair market values of certain intangible assets acquired in regard to the 2022 Smiths Medical acquisition were adjusted down after the same period in the prior year. Compensation costs decreased primarily due to a decrease in cash incentive compensation. IT expenses decreased based on current operating needs. Dealer fees increased due to an increase in revenues to distributors. Stock based compensation increased due to an increase in the fair value of amounts awarded in the current year over the fair value of the awards in the prior year.

SG&A expenses decreased for the nine months ended September 30, 2023, as compared to the same period in the prior year primarily due to decreases of $9.9 million in depreciation and amortization, $3.1 million in dealer fees, and $3.0 million in IT expenses. Partially offsetting these decreases was a $3.3 million increase in commissions. Commissions increased primarily due to sales performance in the current period measured against preset sales targets as compared to sales performance achieved against targets in the comparable prior year period.

Research and Development (“R&D”) Expenses

    The following table summarizes our total R&D Expenses (in millions):

	Three months ended September 30,								Nine months ended September 30,
	2023		2022		$ Change		% Change		2023		2022		$ Change		% Change
R&D	$	20.9	$	23.1	$	(2.2)	(9.5)	%	$	62.9	$	69.5	$	(6.6)	(9.5)	%

R&D expenses decreased for the three and nine months ended September 30, 2023, as compared to the same periods in the prior year. R&D expenses during both periods primarily relate to headcount and employment expense in support of ongoing R&D projects.

Restructuring, Strategic Transaction and Integration Expenses

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    Restructuring, strategic transaction and integration expenses were $7.2 million and $30.5 million for the three and nine months ended September 30, 2023, respectively, as compared to $14.4 million and $61.8 million for the three and nine months ended September 30, 2022, respectively.

Restructuring charges

    Restructuring charges were $1.1 million and $5.1 million for the three and nine months ended September 30, 2023, respectively, as compared to $2.4 million and $7.3 million for the three and nine months ended September 30, 2022, respectively, and were primarily related to severance costs for all periods. The restructuring charges for the three and nine months ended September 30, 2023 were net of $0.2 million of facility closures costs that were reversed in the current period. We expect to pay the majority of unpaid restructuring charges as of September 30, 2023 during the remainder of 2023 and 2024.

Strategic transaction and integration expenses

    Strategic transaction and integration expenses were $6.1 million and $25.4 million for the three and nine months ended September 30, 2023, respectively, as compared to $12.0 million and $54.5 million for the three and nine months ended September 30, 2022, respectively. The strategic transaction and integration expenses during the three and nine months ended September 30, 2023 were primarily related to consulting expenses and employee costs incurred to integrate our Smiths Medical business acquired in 2022. The strategic transaction and integration expenses for the three and nine months ended September 30, 2022 were primarily related to transaction and integration expenses associated with our acquisition of Smiths Medical on January 6, 2022 which primarily included legal expenses, bank fees, and employee costs. The nine months ended September 30, 2022 also included a United Kingdom stamp tax.

Change in Fair Value of Contingent Earn-out

For the three and nine months ended September 30, 2023, we recorded gains of $15.6 million and $12.3 million, respectively, related to a change in the fair value of contingent earn-outs as compared to a gain of $4.1 million and $31.3 million, respectively, for the three and nine months ended September 30, 2022, primarily related to the Smiths Medical acquisition. During the three and nine months ended September 30, 2023, the fair value of the Smiths Medical contingent earn-out decreased due to decreases in our stock price.

Interest Expense, net

The following table presents interest expense, net (in thousands): 

	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2023		2022		2023		2022
Interest expense	$	(25,921)	$	(21,151)	$	(76,021)	$	(51,068)
Interest income	1,746		3,343		5,210		4,765
Interest expense, net	$	(24,175)	$	(17,808)	$	(70,811)	$	(46,303)

    Interest expense, net for the three and nine months ended September 30, 2023 and 2022 primarily includes the contractual interest incurred on borrowings under the Credit Agreement, the per annum commitment fee charged on the available amount of the revolving credit facility contained in the Credit Agreement, the amortization of debt issuance costs incurred in connection with entering into the Credit Agreement (see Note 17: Long-Term Debt in our accompanying condensed consolidated financial statements) and the impact of the interest rate swaps. The interest expense increased for the three and nine months ended September 30, 2023, as compared to the respective prior year periods, primarily due to increases in the applicable SOFR reference rate. These increases were partially offset by the impact of the interest rate swaps (see Note 8: Derivatives and Hedging in our accompanying condensed consolidated financial statements).

Other Expense, net

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The following table presents other expense, net (in thousands): 

	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2023		2022		2023		2022
Foreign exchange losses, net	$	(3,010)	$	(2,072)	(3,349)		(4,587)
Loss on disposition of assets	(446)		$	(1,366)	(973)		(2,321)
Other miscellaneous (expense) income, net	(588)		406		(1,493)		2,925
Other expense, net	$	(4,044)	$	(3,032)	$	(5,815)	$	(3,983)

Income Taxes

    For the three and nine months ended September 30, 2023, income taxes were accrued at an estimated effective tax rate of 235% and 70%, respectively, as compared to 38% and 37% for the three and nine months ended September 30, 2022, respectively.

The effective tax rate for the three and nine months ended September 30, 2023 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, foreign-derived intangible income (“FDII”) and tax credits. The effective tax rate for both the three and nine months ended September 30, 2023 included a tax benefit of $0.0 million and $6.0 million, respectively, primarily related to unrecognized tax benefits released as a result of the expiration of the statute of limitations. The effective tax rate during the three and nine months ended September 30, 2023 also included a tax benefit of $0.6 million and $0.8 million, respectively, related to the excess tax benefits recognized on stock option exercises and the vesting of restricted stock during the period. Additionally, the effective tax rate for both the three and nine months ended September 30, 2023 included a tax benefit of $7.5 million related to U.S. federal return-to-provision adjustments net of related tax reserves. The adjustments related to primarily to changes in estimates for the research and development credit and foreign tax credits. Additionally, the effective tax rate for the three and nine months ended September 30, 2023 also included the nil tax impact of the revaluation of contingent consideration for $15.6 million and $12.3 million, respectively.

    The effective tax rate for the three and nine months ended September 30, 2022 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, FDII and tax credits. The effective tax rate during the three and nine months ended September 30, 2022 included a discrete tax benefit of $1.5 million and $4.1 million, respectively, related to excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period. The revaluation of the contingent consideration during the three and nine months ended September 30, 2022 of $4.1 million and $31.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

Liquidity and Capital Resources

We regularly evaluate our liquidity and capital resources, including our access to external capital, to assess our ability to meet our principal cash requirements, which include working capital requirements, planned capital investments in our business, commitments, acquisition restructuring and integration expenses, investments in quality systems and quality compliance objectives, payment of interest expense, repayment of outstanding borrowings, income tax obligations and acquisition opportunities in accordance with our growth strategy.

Sources of Liquidity

Our primary sources of liquidity are cash and cash equivalents, our short-term investment portfolio, cash flows from our operations and access to borrowing arrangements.

Funds generated from operations are held in cash and cash equivalents and investment securities. During the nine months ended September 30, 2023, our cash and cash equivalents and short-term investment securities decreased by $14.0 million from $213.0 million at December 31, 2022 to $199.0 million at September 30, 2023. This decrease was driven by a decrease in our accounts payable balances, capital expenditures, principal payments on our long-term debt and the related interest payments. Our short-term investment portfolio currently consists of investment-grade corporate and federal treasury bonds and is primarily intended to facilitate capital preservation.

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2022 Credit Agreement and Access to Capital

As discussed in Note 17: Long-Term Debt to our accompanying condensed consolidated financial statements, we entered into the Credit Agreement with various lenders on January 6, 2022 in connection with the closing of the Smiths Medical acquisition. The Credit Agreement provides for a five-year term loan A facility of $850.0 million (the "Term Loan A"), a seven-year term loan B facility of $850.0 million (the "Term Loan B") and a five-year revolving credit facility of $500.0 million (the "Revolving Credit Facility") (collectively, the "Senior Secured Credit Facilities"). The proceeds from the term loans were used to finance a portion of the cash consideration for the Smiths Medical acquisition. The outstanding aggregate principal amount of the term loans is $1.7 billion as of September 30, 2023, which includes the Term Loan A that will mature in January 2027 and the Term Loan B that will mature in January 2029. The proceeds of future borrowings under the Revolving Credit Facility, which expires in January 2027, may be used as a source of liquidity to support our ongoing working capital requirements and other general corporate purposes. There are no outstanding borrowings under the Revolving Credit Facility as of September 30, 2023. As part of entering into the Senior Secured Credit Facilities, we were assigned issuer and Term Loan B credit ratings. At the date of issuance of this report, our issuer and Term Loan B credit ratings assigned and outlook were as follows:

	Issuer/Term Loan B Credit Ratings	Outlook
Moody's	Ba3/Ba3	Stable
Fitch	BB/BB+	Stable
Standard & Poor's	BB-/BB-	Negative

The Credit Agreement contains financial covenants that pertain to the Term Loan A and the Revolving Credit Facility. Specifically, we are required to maintain a Senior Secured Leverage Ratio of no more than 4.50 to 1.00 until June 30, 2024, with stepdowns to 4.00 to 1.00 thereafter, and an Interest Coverage Ratio of no less than 3.00 to 1.00 (defined and discussed in greater detail in Note 17: Long-Term Debt to our accompanying condensed consolidated financial statements). We were in compliance with these financial covenants as of September 30, 2023.

We believe that our existing cash and cash equivalents along with cash flows expected to be generated from future operations including the cash received from our uncommitted trade accounts receivable purchase facility and the funds received and accessible under the Senior Secured Credit Facilities will provide us with sufficient liquidity to finance our cash requirements for the next twelve months. In the event that we experience downturns, cyclical fluctuations in our business that are more severe or longer than anticipated, fail to achieve anticipated revenue and expense levels, or have significant unplanned cash expenditures, we may need to obtain or seek alternative sources of capital or financing, and we can provide no assurances that the terms of such capital or financing will be available to us on favorable terms, if at all. Our ability to generate cash flows from operations, issue debt or enter into other financing arrangements on acceptable terms could be adversely affected if there is a material decline in the demand for our products or in the solvency of our customers or suppliers, deterioration in our key financial ratios or credit ratings or other significantly unfavorable changes in economic conditions. See Part I. Item 1A. "Risk Factors” in our 2022 Annual Report on Form 10-K for discussion of the risks and uncertainties associated with our debt financing.

Uses of Liquidity

Capital Expenditures

At September 30, 2023, we estimate that our capital expenditures in 2023 will be in the range of $75 million to $85 million.

Contractual Obligations

Our principal commitments at September 30, 2023 include both short and long-term future obligations.

Operating Leases

We have non-cancelable operating lease agreements where we are contractually obligated for certain lease payment amounts. We assumed additional operating leases as a result of our acquisition of Smiths Medical. For more information

51

regarding our operating lease obligations, (see Note 6: Leases to our accompanying condensed consolidated financial statements).

Long-term Debt

In January 2022, we incurred borrowings under Senior Secured Credit Facilities. The principal repayment obligations and estimated interest payments on the term loans and estimated commitment fee payments on the revolver are estimated in the table below. Interest payments on the term loans were estimated using an Adjusted Term SOFR rate and an initial applicable margin of 1.75% for Term Loan A and 2.50% for Term Loan B and the revolver commitment fees were estimated using the initial rate of 0.25%. The applicable margin rate and commitment fee rate will change from time to time in accordance with a preset pricing grid based on the leverage ratio (see Note 17: Long-Term Debt to our accompanying condensed consolidated financial statements for pricing grids related to the Senior Secured Credit Facilities). We expect to fund these obligations with our existing cash and cash equivalents and cash generated from our future operations.

	(in millions)
	Remainder of 2023		2024		2025		2026		2027		2028		Thereafter
Term Loan A Principal Payments	$	5.3	$	42.5	$	42.5	$	63.8	$	664.1	$	—	$	—
Term Loan A Interest Payments	15.6		59.6		49.5		43.5		—		0		0
Term Loan B Principal Payments	2.1		8.5		8.5		8.5		8.5		8.5		792.6
Term Loan B Interest Payments	17.0		66.4		58.2		54.5		54.4		54.0		0
Revolver Commitment Fee	0.4		1.5		1.5		1.5		—		0		0
	$	40.4	$	178.5	$	160.2	$	171.8	$	727.0	$	62.5	$	792.6

Other Future Capital Investments

At September 30, 2023, there have been no material changes to our estimate for restructuring and integration expenses along with spending to support quality systems and quality compliance objectives, as previously disclosed in our 2022 Annual Report on Form 10-K.

Indemnifications

In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters related to sales of our products. There is no maximum limit on the indemnification that may be required under these agreements. Although we can provide no assurances, we have never incurred, nor do we expect to incur, any liability for indemnification.

Historical Cash Flows

Cash Flows from Operating Activities

Our net cash provided by operations for the nine months ended September 30, 2023 was $74.9 million. The changes in operating assets and liabilities included a $66.7 million increase in inventories, a $18.9 million increase in other assets, a $65.0 million decrease in accounts payable, $42.9 million in net changes in income taxes, including excess tax benefits and deferred income taxes and a $10.5 million decrease in accrued liabilities. Offsetting these amounts was a $43.1 million decrease in accounts receivable and a $11.3 million decrease in prepaid expenses and other current assets. The increase in inventory was primarily to build inventory safety stock levels. The increase in other assets was due to the purchase of spare parts. The decrease in accounts payable was due to the timing of payments. The net changes in income taxes was a result of recording the current deferred provision and the timing of payments. The increase in accrued liabilities was primarily due to employee costs. The decrease in accounts receivable was primarily due to the sale of accounts receivable as part of our accounts receivable purchase program with Bank of the West (see Note 21: Accounts Receivable Purchase Program). The decrease in prepaid expenses and other current assets was primarily due to insurance and property taxes.

52

Our net cash used in operations for the nine months ended September 30, 2022 was $60.4 million. The changes in operating assets and liabilities included a $151.8 million increase in inventories, a $22.6 million increase in other assets, a $38.1 million decrease in accrued liabilities, $63.0 million in net changes in income taxes, including excess tax benefits and deferred income taxes and a $9.0 million increase in accounts receivable. Offsetting these amounts was a $20.1 million decrease in prepaid expenses and other current assets and a $30.4 million increase in accounts payable. The increase in inventory was primarily to build inventory safety stock levels. The increase in other assets was due to the purchase of spare parts and the capitalization of debt issuance costs allocated to the revolving credit facility. The decrease in accrued liabilities was primarily due to the payout of annual bonuses. The net changes in income taxes was a result of recording the current deferred provision and the timing of payments. The increase in accounts receivable was primarily due to the net impact of collection efforts and the timing of revenue. The net decrease in prepaid expenses and other current assets was primarily due to a decrease in deferred costs mostly offset by capitalized debt issuance costs allocated to the revolving credit facility. The increase in accounts payable was due to the timing of payments.

Cash Flows from Investing Activities

    The following table summarizes the changes in our investing cash flows (in thousands):

	Nine months ended September 30,
	2023		2022		Change
Investing Cash Flows:
Purchases of property, plant and equipment	$	(53,956)	$	(68,715)	$	14,759	(1)
Proceeds from sale of assets	1,481		933		548
Business acquisitions, net of cash acquired	—		(1,844,164)		1,844,164		(2)
Intangible asset additions	(7,742)		(6,560)		(1,182)
Purchases of investment securities	—		(3,397)		3,397		(3)
Proceeds from sale of investment securities	2,920		36,433		(33,513)		(4)
Net cash used in investing activities	$	(57,297)	$	(1,885,470)	$	1,828,173

_______________________________

(1) Our purchases of property, plant and equipment will also vary from period to period based on additional investments needed to support new and existing products and expansion of our manufacturing facilities.

(2) Our business acquisitions will vary from period to period based upon our current growth strategy and our ability to execute on desirable target companies. On January 6, 2022, we completed the acquisition of Smiths Medical. The cash consideration for the transaction was $1.9 billion, which was financed with existing cash balances and borrowings under the Credit Agreement. Acquired cash was $78.8 million.

(3)    Our purchases of investment securities will vary from period to period based on current cash needs, planning for known future transactions and changes in our investment strategy.

(4)    Proceeds from the sale of our investment securities will vary from period to period based on the maturity dates of the investments.

Cash Flows from Financing Activities

    The following table summarizes the changes in our financing cash flows (in thousands):    

53

	Nine months ended September 30,
	2023		2022		Change
Financing Cash Flows:
Proceeds from issuance of long-term debt, net of lender debt issuance costs	$	—	$	1,672,631	$	(1,672,631)	(1)
Principal payments on long-term debt	(22,250)		(20,250)		(2,000)		(2)
Payment of third-party debt issuance costs	—		(1,852)		1,852		(3)
Proceeds from exercise of stock options	4,022		7,906		(3,884)		(4)
Payments on finance leases	(681)		(477)		(204)
Tax withholding payments related to net share settlement of equity awards	(9,221)		(10,541)		1,320		(5)
Net cash (used in) provided by financing activities	$	(28,130)	$	1,647,417	$	(1,675,547)

_______________________________

(1)    In January 2022, we borrowed an aggregate of $1.7 billion under the Senior Secured Credit Facilities to partially finance our acquisition of Smiths Medical (see Note 17: Long-Term Debt to our accompanying condensed consolidated financial statements for additional information). The proceeds were net of $27.3 million in payments of lender debt issuance costs.

(2)    Relates to scheduled principal payments on the Senior Secured Credit Facilities.

(3)    Relates to third-party debt issuance costs in connection with entering into the Senior Secured Credit Facilities.

(4)    Proceeds from the exercise of stock options will vary from period to period based on the volume of options exercised and the exercise price of the specific options exercised.

(5) During the nine months ended September 30, 2023, our employees surrendered 58,089 shares of our common stock from vested restricted stock unit awards as consideration for approximately $9.2 million in minimum statutory withholding obligations paid on their behalf. During the nine months ended September 30, 2022, our employees surrendered 45,370 shares of our common stock from vested restricted stock unit awards as consideration for approximately $10.5 million in minimum statutory withholding obligations paid on their behalf.

Our common stock purchase plan, which authorized the repurchase of up to $100.0 million of our common stock, was approved by our Board of Directors in August 2019. This plan has no expiration date. As of September 30, 2023, all of the $100.0 million available for purchase was remaining under the plan.

Critical Accounting Policies

In our 2022 Annual Report on Form 10-K, we identified the critical accounting policies which affect our more significant estimates and assumptions used in preparing our consolidated financial statements. There have been no material changes to our critical accounting policies from those previously disclosed in our 2022 Annual Report on Form 10-K.

New Accounting Pronouncements

See Note 2: New Accounting Pronouncements in Part I, Item 1. "Financial Statements."

Item 3.Quantitative and Qualitative Disclosures about Market Risk

Interest Rate Risk    

Credit Facility

    In connection with the Smiths Medical acquisition on January 6, 2022 we entered into the Senior Secured Credit Facilities totaling approximately $2.2 billion consisting of a variable-rate term loan A facility of $850.0 million, a variable-rate term loan B facility of $850.0 million and a revolving credit facility of $500.0 million. We are exposed to changes in interest rates on all of these variable-rate debt instruments.

54

The term loan A facility currently bears interest based on Adjusted Term SOFR plus an initial applicable margin of 1.75% per year. The term loan B facility currently bears interest based on Adjusted Term SOFR subject to a 0.50% floor plus an initial applicable margin of 2.5%. We used a sensitivity analysis to measure our interest rate risk exposure. If the SOFR rate increases or decreases 1% from September 30, 2023, the additional annual interest expense or savings related to the term loans would amount to approximately $16.6 million.

In order to mitigate and offset a portion of this interest rate risk exposure associated with these debt instruments we entered into interest rate swaps to achieve a targeted mix of fixed and variable-rate debt. The term loan A swap has an initial notional amount of $300.0 million, reducing to $150.0 million evenly on a quarterly basis excluding its final maturity on March 30, 2027 and we will pay a fixed rate of 1.32% and will receive the greater of 3-month USD SOFR or (0.15)%. The term loan B swap has an initial notional amount of $750.0 million, reducing to $46.9 million evenly on a quarterly basis excluding its final maturity on March 30, 2026 and we will pay a fixed rate of 1.17% and will receive the greater of 3-month USD SOFR or 0.35%. In June 2023, we entered into an additional swap with a notional amount of $300 million with a maturity date of June 30, 2028 and we will pay a fixed rate of 3.8765% starting on June 30, 2023 and receive 3-month USD SOFR. See Note 8: Derivatives and Hedging Activities to the condensed consolidated financial statements in Part I, Item 1 of this Form 10-Q.

Accounts Receivable Purchase Program

Additionally, our accounts receivable purchase program with Bank of the West bears discount rates tied to SOFR. These variable discount rates would affect the amount of factoring costs we incur, and the amount of cash we receive upon the sales of accounts receivable under this program. A 1% increase in SOFR rates on the accounts receivable sales would not have a material impact on our results of operations.

Foreign Currency Exchange Rate Risk    

    We transact business globally in multiple currencies, some of which are considered volatile. Our international revenues and expenses and working capital positions denominated in these foreign currencies expose us to the risk of fluctuations in foreign currency exchange rates against the U.S. dollar. As the receiver of foreign currencies we are adversely affected by the strengthening of the U.S. dollar and other currencies relative to the operating unit functional currency. Our hedging policy attempts to manage these risks to an acceptable level. We manage our foreign currency exposures on a consolidated basis to take advantage of net exposures and natural offsets, which are then further reduced by the gains and losses of our hedging instruments. Gains and losses on the hedging instruments offset gains and losses on the hedged forecasted transactions and reduce the earnings volatility related to foreign exchange, however we do not hedge our entire foreign exchange exposure and are still subject to earnings volatility due to foreign currency exchange rate risk.

Our foreign currency exchange forward contracts hedge a portion of our forecasted foreign currency-denominated revenues and expenses (principally Mexican Pesos, Euros, Japanese Yen, U.S. Dollar, Chinese Renminbi, Canadian Dollar, and Australian Dollar) that differ from the functional currency of the operating unit. These derivative contracts are designated and qualify as cash flow hedges (see Note 8: Derivatives and Hedging Activities to the condensed consolidated financial statements in Part I, Item 1 of this Quarterly Report on Form 10-Q). We performed a sensitivity analysis to estimate changes in the fair value of our foreign exchange derivatives due to potential changes in near-term foreign currency exchange rates. At September 30, 2023, the effect of a hypothetical 10% weakening in the actual foreign currency exchange rates used for the applicable currencies would result in an estimated decrease in the fair value of these outstanding derivative contracts by approximately $2.6 million.

Item 4.Controls and Procedures

Limitations on Effectiveness of Controls and Procedures

In designing and evaluating our disclosure controls and procedures, management recognizes that any controls

and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the

desired control objectives. In addition, the design of disclosure controls and procedures must reflect the fact that there

are resource constraints, and that management is required to apply judgment in evaluating the benefits of possible

controls and procedures relative to their costs

Evaluation of Disclosure Controls and Procedures

55

Our management, with the participation of our principal executive officer and principal financial officer, has evaluated the effectiveness of our disclosure controls and procedures (as such term is defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the "Exchange Act")), as of the end of the period covered by this Quarterly Report. Based on the evaluation, our principal executive officer and principal financial officer concluded that, as of September 30, 2023, our disclosure controls and procedures were effective at the reasonable assurance level.

Changes in Internal Control Over Financial Reporting

There was no change in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the quarter ended September 30, 2023 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

PART II - OTHER INFORMATION

Item 1.Legal Proceedings

    Certain legal proceedings in which we are involved are discussed in Part I, Item 1. "Financial Statements" of this Form 10-Q in Note 19. Commitments and Contingencies to the Condensed Consolidated Financial Statements, and is incorporated herein by reference.

Item 1A.Risk Factors

    In evaluating an investment in our common stock, investors should consider carefully, among other things, the risk factors previously disclosed in Part I, Item 1A of our 2022 Annual Report on Form 10-K, as well as the information contained in this Quarterly Report, in each case as updated by our periodic reports and registration statements filed with the SEC. There have been no material changes to the risk factors disclosed in Part I. Item 1A of our 2022 Annual Report on Form 10-K.

Item 2.Unregistered Sales of Equity Securities, Use of Proceeds, and Issuer Purchases of Equity Securities

Purchase of Equity Securities

    The following is a summary of our stock repurchasing activity during the third quarter of 2023:

Period	Total number of shares purchased	Average price paid per share		Total number of shares purchased as part of a publicly announced program	Approximate dollar value that may yet be purchased under the program(1)
07/01/2023 — 07/31/2023	—	$	—	—	$	100,000,000
08/01/2023 — 08/31/2023	—	$	—	—	$	100,000,000
09/01/2023 — 09/30/2023	—	$	—	—	$	100,000,000
Third quarter of 2023 total	—	$	—	—	$	100,000,000

____________________________

(1)    Our common stock purchase plan, which authorized the repurchase of up to $100.0 million of our common stock, was authorized by our Board of Directors and publicly announced in August, 2019. This plan has no expiration date. We are not obligated to make any purchases under our stock purchase program. Subject to applicable state and federal corporate and securities laws and any restrictions on share purchases under our debt agreements, purchases under a stock purchase program may be made at such times and in such amounts as we deem appropriate. Purchases made under our stock purchase program can be discontinued at any time we feel additional purchases are not warranted.

Item 5. Other Information

(a)    None

(b)    None

56

(c)    

The following table shows any “Rule 10b5-1 trading arrangement” or “non-Rule 10b5-1 trading arrangement,” each as defined in Item 408(a) of Regulation S-K, adopted, modified, or terminated by our directors or "officers" (as defined in Rule 16a-1(f) under the Exchange Act) during the three months ended September 30, 2023. In accordance with our insider trading policy, the trading arrangement shown below was adopted during an open trading window.

Name/Title	Action	Type of Plan	Adoption Date	End Date	Aggregate Number of Securities to be Sold	Plan Description
Virginia Sanzone / CVP, General Counsel	Adopt	Rule 10b5-1 trading plan	August 14, 2023	August 14, 2024	2,050	Sale of shares
Vivek Jain, Chief Executive Officer	Terminated	Rule 10b5-1 trading plan	March 15, 2023	February 9, 2024	206,366	Exercise and sale of options

Other than as disclosed above, no other officer (as defined in Rule 16a-1(f) under the Exchange Act) or director of the Company adopted, modified, or terminated a "Rule 10b5-1 trading arrangement" or “non-Rule 10b5-1 trading arrangement,” each as defined in Item 408(a) of Regulation S-K.

Item 6. Exhibits

Exhibit Index

Exhibit 31.1	Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
Exhibit 31.2	Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
Exhibit 32.1	Certifications of Chief Executive Officer and Chief Financial Officer pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
Exhibit 101.INS	XBRL Instance Document - this instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
Exhibit 101.SCH	XBRL Taxonomy Extension Schema Document
Exhibit 101.CAL	XBRL Taxonomy Extension Calculation Linkbase Document
Exhibit 101.DEF	XBRL Taxonomy Extension Definition Linkbase Document
Exhibit 101.LAB	XBRL Taxonomy Extension Label Linkbase Document
Exhibit 101.PRE	XBRL Taxonomy Extension Presentation Linkbase Document
Exhibit 104	Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)

57

Signature

Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

ICU Medical, Inc.

(Registrant)
/s/ Brian M. Bonnell	Date:	November 6, 2023
Brian M. Bonnell
Chief Financial Officer
(Principal Financial Officer and Authorized Officer)

58

EX-31.1

Exhibit 31.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Vivek Jain, certify that:

1.I have reviewed this quarterly report on Form 10-Q of ICU Medical, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b)Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c)Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d)Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5.The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	November 6, 2023	/s/ Vivek Jain
		Chief Executive Officer

EX-31.2

Exhibit 31.2

CERTIFICATION OF CHIEF FINANCIAL OFFICER PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Brian M. Bonnell, certify that:

1.I have reviewed this quarterly report on Form 10-Q of ICU Medical, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b)Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c)Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d)Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date:	November 6, 2023	/s/ Brian M. Bonnell
		Chief Financial Officer

EX-32.1

Exhibit 32.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of ICU Medical, Inc. (the “Company”) on Form 10-Q for the period ended September 30, 2023 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Vivek Jain, Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:

(1)the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

(2)the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

November 6, 2023	/s/ Vivek Jain
Date	Vivek Jain
	Chief Executive Officer
	(principal executive officer)

CERTIFICATION OF CHIEF FINANCIAL OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of ICU Medical, Inc. (the “Company”) on Form 10-Q for the period ended September 30, 2023 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Brian M. Bonnell, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:

(1)the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

(2)the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

November 6, 2023	/s/ Brian M. Bonnell
Date	Brian M. Bonnell
	Chief Financial Officer
	(principal financial officer)

XML

DEI Document - shares	9 Months Ended
	Sep. 30, 2023	Oct. 31, 2023
Document And Entity Information [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-34634
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	33-0022692
Entity Address, Address Line One	951 Calle Amanecer
Entity Address, City or Town	San Clemente
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92673
City Area Code	949
Local Phone Number	366-2183
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Title of 12(b) Security	Common stock, par value $0.10 per share
Trading Symbol	ICUI
Security Exchange Name	NASDAQ
Entity Common Stock, Shares Outstanding		24,140,076
Entity Central Index Key	0000883984
Entity Registrant Name	ICU MEDICAL INC/DE
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3

XML

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
CURRENT ASSETS:
Cash and Cash Equivalents	$ 197,192	$ 208,784	[1]
Short-term investment securities	1,806	4,224	[1]
TOTAL CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENT SECURITIES	198,998	213,008	[1]
Accounts receivable, net of allowance for doubtful accounts	161,797	221,719	[1]
Inventories	759,622	696,009	[1]
Prepaid income taxes	14,579	15,528	[1]
Prepaid expenses and other current assets	84,412	88,932	[1]
TOTAL CURRENT ASSETS	1,219,408	1,235,196	[1]
PROPERTY, PLANT AND EQUIPMENT, net	608,762	636,113	[1]
Operating Lease Right-of-Use Asset	73,767	74,864	[1]
Long-term investment securities	0	516
GOODWILL	1,444,456	1,449,258	[1]
INTANGIBLE ASSETS, net	891,280	982,766	[1]
Deferred Income Taxes	31,466	31,466
OTHER ASSETS	107,725	105,462	[1]
TOTAL ASSETS	4,376,864	4,515,641	[1]
CURRENT LIABILITIES:
Accounts payable	149,288	215,902	[1]
Accrued liabilities	251,324	242,769	[1]
Current portion of long-term debt	45,688	29,688
Income tax payable	11,443	6,200	[1]
Contingent earn-out liability	6,300	0
TOTAL CURRENT LIABILITIES	464,043	494,559	[1]
Contingent Earn-Out Liability	7,061	25,572	[1]
Long-term Debt	1,589,244	1,623,675
Other long-term liabilities	100,005	114,104
DEFERRED INCOME TAXES	77,845	126,007	[1]
INCOME TAX LIABILITY	40,310	41,796	[1]
COMMITMENTS AND CONTINGENCIES	0	0	[1]
STOCKHOLDERS' EQUITY:
Convertible preferred stock, $1.00 par value Authorized-500 shares; Issued and outstanding - none	0	0	[1]
Common stock, $0.10 par value - Authorized-80,000 shares	2,414	2,399	[1]
Additional paid-in capital	1,356,348	1,331,249	[1]
Treasury Stock, at cost	(672)	(243)	[1]
Retained earnings	824,993	837,501	[1]
Accumulated other comprehensive loss	(84,727)	(80,978)	[1]
TOTAL STOCKHOLDERS' EQUITY	2,098,356	2,089,928	[1]
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY	$ 4,376,864	$ 4,515,641	[1]

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

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Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts Receivable, Allowance for Credit Loss	$ 10,556	$ 8,530
Convertible preferred stock, par value	$ 1.00
Convertible preferred stock, authorized shares	500,000
Convertible preferred stock, issued shares	0	0
Convertible preferred stock, outstanding shares	0	0
Common stock, par value	$ 0.10
Common stock, shares authorized	80,000,000
Common stock, shares issued	24,144,000	23,995,000
Common stock, shares outstanding	24,139,000	23,993,000
Treasury Stock, Common, Shares	4,638	1,633

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Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
REVENUES:
TOTAL REVENUES	$ 553,311	$ 597,857	$ 1,671,270	$ 1,701,983
Cost of goods sold	369,391	411,461	1,102,982	1,179,167
Gross Profit	183,920	186,396	568,288	522,816
OPERATING EXPENSES:
Selling, general and administrative	148,609	153,452	452,076	465,412
Research and development	20,870	23,105	62,933	69,538
Restructuring, strategic transaction and integration	7,160	14,365	30,527	61,795
Change in fair value of contingent earn-out	(15,572)	(4,059)	(12,256)	(31,253)
TOTAL OPERATING EXPENSES	161,067	186,863	533,280	565,492
INCOME (LOSS) FROM OPERATIONS	22,853	(467)	35,008	(42,676)
Interest Expense,net	(24,175)	(17,808)	(70,811)	(46,303)
OTHER EXPENSE, net	(4,044)	(3,032)	(5,815)	(3,983)
Loss Before Income Taxes	(5,366)	(21,307)	(41,618)	(92,962)
BENEFIT FOR INCOME TAXES	12,604	8,099	29,110	34,212
NET LOSS	$ 7,238	$ (13,208)	$ (12,508)	$ (58,750)
NET LOSS PER SHARE
Basic (in dollars per share)	$ 0.30	$ (0.55)	$ (0.52)	$ (2.47)
Diluted (in dollars per share)	$ 0.30	$ (0.55)	$ (0.52)	$ (2.47)
WEIGHTED AVERAGE NUMBER OF SHARES
Basic (in shares)	24,132	23,908	24,075	23,828
Diluted (in shares)	24,368	23,908	24,075	23,828

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Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Net (Loss) Income	$ 7,238	$ (13,208)	$ (12,508)	$ (58,750)
Other comprehensive income (loss), net of tax
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification and Tax	1,659	16,915	1,356	48,631
Foreign currency translation adjustment, net of taxes of $0 for all periods	(37,557)	(90,549)	(5,005)	(195,300)
Other Comprehensive Income (Loss), Other Adjustments, after Tax	(35)	227	(100)	256
Other comprehensive income (loss), net of taxes	(35,933)	(73,407)	(3,749)	(146,413)
Comprehensive Income	$ (28,695)	$ (86,615)	$ (16,257)	$ (205,163)

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Condensed Consolidated Statements of Comprehensive Income (Paranthetical) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), after Reclassification, Tax	$ (514)	$ (3,676)	$ (457)	$ (15,357)
Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Tax	0	0	0	0
Other Comprehensive (Income) Loss, Defined Benefit Plan, after Reclassification Adjustment, Tax	$ 0	$ 0	$ 0	$ 0

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Condensed Consolidated Statements of Stockholders' Equity Statement - USD ($) $ in Thousands	Total	Common Stock Shares [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Treasury Stock, Common	Retained Earnings [Member]	AOCI Attributable to Parent [Member]
Common Stock, Shares, Issued at Dec. 31, 2021		21,280,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		154,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(37,000)
Stock Issued During Period, Shares, Acquisitions		2,500,000
Common Stock, Shares, Issued at Mar. 31, 2022		23,897,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2021	$ 1,616,031		$ 2,128	$ 721,412	$ (27)	$ 911,787	$ (19,269)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	2,974		12	(2,965)	5,927
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(8,743)				(8,743)
Stock Issued During Period, Value, Acquisitions	575,975		250	575,725
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	12,092			12,092
Other Comprehensive income (loss), net of Tax	18,641						18,641
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	18,641
Net Income Attributable to Parent	(38,068)					(38,068)
Stockholders' Equity Attributable to Parent at Mar. 31, 2022	$ 2,178,902		2,390	1,306,264	(2,843)	873,719	(628)
Common Stock, Shares, Issued at Dec. 31, 2021		21,280,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(45,370)
Common Stock, Shares, Issued at Sep. 30, 2022		23,979,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2021	$ 1,616,031		2,128	721,412	(27)	911,787	(19,269)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	(146,413)
Stockholders' Equity Attributable to Parent at Sep. 30, 2022	2,012,805		2,398	1,323,178	(126)	853,037	(165,682)
Common Stock, Shares, Issued at Mar. 31, 2022		23,897,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		10,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(8,000)
Common Stock, Shares, Issued at Jun. 30, 2022		23,899,000
Stockholders' Equity Attributable to Parent at Mar. 31, 2022	2,178,902		2,390	1,306,264	(2,843)	873,719	(628)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	18		0	(4,428)	4,446
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(1,695)				(1,695)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	7,762			7,762
Other Comprehensive income (loss), net of Tax	(91,647)						(91,647)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(91,647)
Net Income Attributable to Parent	(7,474)					(7,474)
Stockholders' Equity Attributable to Parent at Jun. 30, 2022	2,085,866		2,390	1,309,598	(92)	866,245	(92,275)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		82,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(2,000)
Common Stock, Shares, Issued at Sep. 30, 2022		23,979,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	4,914		8	4,837	69
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(103)				(103)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	8,743			8,743
Other Comprehensive income (loss), net of Tax	(73,407)						(73,407)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(73,407)
Net Income Attributable to Parent	(13,208)					(13,208)
Stockholders' Equity Attributable to Parent at Sep. 30, 2022	$ 2,012,805		2,398	1,323,178	(126)	853,037	(165,682)
Common Stock, Shares, Issued at Dec. 31, 2022	23,995,000	23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		172,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(53,000)
Common Stock, Shares, Issued at Mar. 31, 2023		24,114,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2022	$ 2,089,928		2,399	1,331,249	(243)	837,501	(80,978)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	171		12	(503)	662
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(8,425)				(8,425)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	9,158			9,158
Adjustments to Additional Paid in Capital, Other				4
Other Comprehensive income (loss), net of Tax	19,375						19,375
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	19,379
Net Income Attributable to Parent	(9,812)					(9,812)
Stockholders' Equity Attributable to Parent at Mar. 31, 2023	$ 2,100,399		2,411	1,339,908	(8,006)	827,689	(61,603)
Common Stock, Shares, Issued at Dec. 31, 2022	23,995,000	23,995,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation	(58,089)
Common Stock, Shares, Issued at Sep. 30, 2023	24,144,000	24,144,000
Stockholders' Equity Attributable to Parent at Dec. 31, 2022	$ 2,089,928		2,399	1,331,249	(243)	837,501	(80,978)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other Comprehensive income (loss), net of Tax	(3,749)
Stockholders' Equity Attributable to Parent at Sep. 30, 2023	2,098,356		2,414	1,356,348	(672)	824,993	(84,727)
Common Stock, Shares, Issued at Mar. 31, 2023		24,114,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		2,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(2,000)
Common Stock, Shares, Issued at Jun. 30, 2023		24,114,000
Stockholders' Equity Attributable to Parent at Mar. 31, 2023	2,100,399		2,411	1,339,908	(8,006)	827,689	(61,603)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	2,062		0	(4,626)	6,688
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(293)				(293)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	9,773			9,773
Adjustments to Additional Paid in Capital, Other				2
Other Comprehensive income (loss), net of Tax	12,809						12,809
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	12,811
Net Income Attributable to Parent	(9,934)					(9,934)
Stockholders' Equity Attributable to Parent at Jun. 30, 2023	$ 2,114,818		2,411	1,345,057	(1,611)	817,755	(48,794)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Shares, New Issues		34,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation		(4,000)
Common Stock, Shares, Issued at Sep. 30, 2023	24,144,000	24,144,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock Issued During Period, Value, New Issues	$ 1,789		3	344	1,442
Share-based Payment Arrangement, Decrease for Tax Withholding Obligation	(503)				(503)
APIC, Share-based Payment Arrangement, Increase for Cost Recognition	10,947			10,947
Adjustments to Additional Paid in Capital, Other				0
Other Comprehensive income (loss), net of Tax	(35,933)						(35,933)
Other Comprehensive (Loss) Income, Foreign Currency Transaction and Translation Gain (Loss) Arising During Period, Net of Tax	(35,933)
Net Income Attributable to Parent	7,238					7,238
Stockholders' Equity Attributable to Parent at Sep. 30, 2023	$ 2,098,356		$ 2,414	$ 1,356,348	$ (672)	$ 824,993	$ (84,727)

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Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
CASH FLOWS FROM OPERATING ACTIVITIES:
Net (Loss) Income	$ (12,508)	$ (58,750)
Depreciation and amortization	171,615	178,338
Amortization of Inventory Step-up	0	22,676
Noncash lease expense	16,543	17,382
Provision for doubtful accounts	865	214
Provision for warranty and returns	5,597	3,439
Stock compensation	29,878	28,597
Loss on disposal of property and equipment	1,757	2,391
Bond premium amortization	14	254
Debt Issuance Costs amortization	5,108	5,254
Change in fair value of contingent earn-out	(12,256)	(31,253)
Sparepartsusage	13,587	7,915
Other Noncash Income (Expense)	4,393	(2,855)
Accounts receivable	43,086	(8,956)
Inventories	(66,662)	(151,840)
Prepaid expenses and other assets	11,295	20,074
Increase (Decrease) in Other Operating Assets	(18,860)	(22,594)
Accounts payable	(65,049)	30,413
Accrued liabilities	(10,532)	(38,070)
Income taxes, including excess tax benefits and deferred income taxes	(42,939)	(63,047)
Net cash provided by operating activities	74,932	(60,418)
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment	(53,956)	(68,715)
Proceeds from sale of asset	1,481	933
Intangible assets additions	(7,742)	(6,560)
Purchases of investment securities	0	(3,397)
Proceeds from sale of investment securities	2,920	36,433
Net cash used in investing activities	(57,297)	(1,885,470)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of long-term debt, net of lender debt issuance costs	0	1,672,631
Repayments of Long-term Debt	22,250	20,250
Payments of Debt Issuance Costs	0	(1,852)
Proceeds from exercise of stock options	4,022	7,906
Finance Lease, Principal Payments	(681)	(477)
Payment, Tax Withholding, Share-based Payment Arrangement	9,221	10,541
Net cash (used in) provided by financing activities	(28,130)	1,647,417
Effect of Exchange Rate on Cash [Abstract]
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Continuing Operations	(1,097)	(10,477)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	(11,592)	(308,948)
Cash and Cash Equivalents	197,192	243,879
Supplemental Cash Flow Information [Abstract]
Capital Expenditures Incurred but Not yet Paid	3,712	2,757
NON-CASH INVESTING ACTIVITIES
Payments to Acquire Businesses, Net of Cash Acquired	0	(1,844,164)
SmithsMedical
CASH FLOWS FROM OPERATING ACTIVITIES:
Net (Loss) Income		79,000
Change in fair value of contingent earn-out	$ 12,300	31,300
NON-CASH INVESTING ACTIVITIES
Fair Value of Assets Acquired		1,658,937
Net Cash Paid (Received) for current and prior acquisitions		(1,844,164)
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable		(575,975)
Business Combination, Liabilities Arising from Contingencies, Amount Recognized		(55,158)
Goodwill, Period Increase (Decrease)		1,442,849
Liabilities Assumed		$ (626,489)

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Basis of Presentation:

9 Months Ended

Sep. 30, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation [Text Block]

Basis of Presentation

The accompanying unaudited interim condensed consolidated financial statements of ICU Medical, Inc., ("ICU" or the "Company"), a Delaware corporation, have been prepared in accordance with accounting principles generally accepted in the United States of America ("U.S.") and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments, consisting of only normal recurring adjustments, which are, in the opinion of management, necessary for a fair statement of the consolidated results for the interim periods presented. Results for the interim period are not necessarily indicative of results for the full year. Certain information and footnote disclosures normally included in annual consolidated financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations. The condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Annual Report on Form 10-K of ICU for the year ended December 31, 2022.

We develop, manufacture and sell innovative medical products used in infusion therapy, vascular access, and vital care applications. ICU's product portfolio includes ambulatory, syringe, and large volume IV pumps and safety software; dedicated and non-dedicated IV sets, needlefree IV connectors, peripheral IV catheters, and sterile IV solutions; closed system transfer devices and pharmacy compounding systems; as well as a range of respiratory, anesthesia, patient monitoring, and temperature management products. We sell the majority of our products through our direct sales force and through independent distributors throughout the U.S. and internationally. We also sell certain products on an original equipment manufacturer basis to other medical device manufacturers. All subsidiaries are wholly owned and are included in the condensed consolidated financial statements. All intercompany balances and transactions have been eliminated.

Certain reclassifications have been made to the prior year financial statements and footnotes to conform to the presentation used in the current year. In the statements of operations we reclassified interest income to interest expense, net from other expense, net and in Note 5: Revenues, certain reclassifications were made to revenues disaggregated by product line and by geography. Also, in Note 9: Fair Value Measurements the table indicating the Level inputs for the assets and liabilities measured at fair value on a recurring basis was updated to correct the Level input identified for the hedge assets and liabilities. These reclassifications had no impact on total revenues, net loss, shareholder's equity or cash flows as previously reported.

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New Accounting Pronouncements:

9 Months Ended

Sep. 30, 2023

Accounting Standards Update and Change in Accounting Principle [Abstract]

New Accounting Pronouncements and Changes in Accounting Principles [Text Block]

New Accounting Pronouncements

Recently Issued Accounting Standards

    In March 2020, the Financial Accounting Standards Board issued ASU No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendments in this update provide optional guidance for a limited period of time to ease the potential burden for reference rate reform on financial reporting. Due to concerns about structural risks of interbank offered rates and, particularly, the risk of cessation of the London Interbank Offered Rate ("LIBOR"), regulators around the world have undertaken reference rate reform initiatives to identify alternative reference rates that are more observable or transaction-based and less susceptible to manipulation. The amendments in this update apply only to contracts, hedging relationships, and other transactions that reference LIBOR or another reference rate expected to be discontinued as a result of reference rate reform. Optional expedients may be applied to contracts that are modified as a result of the reference rate reform. Modifications of contracts within the scope of Topic 470, Debt, should be accounted for by prospectively adjusting the effective interest rate. Modifications of contracts within the scope of ASC 842, Leases, should be accounted for as a continuation of the existing contracts with no reassessments of the lease classification and the discount rate (incremental borrowing rate). Exceptions to Topic 815, Derivatives and Hedging, results in not having a de-designation of a hedging relationship if certain criteria are met. The amendments in this ASU are effective for all entities as of March 12, 2020 through December 31, 2022. ASU No. 2022-06, Reference Rate Reform: Deferral of the Sunset Date of Topic 848 deferred the sunset date to December 31, 2024. In November 2021, we entered into two forward-starting swaps whereby the variable leg of the swap referenced LIBOR. These swaps were amended in early 2022 to transition to an alternative reference rate (see Note 8: Derivatives and Hedging Activities). The amendments in this ASU allow for certain expedients that will allow us to assume that our hedged interest payments are probable of occurring regardless of any expected modification in their terms related to reference rate reform and will allow us to continue hedge accounting for a cash flow hedge for which the hedged interest rate risk changes if the hedge is highly effective under ASC 815, Derivatives and Hedging, or the optional expedient under this ASU is elected. The impact of this ASU on our contracts has not been and is not expected to be material.

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Business Combinations and Asset Acquisitions

9 Months Ended

Sep. 30, 2023

Business Combination and Asset Acquisition [Abstract]

Business Combination Disclosure

Acquisitions

2022 Acquisition

On January 6, 2022, we acquired 100.0% of the equity interests in Smiths Medical, the holding company of Smiths Group plc's global medical device business, from Smiths Group International Holdings Limited (“Smiths”). Consistent with our strategic growth plans, the acquisition of Smiths Medical enabled us to broaden our product offerings to include syringe and ambulatory infusion devices, vascular access, and vital care products and to strengthen and expand our global market reach.

Total cash consideration for the acquisition was $1.9 billion, which was financed with existing cash balances and proceeds from the credit agreement entered into on January 6, 2022 (see Note 17: Long-Term Debt). We also issued share consideration to Smiths of 2.5 million shares of our common stock. The fair value of the common shares issued to Smiths was determined based on the opening market price of our common stock on the acquisition date. Smiths may be entitled to an additional $100.0 million in cash consideration contingent on our common stock achieving certain price targets for certain periods after closing in accordance with the terms of the Share Sale and Purchase Agreement (the "Purchase Agreement"). In the event that (a) on or prior to the third anniversary of closing the 30-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share or (b) on or prior to the fourth anniversary of closing the 45-day volume-weighted average price for our common stock, as defined in the Purchase Agreement, equals or exceeds $300.00 per share (each a "Price Target"), and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved, then Smiths will be entitled to receive the additional $100.0 million in cash consideration. The fair value of the contingent consideration was determined using an option pricing model, specifically the Monte Carlo Simulation. In the analysis, the determinants of payout are simulated in a risk neutral framework over a large number of simulation paths. The fair value of the contingent consideration is then calculated as the average present value across all simulated paths.

Smiths became a related party to us when we issued 2.5 million shares of our common stock as partial consideration for the acquisition of Smiths Medical. Additionally, we entered into a transition services agreement ("TSA") with certain members of Smiths Group, plc. The TSA includes certain information technology, human resource and tax support services for an initial term of twelve months with the option to extend up to 24 months. During the three and nine months ended September 30, 2023, we expensed $0.3 million and $8.3 million, respectively, for services provided under the TSA. As of September 30, 2023, we have no open payables related to the services received under the TSA.

Final Purchase Price Allocation

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets acquired and liabilities assumed (in thousands):

Cash consideration for acquired assets	$	1,922,955
Fair value of contingent consideration payable to Smiths	53,520
Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Smiths	2,500
Price per share (ICU's opening market price on the acquisition date)	$	230.39
Fair value of ICU shares issued to Smiths	$	575,975
Total Consideration	$	2,552,450
Purchase Price Allocation:
Cash and cash equivalents	$	78,791
Accounts receivable	106,132
Inventories	228,919
Prepaid expenses and other current assets	53,554
Property, plant and equipment	206,333
Operating lease right-of-use assets	55,161
Intangible assets(1)	945,000
Other assets	379
Accounts payable	(105,291)
Accrued liabilities(2)	(173,151)
Income tax payable	(40,312)
Other long-term liabilities	(85,490)
Deferred income taxes	(187,455)
Total identifiable net assets acquired	$	1,082,570
Goodwill - not tax deductible	1,469,880
Estimated Purchase Consideration	$	2,552,450

_______________________________

(1)    Identifiable intangible assets include $510.0 million of customer relationships, $400.0 million of developed technology, $30.0 million of internally developed software, and $5.0 million of trademark. The estimated weighted-average amortization period for the total identifiable intangible assets is approximately nine years, and, for each identifiable intangible asset is estimated as follows: eight years for customer relationships, ten years for developed technology, five years for internally developed software, and six months for the trademark.

(2)    Accrued liabilities includes, among other things, accrued warranty reserves, accrued restructuring initiatives, accrued salaries and related benefits, deferred revenue and accrued sales and use taxes.

The identifiable intangible assets and other long-lived assets acquired have been valued utilizing Level 3 inputs as defined in Note 9: Fair Value Measurements. The fair value of identifiable intangible assets was generally developed using the income approach and are based on critical estimates, judgments and assumptions derived from: analysis of market conditions; discount rate; discounted cash flows; royalty rates; customer retention rates; and/or estimated useful lives. Certain other intangible assets were valued using a cost to replace method, estimating the labor and non-labor costs required to replace the asset under the premise that it was not part of the transaction. Property, plant and equipment was valued with the consideration of remaining economic lives. The raw materials inventory was valued at historical cost and adjusted for any obsolescence which we estimate to approximate replacement cost, the work in process inventory was valued at estimated sales proceeds less costs to complete and costs to sell, and finished goods inventory was valued at estimated sales proceeds less costs to sell. The prepaid expenses and other current assets and assumed liabilities were recorded at their carrying values as of the date of the acquisition, as their carrying values approximated their fair values due to their short-term nature.

Unaudited Pro Forma Information

Smiths Medical is included in our consolidated results beginning on January 7, 2022. Total revenues and net loss attributable to Smiths Medical for the period from January 7, 2022 to September 30, 2022 were estimated to be $699.1 million

and $79.0 million, respectively, and for the three months ended September 30, 2022 were estimated to be $261.4 million and $13.6 million, respectively. The following unaudited pro forma financial information presents the combined results of operations of ICU and Smiths Medical as if the acquisition had occurred on January 1, 2021. The pro forma financial information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisition had taken place on the date indicated or of results that may occur in the future.

(In thousands)	Three months ended September 30, 2022		Nine months ended September 30, 2022
Revenues	$	597,857	$	1,722,357
Net Loss	$	(13,208)	$	(54,840)

The unaudited pro forma results presented above include the impact of the following adjustments: incremental amortization expense on intangible assets acquired of $1.9 million for the nine months ended September 30, 2022, incremental interest expense, including amortization of debt discount and debt issuance costs on the Senior Secured Credit Facilities (as defined in Note 17: Long-Term Debt) of $1.4 million for the nine months ended September 30, 2022 and a $27.4 million expense adjustment related to the increase in fair value of inventory to remove the expense for the nine months ended September 30, 2022. The unaudited pro forma results include IFRS to U.S. GAAP adjustments for Smiths Medical's historical results and adjustments for accounting policy alignment, which were materially similar to the Company. Any differences in accounting policies were adjusted to reflect the accounting policies of the Company in the unaudited pro forma results presented.

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Restructuring, Strategic Transaction and Integration (Notes)

9 Months Ended

Sep. 30, 2023

Restructuring and Related Activities [Abstract]

Restructuring and Related Activities Disclosure

Restructuring, Strategic Transaction and Integration

    Restructuring, strategic transaction and integration expenses were $7.2 million and $14.4 million for the three months ended September 30, 2023 and 2022, respectively and $30.5 million and $61.8 million for the nine months ended September 30, 2023 and 2022 respectively.

Restructuring

    During the three and nine months ended September 30, 2023, restructuring charges were $1.1 million and $5.1 million, respectively, as compared to $2.4 million and $7.3 million, respectively, for the three and nine months ended September 30, 2022 and were primarily related to severance costs for all periods. The restructuring charges for the three and nine months ended September 30, 2023 are net of $0.2 million of facility closures costs that were reversed in the current periods.    

The following table summarizes the activity in our restructuring-related accrual by major type of cost (in thousands):

	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2023	$	4,416	$	1,507	$	5,923
Charges incurred	2,732		—		2,732
Payments	(1,284)		—		(1,284)
Other(1)	(291)		(620)		(911)
Currency translation	70		16		86
Accrued balance, March 31, 2023	$	5,643	$	903	$	6,546
Charges incurred	1,290		20		1,310
Payments	(3,302)		(27)		(3,329)
Currency translation	227		17		244
Accrued balance, June 30, 2023	$	3,858	$	913	$	4,771
Charges incurred	583		522		1,105
Payments	(802)		(495)		(1,297)
Other(2)	—		(165)		(165)
Currency translation	(52)		(27)		(79)
Accrued balance, September 30, 2023	$	3,587	$	748	$	4,335

__________________________

(1) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended March 31, 2023.

(2) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended September 30, 2023.

Strategic Transaction and Integration Expenses

    We incurred and expensed $6.1 million and $12.0 million in strategic transaction and integration expenses during the three months ended September 30, 2023 and 2022, respectively, and we incurred and expensed $25.4 million and $54.5 million in strategic transaction and integration expenses during the nine months ended September 30, 2023 and 2022, respectively, which are included in restructuring, strategic transaction and integration expenses in our condensed consolidated statements of operations. The strategic transaction and integration expenses during the three and nine months ended September 30, 2023 were primarily related to consulting expenses and employee costs incurred to integrate our Smiths Medical business acquired in 2022. The strategic transaction and integration expenses for the three and nine months ended September 30, 2022 were primarily related to transaction and integration expenses associated with our acquisition of Smiths Medical on January 6, 2022 (see Note 3: Acquisitions) which primarily included legal expenses, bank fees, and employee costs. The nine months ended September 30, 2022 also included a United Kingdom stamp tax.

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Revenue (Notes)

9 Months Ended

Sep. 30, 2023

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customer [Text Block]

Revenue

Revenue Recognition

    As part of the integration of our acquisition of Smiths Medical, we have now migrated to our new business unit structure of Consumables, Infusion Systems and Vital Care. The vast majority of our sales of products within these business units are made on a stand-alone basis to hospitals and distributors. Our revenues are recorded at the net sales price, which includes an estimate for variable consideration related to rebates, chargebacks and product returns. Revenue is typically recognized upon transfer of control of the products, which we deem to be at point of shipment. However, for purposes of revenue recognition for our software licenses and renewals, we consider the control of these products to be transferred to a customer at a certain point in time; therefore, we recognize revenue at the start of the applicable license term.

    Payment is typically due in full within 30 days of delivery or the start of the contract term. Revenue is recorded in an amount that reflects the consideration we expect to be entitled to in exchange for those goods or services. We offer certain volume-based rebates to our distribution customers, which we record as variable consideration when calculating the transaction price. Rebates are offered on both a fixed and tiered/variable basis. In both cases, we use information available at the time and our historical experience with each customer to estimate the most likely rebate amount. We also provide chargebacks to distributors that sell to end customers at prices determined under a contract between us and the end customer. Chargebacks are the difference between the prices we charge our distribution customers and the contracted prices we have with the end customer which are processed as credits to our distribution customers. In estimating the expected value of chargeback amounts in order to determine the transaction price, we use information available at the time, including our historical experience.

    We also warranty products against defects and have a policy permitting the return of defective products, for which we accrue and expense at the time of sale using information available at that time and our historical experience. We also provide extended service-type warranties, which we consider to be separate performance obligations. We allocate a portion of the transaction price to the extended service-type warranty based on its estimated relative stand-alone selling price, and recognize revenue over the period the warranty service is provided.

Revenue Disaggregated

The following table represents our revenues disaggregated by product line (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Product line	2023		2022		2023		2022
Consumables	242,010		251,572		715,108		732,756
Infusion Systems	148,981		161,555		463,836		448,426
Vital Care	162,320		184,730		492,326		520,801
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

For the three and nine months ended September 30, 2023, net sales to Medline made up approximately 18% and 16% of total revenues, respectively. For the three and nine months ended September 30, 2022, net sales to Medline made up approximately 16% and 15% of total revenues, respectively.

The following table represents our revenues disaggregated by geography (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Geography	2023		2022		2023		2022
United States	$	355,984	$	376,691	$	1,063,037	$	1,088,348
Europe, the Middle East and Africa	88,014		101,869		276,994		275,488
APAC	59,064		66,569		177,719		191,847
Other Foreign	50,249		52,728		153,520		146,300
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

Contract Balances

    The following table presents the changes in our contract balances for the nine months ended September 30, 2023 and 2022 (in thousands):

	Contract Liabilities
Beginning balance, January 1, 2023	$	(45,866)
Equipment revenue recognized	24,872
Equipment revenue deferred	(25,620)
Software revenue recognized	13,546
Software revenue deferred	(12,797)
Government grant deferred income*	(944)
Government grant recognized	3,164
Other deferred revenue	(1,674)
Other deferred revenue recognized	4,748
Ending balance, September 30, 2023	$	(40,571)
Beginning balance, January 1, 2022	$	(7,461)
Fair value of acquired deferred revenue	(51,245)
Equipment revenue recognized	22,757
Equipment revenue deferred	(13,420)
Software revenue recognized	12,761
Software revenue deferred	(12,978)
Government grant deferred income*	(3,434)
Government grant recognized	178
Other deferred revenue	(1,285)
Other deferred revenue recognized	3,488
Ending balance, September 30, 2022	$	(50,639)

____________________________

*The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

Our contract liabilities are included in accrued liabilities or other long-term liabilities in our condensed consolidated balance sheet based on the expected timing of revenue recognition.    

As of September 30, 2023, revenue from remaining performance obligations is as follows:

	Recognition Timing
(in millions)	< 12 Months		> 12 Months
Equipment deferred revenue	$	(16,448)	$	(12)
Software deferred revenue	(8,261)		(707)
Government grant deferred income*	(1,451)		(10,548)
Other deferred revenue**	(2,575)		(569)
Total	$	(28,735)	$	(11,836)

_________________________________

*The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

**Other deferred revenue includes pump development programs, purchased training and extended warranty.

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Leases (Notes)

9 Months Ended

Sep. 30, 2023

Leases [Abstract]

Lessee, Operating Leases [Text Block]

Leases

    We determine if an arrangement is a lease at inception. Our operating lease assets are separately stated in operating lease right-of-use ("ROU") assets and our financing lease assets are included in other assets on our condensed consolidated

balance sheets. Our lease liabilities are included in accrued liabilities and other long-term liabilities on our condensed consolidated balance sheets. We have elected not to recognize an ROU asset and lease liability for leases with terms of twelve months or less.

    Lease ROU assets and lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. Most of our leases do not provide an implicit rate, therefore we use our incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a similar term based on the information available at commencement date. Our lease ROU assets exclude lease incentives and initial direct costs incurred. Our lease terms include options to extend when it is reasonably certain that we will exercise that option. All of our leases have stated lease payments, which may include fixed rental increases. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

    Our leases are for corporate, research and development and sales and support offices, distribution facilities, device service centers and certain equipment. Our leases have original lease terms of one year to fifteen years, some of which include options to extend the leases for up to an additional five years. For all of our leases, we do not include optional periods of extension in our current lease terms because we determine the exercise of options to extend is not reasonably certain.

The following table presents the components of our lease cost (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Operating lease cost	$	5,968	$	5,819	$	18,162	$	16,472
Finance lease cost — interest	32		25		91		82
Finance lease cost — reduction of ROU asset	279		176		757		516
Short-term lease cost	3		1		29		7
Total lease cost	$	6,282	$	6,021	$	19,039	$	17,077

Interest expense on our finance leases is included in interest expense, net in our condensed consolidated statements of operations. The reduction of the operating and finance ROU assets is included as noncash lease expense in selling, general and administrative expenses in our condensed consolidated statements of operations.    

The following table presents the supplemental cash flow information related to our leases (in thousands):

	Nine months ended September 30,
	2023		2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	18,477	$	18,886
Operating cash flows from finance leases	$	91	$	25
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	14,423	$	4,771
Finance leases	$	932	$	266

The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

	As of
	September 30, 2023			December 31, 2022
Operating leases
Operating lease right-of-use assets	$	73,767		$	74,864
Accrued liabilities	$	19,850		$	18,169
Other long-term liabilities	57,277			60,916
Total operating lease liabilities	$	77,127		$	79,085
Weighted-Average Remaining Lease Term
Operating leases	5.7 years			6.1 years
Weighted-Average Discount Rate
Operating leases	4.23		%	4.34		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of
	September 30, 2023			December 31, 2022
Finance leases
Finance lease right-of-use assets	$	2,814		$	2,598
Accrued liabilities	$	897		$	816
Other long-term liabilities	2,018			1,855
Total finance lease liabilities	$	2,915		$	2,671
Weighted-Average Remaining Lease Term
Finance leases	4.2 years			4.8 years
Weighted-Average Discount Rate
Finance leases	4.85		%	4.23		%

As of September 30, 2023, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2023	$	5,866	$	301
2024	21,457		919
2025	16,108		711
2026	14,179		590
2027	10,316		266
2028	5,684		189
Thereafter	12,570		236
Total Lease Payments	86,180		3,212
Less imputed interest	(9,053)		(297)
Total	$	77,127	$	2,915

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Net Income Per Share:

9 Months Ended

Sep. 30, 2023

Earnings Per Share [Abstract]

Net Income Per Share [Text Block]

Net Income (Loss) Per Share

Basic earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing net income by the weighted-average number of common shares outstanding during the period plus dilutive securities. Dilutive securities include outstanding common stock options and unvested restricted stock units, less the number of shares that could have been purchased with the proceeds from the exercise of the options, using the treasury stock method. Options and restricted stock units that are anti-dilutive are not included in the treasury stock method calculation. Due to the net loss for the nine months ended September 30, 2023 and for the three and nine months ended September 30, 2022, any potentially dilutive common shares were not included in the computation of diluted earnings per share as they would have had an anti-dilutive effect; therefore, basic and diluted net loss per share are equal for each of these periods. There were 247,530 anti-dilutive securities for the three months ended September 30, 2023.

    The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Net income (loss)	$	7,238	$	(13,208)	$	(12,508)	$	(58,750)
Weighted-average number of common shares outstanding (basic)	24,132		23,908		24,075		23,828
Dilutive securities(1)	236		—		—		—
Weighted-average common and common equivalent shares outstanding (diluted)	24,368		23,908		24,075		23,828
EPS — basic	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)
EPS — diluted	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)

_______________________________

(1)    Due to the net loss for the nine months ended September 30, 2023 and the three and nine

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Derivative Financial Instruments (Notes)

3 Months Ended

Sep. 30, 2023

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivative Instruments and Hedging Activities Disclosure [Text Block]

Derivatives and Hedging Activities

Hedge Accounting and Hedging Program

     The purposes of our cash flow hedging programs are to manage the foreign currency exchange rate risk on forecasted revenues and expenses denominated in currencies other than the functional currency of the operating unit, and to manage floating interest rate risk associated with future interest payments on the variable-rate term loans issued in January 2022. We do not issue derivatives for trading or speculative purposes.

    To receive hedge accounting treatment, all hedging relationships are formally documented at the inception of the hedge, and the hedges must be highly effective in offsetting changes to future cash flows on hedged transactions. The derivative instruments we utilize, including various foreign exchange contracts and interest rate swaps, are designated and qualify as cash flow hedges. Our derivative instruments are recorded at fair value on the condensed consolidated balance sheets and are classified based on the instrument's maturity date. We record gains or losses from changes in the fair values of the derivative instruments as a component of other comprehensive income (loss) and we reclassify those gains or losses into earnings in the same line item associated with the forecasted transaction and in the same period during which the hedged transaction affects earnings. If the underlying forecasted transaction does not occur, or it becomes probable that it will not occur, we reclassify the gain or loss on the related derivative instrument from accumulated other comprehensive loss into earnings immediately.

Foreign Currency Exchange Rate Risk

Foreign Exchange Forward Contracts

We enter into foreign exchange forward contracts to hedge a portion of our forecasted foreign currency-denominated revenues and expenses to minimize the effect of foreign exchange rate movements on the related cash flows. These contracts are agreements to buy or sell a quantity of a currency at a predetermined future date and at a predetermined exchange rate. Our foreign exchange forward contracts hedge exposures principally denominated in Mexican Pesos ("MXN"), Euros, Czech Koruna ("CZK"), Japanese Yen ("JPY"), Swedish Krona ("SEK"), Danish Krone ("DKK"), Chinese Renminbi ("CNH"), Canadian Dollar ("CAD"), U.S. Dollar ("USD") and Australian Dollar ("AUD") and have varying maturities with an average term of approximately eleven months. The total notional amount of these outstanding derivative contracts as of September 30, 2023 was $152.7 million, which included the notional equivalent of $44.1 million in MXN, $25.5 million in Euros, $14.4 million in JPY, $6.4 million in CNH, $13.8 million in CAD, $10.3 million in AUD, $30.8 million in USD and $7.4 million in other foreign currencies, with terms currently through January 2025.

Cross-currency Par Forward Contracts

We have entered into cross-currency par forward contracts to hedge a portion of our Mexico forecasted expenses denominated in MXN. These contracts are agreements to exchange cash flows from one currency to another at specified intervals over the contract term with all exchanges occurring at the same predetermined rate. In November 2021, we entered into a one-year cross-currency par forward contract with a term from December 1, 2021 to December 1, 2022. The total notional amount of this outstanding derivative as of September 30, 2022 was approximately 103.8 million MXN. This derivative instrument matured in equal monthly amounts at a fixed forward rate of 21.60 MXN/USD.

Floating Interest Rate Risk

In November 2021, in anticipation of entering into the new senior secured credit facilities in January 2022, which includes a variable-rate term loan A and a variable-rate term loan B (see Note 17: Long-Term Debt), we entered into two forward-starting interest rate swaps. In February 2022, certain terms under the agreements were amended to reflect the transition from LIBOR to the Secured Overnight Financing Rate ("SOFR"), an alternative reference rate. Under the interest rate swap agreements, we exchange, at specified intervals, the difference between fixed and floating interest amounts calculated by reference to an agreed-upon notional amount. Effective March 30, 2022, the term loan A swap, as amended, has an initial notional amount of $300.0 million, reducing to $150.0 million evenly on a quarterly basis excluding its final maturity on March 30, 2027. We will pay a fixed rate of 1.32% and will receive the greater of 3-months USD SOFR or (0.15)%. Effective March 30, 2022, the term loan B swap, as amended, has an initial notional amount of $750.0 million, reducing to $46.9 million evenly on a quarterly basis excluding its final maturity on March 30, 2026. We will pay a fixed rate of 1.17% and will receive the greater of 3-months USD SOFR or 0.35%.

In June 2023, we entered into an additional interest rate swap that hedges both term loan A and term loan B interest payments. The total notional amount of the swap is $300 million. The hedge matures on June 30, 2028. We will pay a fixed rate of 3.88% and will receive 3-months USD SOFR.

These swaps effectively convert the relevant portion of the floating-rate term loans to fixed rates.

The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets (in thousands):

	Derivatives Designated as Cash Flow Hedging Instruments
Condensed Consolidated Balance Sheet Location	Foreign Exchange Contracts		Interest Rate Swaps		Gross Derivatives
As of September 30, 2023
Prepaid expenses and other current assets	$	8,630	$	30,447	$	39,077
Other assets	542		22,167		22,709
Total assets	$	9,172	$	52,614	$	61,786
Accrued liabilities	$	1,890	$	—	$	1,890
Other long-term liabilities	91		—		91
Total liabilities	$	1,981	$	—	$	1,981
As of December 31, 2022
Prepaid expenses and other current assets	$	4,860	$	28,431	$	33,291
Other assets	94		26,753		26,847
Total assets	$	4,954	$	55,184	$	60,138
Accrued liabilities	$	1,847	$	—	$	1,847
Other long-term liabilities	167		—		167
Total liabilities	$	2,014	$	—	$	2,014

We recognized the following gains on our derivative instruments designated as cash flow hedges in other comprehensive income before reclassifications to net loss (in thousands):

	Gain Recognized in Other Comprehensive Income
	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	$	1,757	$	3,383	$	10,260	$	11,720
Interest rate swaps	12,496		21,201		21,236		60,398
Total derivatives designated as cash flow hedging instruments	$	14,253	$	24,584	$	31,496	$	72,118

The following table presents the effects of our derivative instruments designated as cash flow hedges on the Condensed Consolidated Statements of Operations (in thousands):

	Gain (Loss) Reclassified From Accumulated Other Comprehensive Loss into Income
			Three months ended September 30,				Nine months ended September 30,
	Location of Gain (Loss) Recognized in Income		2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	Total revenues		$	1,019	$	(1,690)	$	(429)	$	2,666
Foreign exchange contracts	Cost of goods sold		2,247		3,090		6,063		4,140
Foreign exchange contracts	Other expense, net	(1)	—		—		229		—
Foreign exchange contracts	Interest expense	(2)	—		462		13		717
Interest rate swaps	Interest expense		8,813		2,133		23,807		608
Total derivatives designated as cash flow hedging instruments			$	12,079	$	3,995	$	29,683	$	8,131

_______________________________

(1)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of ineffectiveness.

(2)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of forecasted transactions no longer probable of occurring.

As of September 30, 2023, we expect an estimated $6.7 million in deferred gains on the outstanding foreign exchange contracts and an estimated $31.6 million in deferred gains on the interest rate swaps will be reclassified from accumulated other comprehensive loss to net income during the next 12 months concurrent with the underlying hedged transactions also being reported in net income.

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Fair Value Measures and Disclosures (Notes)

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

Fair Value Disclosures

Fair Value Measurements

    Fair value is the price that would be received from selling an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. There are three levels of inputs that may be used to measure fair value:

•Level 1: quoted prices in active markets for identical assets or liabilities;

•Level 2: inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices in active markets for similar assets or liabilities, quoted prices for identical or similar assets or liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities; or

•Level 3: unobservable inputs that are supported by little or no market activity and that are significant to the fair values of the assets or liabilities.

Contingent Earn-out Liabilities

On January 6, 2022, we acquired Smiths Medical with a combination of cash consideration and share consideration issued at closing. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving certain Price Targets from the closing date to either the third or fourth anniversary of closing (see Note 3: Acquisitions for additional information) and provided Smiths beneficially owns at least 50.0% of the shares of common stock issued at closing at the time the Price Target is achieved. The initial estimated fair value of the earn-out was determined to be $53.5 million. The initial fair value of the earn-out was determined using a Monte Carlo simulation model. The model utilized several assumptions including volatility and the risk-free interest rate. The assumed volatility is based on the average of the historical volatility of our common stock price and the implied volatility of certain at-the-money traded options. The risk-free interest rate is equal to the yield on U.S. Treasury securities at constant maturity for the period commensurate with the term of the earn-out. At each reporting date subsequent to the acquisition, we remeasure the earn-out liability and recognize any changes in its fair value in our consolidated statements of operations. If the probability of achieving the Price Targets during their respective measurement periods is significantly greater than initially anticipated, the realization of an additional liability and related expense will have a significant impact on our consolidated financial statements in the period recognized. As of September 30, 2023, the estimated fair value of the contingent earn-out is $7.1 million.

In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. As of December 31, 2022, the measurement period related to (i) above ended, and based on the actual revenue achieved during the measurement period we determined that the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2023, the estimated fair value for the contingent earn-out related to certain product-related regulatory certifications was estimated to be $1.5 million.

In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out payment shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of September 30, 2023, the estimated fair value of the contingent earn-out is $4.3 million. The estimated fair value of the contingent earn-out is calculated using a probability-weighted cash flow model based on historical revenue streams and the likelihood that the revenue targets will be met.

    Our contingent earn-out liabilities are separately stated on our condensed consolidated balance sheets.

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Earn-out Liability
Accrued balance, January 1, 2023	$	25,572
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(700)
Currency translation	33
Accrued balance, March 31, 2023	24,905
Change in fair value of earn-out (included in income from operations as a separate line item)(2)	4,016
Other	11
Currency translation	1
Accrued balance, June 30, 2023	28,933
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(15,572)
Other	58
Currency translation	(58)
Accrued balance, September 30, 2023	$	13,361

	Earn-out Liability
Accrued balance, January 1, 2022	$	2,589
Acquisition date fair value estimate of earn-out(3)	55,158
Currency translation	(46)
Accrued balance, March 31, 2022	57,701
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(27,194)
Currency translation	(98)
Accrued balance, June 30, 2022	30,409
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(4,059)
Currency translation	(108)
Accrued balance, September 30, 2022	$	26,242

_______________________________

(1) Primarily relates to the change in fair value of our Smiths Medical earn-out.

(2) Primarily relates to the change in fair value of our Smiths Medical earn-out and the earnout with one of our international distributors.

(3) $53.5 million of the change in fair value of earn-out relates to our acquisition of Smiths Medical, and $1.6 million of the change in fair value of earn-out relates to our acquisition of a small foreign infusions systems supplier in the fourth quarter of 2021 (see Note 3: Acquisitions).

The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities related to Smiths Medical:

Smiths Medical Earn-out Liability

Simulation Input	As of September 30, 2023		As of December 31, 2022
Volatility	41.00	%	38.00	%
Risk-Free Rate	4.91	%	4.17	%

Investments, Foreign Exchange Contracts and Interest Rate Contracts    

    Our investments consist of corporate and government bonds and U.S. treasury securities. The fair value of our corporate and government bonds is estimated using observable market-based inputs such as quoted prices, interest rates and yield curves or Level 2 inputs. The fair value of our U.S. treasury securities are based on quoted market prices in active markets and are included in the Level 1 fair value hierarchy.

    The fair value of our Level 2 foreign exchange contracts, including forward contracts and cross-currency par forward contracts, is estimated using observable market inputs such as known notional value amounts, spot and forward exchange rates. These inputs relate to liquid, heavily traded currencies with active markets which are available for the full term of the derivative.

The fair value of our Level 2 interest rate swaps is estimated using a pricing model that reflects the terms of the contracts, including the period to maturity, and relies on observable market inputs such as known notional value amounts and USD interest rate curves.

Our assets and liabilities measured at fair value on a recurring basis consisted of the following Level 1, 2 and 3 inputs as defined above (in thousands):

	Fair value measurements as of September 30, 2023
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	1,306	$	—	$	1,306	$	—
Short-term government bonds	500		—		500		—
Foreign exchange contracts:
Prepaid expenses and other current assets	8,630		—		8,630		—
Other assets	542		—		542		—
Interest rate contracts:
Prepaid expenses and other current assets	30,446		—		$	30,446	—
Other assets	22,167		—		$	22,167	—
Total Assets	$	63,591	$	—	$	63,591	$	—
Liabilities:
Contingent earn-out liability - ST	$	6,300	$	—			$	6,300
Contingent earn-out liability - LT	7,061		—				$	7,061
Foreign exchange contracts:
Accrued liabilities	1,890		—		$	1,890	—
Other long-term liabilities	91		—		$	91	—
Total Liabilities	$	15,342	$	—	$	1,981	$	13,361

	Fair value measurements as of December 31, 2022
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	2,314	$	—	$	2,314	$	—
Short-term U.S. treasury securities	1,412		1,412		—		—
Short-term government bonds	498		—		$	498	—
Long-term corporate bonds	516		—		$	516	—
Foreign exchange forwards:
Prepaid expenses and other current assets	4,860		—		$	4,860	—
Other assets	94		—		$	94	—
Interest rate contracts:
Prepaid expenses and other current assets	28,431		—		$	28,431	—
Other assets	26,753		—		$	26,753	—
Total Assets	$	64,878	$	1,412	$	63,466	$	—
Liabilities:
Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities	1,847		—		1,847		—
Other long-term liabilities	167		—		167		—
Total Liabilities	$	27,586	$	—	$	2,014	$	25,572

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Investment Securities (Notes)

9 Months Ended

Sep. 30, 2023

Investments, Debt and Equity Securities [Abstract]

investments in Debt and Marketable Equity Securities and Equity Method Investments [Text Block]

Investment Securities

Investments in Available-for-sale Securities

    Our available-for-sale investment securities currently consist of short-term corporate bonds and short-term government bonds and are considered “investment grade” and are carried at fair value. We assess our investment in available-for-sale debt securities for impairment each reporting period. If an unrealized loss exists, we determine whether any portion of the decline in fair value below the amortized cost basis is credit-related by reviewing several factors, including, but not limited to, the extent of the fair value decline and changes in the financial condition of the issuer. We record an impairment for credit-related losses through an allowance, limited to the amount of the unrealized loss. If we either intend to sell or it is more likely than not we will be required to sell the debt security before its anticipated recovery, any allowance is written off and the amortized cost basis is written down to fair value through a charge against net earnings. Unrealized gains and non-credit-related unrealized losses are recorded, net of tax, in other comprehensive income (loss). We did not have any investments in available-for-sale debt securities in unrealized loss positions as of September 30, 2023 or December 31, 2022.

The amortized cost of the debt securities are adjusted for the amortization of premiums computed under the effective interest method. Such amortization is included in interest expense, net in our condensed consolidated statements of operations. Realized gains and losses are accounted for on the specific identification method. There have been no realized gains or losses on the disposal of these investments. The scheduled maturities of the outstanding debt securities are between 2023 and 2024. All short-term investment securities are callable within one year.

Our short-term and long-term investments in available-for-sale securities consist of the following (in thousands):

	As of September 30, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	1,306		$	—	$	1,306
Short-term government bonds	500		—		500
Total investment securities	$	1,806	$	—	$	1,806
	As of December 31, 2022
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	2,314	$	—	$	2,314
Short-term U.S. treasury securities	1,412		—		1,412
Short-term government bonds	498		—		498
Long-term corporate bonds	516		—		516
Total investment securities	$	4,740	$	—	$	4,740

Investments in Non-Marketable Equity Securities

During the third quarter of 2021, we acquired an approximate 20% non-marketable equity interest in a nonpublic company and entered into a three-year distribution agreement where we have the exclusive rights to market, sell and distribute the company's products in exchange for a cash payment of $3.3 million. In addition, we were granted an exclusive license for all of the seller's intellectual property. At the expiration of the distribution agreement we have the right but not the obligation to acquire the remaining interest in the business.

We apply the equity method of accounting for investments when we determine we have a significant influence, but not a controlling interest in the investee. We determine whether we have significant influence by considering key factors such as ownership interest, representation on the board of directors, participation in policy making decisions, business relationship and material intra-entity transactions, among other factors. Our equity method investment is reported at cost and adjusted each period for our share of the investee's income or (loss) and dividend paid, if any. We eliminate any intra-entity profits to the extent of our beneficial interest. We record our share of the investee's income or (loss) on a one quarter lag. We report our proportionate share of the investee's income or (loss) resulting from this investment in other income, net in our condensed consolidated statements of operations. The carrying value of our equity method investment is reported in other assets on our condensed consolidated balance sheets (see Note 11: Prepaid Expenses and Other Current Assets and Other Assets). We assess our equity method investments for impairment on an annual basis or whenever events or circumstances indicate that the carrying value of the investment may not be recoverable. Our recorded share of the investee's loss was not material for the three and nine months ended September 30, 2023 and 2022. We did not receive any dividend distributions from this investment during the three and nine months ended September 30, 2023 and 2022.

Our non-marketable equity method investment consists of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Equity method investment	$	3,145	$	3,178

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Prepaids and Other Current Assets (Notes)

9 Months Ended

Sep. 30, 2023

Prepaid Expense and Other Assets [Abstract]

Prepaids, other current assets and other noncurrent assets [Text Block]

Prepaid Expenses and Other Current Assets and Other Assets

Prepaid expenses and other current assets consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Other prepaid expenses and receivables	$	21,880	$	21,635
Prepaid vendor expenses	1,657		3,052
Deferred costs	5,676		2,395
Prepaid insurance and property taxes	4,245		16,322
VAT/GST receivable	2,390		3,546
Deferred tax charge	4,935		3,830
Foreign exchange contracts	8,630		4,860
Interest rate contracts	30,446		28,431
Deposits	1,227		1,329
Other	3,326		3,532
	$	84,412	$	88,932

Other assets consist of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Pump lease receivables	$	29,070	$	27,086
Spare parts	44,076		38,498
Equity method investment	3,145		3,178
Deferred debt issuance costs	3,867		5,156
Finance lease right-of-use assets	2,814		2,598
Interest rate contracts	22,167		26,753
Other	2,586		2,193
	$	107,725	$	105,462

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Inventories:

9 Months Ended

Sep. 30, 2023

Inventory Disclosure [Abstract]

Inventories [Text Block]

Inventories

    Inventories are stated at the lower of cost or net realizable value with cost determined using the first-in, first-out method. Inventory costs include material, labor and overhead related to the manufacturing of our products.

Inventories consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Raw materials	$	298,753	$	286,964
Work in process	75,935		73,795
Finished goods	384,934		335,250
Total inventories	$	759,622	$	696,009

During the three and nine months ended September 30, 2023, we recorded a $6.3 million reserve to inventory related to certain product at the end of its life cycle due to the integration of acquired product with similar functionality. This adjustment was recorded to cost of goods sold in our condensed consolidated statement of operations.

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Property and Equipment:

9 Months Ended

Sep. 30, 2023

Property, Plant and Equipment [Abstract]

Property and Equipment [Text Block]

Property, Plant and Equipment

Property, plant and equipment consists of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Machinery and equipment	$	477,444	$	414,811
Land, building and building improvements	275,997		274,063
Molds	87,757		77,203
Computer equipment and software	120,743		115,214
Furniture and fixtures	30,311		29,876
Instruments placed with customers(1)	107,673		98,481
Construction in progress	106,051		152,909
Total property, plant and equipment, cost	1,205,976		1,162,557
Accumulated depreciation	(597,214)		(526,444)
Property, plant and equipment, net	$	608,762	$	636,113

______________________________

(1)    Instruments placed with customers consist of drug-delivery and monitoring systems placed with customers under operating leases.

Depreciation expense was $25.0 million and $72.8 million for the three and nine months ended September 30, 2023, respectively, and $23.0 million and $69.4 million for the three and nine months ended September 30, 2022, respectively.

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Goodwill and Intangible Assets (Notes)

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets Disclosure [Text Block]

Goodwill and Intangible Assets, Net

Goodwill

    The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2023	$	1,449,258
Currency translation	(4,802)
Balance as of September 30, 2023	$	1,444,456

Intangible Assets, Net

    Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

	Weighted-Average Amortization Life in Years	September 30, 2023
		Cost		Accumulated Amortization		Net
Patents	10	$	32,741	$	20,107	$	12,634
Customer contracts	12	9,860		6,631		3,229
Non-contractual customer relationships	8	545,192		151,573		393,619
Trademarks	1	5,425		5,425		—
Trade name	15	18,243		6,852		11,391
Developed technology	10	583,845		152,444		431,401
Non-compete	3	9,100		6,900		2,200
Total amortized intangible assets		$	1,204,406	$	349,932	$	854,474
Internally developed software*		$	36,806			$	36,806
Total intangible assets		$	1,241,212	$	349,932	$	891,280

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted-Average Amortization Life in Years	December 31, 2022
		Cost		Accumulated Amortization		Net
Patents	10	$	29,998	$	18,610	$	11,388
Customer contracts	12	10,026		6,443		3,583
Non-contractual customer relationships	8	546,935		101,556		445,379
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		5,959		12,292
Developed technology	10	583,176		108,708		474,468
Non-compete	3	9,100		5,250		3,850
Total amortized intangible assets		$	1,202,911	$	251,951	$	950,960
Internally developed software*		$	31,806			$	31,806
Total intangible assets		$	1,234,717	$	251,951	$	982,766

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

Intangible assets with definite lives are amortized on a straight-line basis over their estimated useful lives. Intangible asset amortization expense was $33.4 million and $98.8 million during the three and nine months ended September 30, 2023, respectively, and $35.6 million and $108.9 million during the three and nine months ended September 30, 2022, respectively.

As of September 30, 2023 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

Remainder of 2023	$	32,407
2024	131,060
2025	123,490
2026	122,832
2027	112,782
2028	112,184
Thereafter	219,719
Total	$	854,474

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Accrued Liabilities (Notes)

9 Months Ended

Sep. 30, 2023

Accrued Liabilities [Abstract]

Accounts Payable and Accrued Liabilities Disclosure [Text Block]

Accrued Liabilities and Other Long-Term Liabilities

    Accrued liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Salaries and benefits	$	53,763	$	44,304
Incentive compensation	25,853		30,254
Operating lease liability-ST	19,850		18,169
Accrued sales taxes	6,440		5,844
Restructuring accrual	4,335		5,923
Deferred revenue	28,768		30,838
Accrued other taxes	5,657		5,794
Accrued professional fees	3,194		5,317
Italy medical device payback provision(1)	22,754		7,900
Legal accrual	1,601		3,137
Distribution fees	12,500		17,063
Warranties and returns	3,576		3,097
Field service corrective action(2)	26,382		24,517
Accrued freight	17,544		17,988
Foreign exchange contracts	1,890		1,847
Accrued research and development	—		3,538
Accrued audit fees	6,362		6,279
Defined benefit plan	2,064		2,928
Accrued interest	1,083		1,033
Other	7,708		6,999
	$	251,324	$	242,769

___________________________

(1)     As of December 31, 2022, there was $12.1 million in payback provision recorded as a reduction to accounts receivable, net. The Company reclassified such amount to accrued liabilities as of September 30, 2023. This amount was not reclassified as of December 31, 2022 to conform to the current year presentation.

(2)    Relates to field service corrective actions associated with certain products in connection with a 2021 Warning Letter received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility, see Note 19: Commitments and Contingencies for further detail.

Other long-term liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Operating lease liability-LT	$	57,277	$	60,916
Benefits	4,999		5,314
Accrued rent	864		997
Finance lease liability-LT	2,018		1,855
Deferred revenue	11,836		16,239
Field service corrective action(1)	19,470		25,294
Other	3,541		3,489
	$	100,005	$	114,104

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Income Taxes:

9 Months Ended

Sep. 30, 2023

Income Tax Disclosure [Abstract]

Income Tax Disclosure [Text Block]

Income Taxes

Income taxes were accrued at an estimated effective tax rate of 235% and 70% for the three and nine months ended September 30, 2023, respectively, as compared to 38% and 37% for the three and nine months ended September 30, 2022, respectively.

    The effective tax rate for the three and nine months ended September 30, 2023 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, foreign-derived intangible income ("FDII") and tax credits and the following discrete items recognized during the interim period:

•Net unrecognized tax benefits resulting primarily from the expiration of statute of limitations during the three and nine months ended September 30, 2023 of $0.0 million and $6.0 million, respectively.

•Excess tax benefit recognized on stock option exercises and the vesting of restricted stock units during the three and nine months ended September 30, 2023 of $0.6 million and $0.8 million, respectively.

•U.S. federal return-to-provision adjustments net of related tax reserves for the year ended December 31, 2022 resulted in a tax benefit of $7.5 million during the three and nine months ended September 30, 2023. The adjustments related primarily to changes in estimates for the research and development credit and foreign tax credits.

•The revaluation of the contingent consideration during the three and nine months ended September 30, 2023 of $15.6 million and $12.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

    The effective tax rate for the three and nine months ended September 30, 2022 differs from the federal statutory rate of 21% principally because of the effect of the mix of U.S. and foreign incomes, state income taxes, section 162(m) excess compensation, FDII and tax credits. The effective tax rate during the three and nine months ended September 30, 2022 included a discrete tax benefit of $1.5 million and $4.1 million, respectively, related to excess tax benefits recognized on stock option exercises and the vesting of restricted stock units during the period. The revaluation of the contingent consideration during the three and nine months ended September 30, 2022 of $4.1 million and $31.3 million, respectively, resulted in a tax expense of $0.0 million for both periods.

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Long-Term Obligations (Notes)

9 Months Ended

Sep. 30, 2023

LOng-Term Obligations Disclosure [Abstract]

Long-term Debt [Text Block]

Long-Term Debt

2022 Credit Agreement

On January 6, 2022, in connection with the acquisition of Smiths Medical, we entered into a Credit Agreement (the "Credit Agreement") with Wells Fargo Bank, National Association, Wells Fargo Securities, LLC, Barclays Bank PLC and certain other financial institutions (the “Lenders”) for $2.2 billion of senior secured credit facilities. The senior secured credit facilities include (i) a five-year Tranche A term loan of $850.0 million (the "Term Loan A"), (ii) a seven-year Tranche B term loan of $850.0 million (the "Term Loan B") and (iii) a five-year revolving credit facility of $500.0 million (the "Revolving

Credit Facility"), with separate sub-limits of $50.0 million for letters of credit and swingline loans (collectively, the "Senior Secured Credit Facilities"). We used the proceeds from borrowings under the Term Loan A and the Term Loan B (collectively, the "Term Loans") to fund a portion of the cash consideration for the purchase of Smiths Medical and the related fees and expenses incurred in connection with the acquisition. We did not incur borrowings under the Revolving Credit Facility on the closing date of the acquisition. The proceeds from any future borrowings under the Revolving Credit Facility may be used for working capital and other general corporate purposes.

In connection with entering into the Credit Agreement, during the period ended March 31, 2022, we incurred $37.8 million in debt discount and issuance costs, which were allocated to the Term Loan A, the Term Loan B and the Revolving Credit Facility based on lender commitment amounts relative to each type of fees paid. The lender and third-party discount and issuance costs allocated to the Term Loan A and the Term Loan B were $15.8 million and $13.4 million, respectively, and are reflected as a direct deduction from the face amount of the corresponding term loans on the condensed consolidated balance sheet. These costs are being amortized to interest expense over the respective terms of the loans using the effective interest method. The issuance costs allocated to the Revolving Credit Facility were $8.6 million, which are capitalized and included in prepaid expenses and other current assets and other assets on our condensed consolidated balance sheets. These costs are being amortized to interest expense over the term of the Revolving Credit Facility using the straight-line method.

The net funds received from the Term Loan A and the Term Loan B, after deducting debt issuance costs, were $834.2 million and $836.6 million, respectively.

Maturity Dates

The maturity date for the Term Loan A and the Revolving Credit Facility is January 6, 2027, and the maturity date for the Term Loan B is January 6, 2029. Pursuant to the terms and conditions of the Credit Agreement, the maturity dates of the Term Loans and the Revolving Credit Facility may be extended upon our request, subject to the consent of the Lenders.

Interest Rate Terms

In general, the Term Loans and borrowings under the Revolving Credit Facility denominated in U.S. dollars bear interest, at our option, on either: (1) the Base Rate, as defined below, plus the applicable margin, as indicated below ("Base Rate Loans") or (2) the Adjusted Term Secured Overnight Financing Rate ("Adjusted Term SOFR"), as defined below, plus the applicable margin, as indicated below ("Term SOFR Loans").

The Base Rate is defined as the highest of (a) the Prime Rate, (b) the Federal Funds Rate plus 0.50% and (c) Adjusted Term SOFR (as defined below) for a one-month period plus, in each case, 1.00%.

Adjusted Term SOFR is the rate per annum equal to (a) the Term SOFR plus (b) the Term SOFR Adjustment. Term SOFR is the forward-looking term rate based on SOFR and is calculated separately for Term SOFR Loans and Base Rate Loans, as specified in the Credit Agreement. The Term SOFR Adjustment is a percentage per annum of 0.10% for Base Rate Loans and between 0.10% to 0.25% for Term SOFR Loans based on the applicable interest period.

Revolving Credit Facility Commitment Fee

The Revolving Credit Facility has a per annum commitment fee at an initial rate of 0.25% which is applied to the available amount of the Revolving Credit Facility. Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the commitment fee will be determined by reference to the leverage ratio in effect from time to time as set forth in the table below.

Applicable Interest Margins

The Term Loan A and borrowings under the Revolving Credit Facility have an initial applicable margin of 0.75% per annum for Base Rate Loans and 1.75% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the applicable margin for the Term Loan A and borrowings under the Revolving Credit Facility will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:

Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
Greater than 4.00 to 1.0	2.25%	1.25%	0.35%
Less than or equal to 4.00 to 1.0 but greater than 3.00 to 1.0	2.00%	1.00%	0.30%
Less than or equal to 3.00 to 1.0 but greater than 2.50 to 1.0	1.75%	0.75%	0.25%
Less than or equal to 2.50 to 1.0 but greater than 2.00 to 1.0	1.50%	0.50%	0.20%
Less than or equal to 2.00 to 1.0	1.25%	0.25%	0.15%

The Term Loan B has an initial applicable margin of 1.5% per annum for Base Rate Loans and 2.5% per annum for Term SOFR Loans.

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the applicable margin for the Term Loan B will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:

Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans
Greater than 2.75 to 1.0	2.50%	1.50%
Less than 2.75 to 1.0	2.25%	1.25%

Principal Payments

Principal payments on the Term Loans are due on the last day of each calendar quarter commencing on June 30, 2022.

The Term Loan A will amortize in nineteen consecutive quarterly installments in an amount equal to 2.50% of the original principal amount in each of the first two years, 5.00% in each of the third and fourth years and 7.50% in the fifth year, with a final payment of the remaining outstanding principal balance due on the maturity date.

The Term Loan B matures in twenty-seven consecutive quarterly installments in an amount equal to 0.25% of the original principal amount, with a final payment of the remaining outstanding principal balance due on the maturity date.

We may borrow, prepay and re-borrow amounts under the Revolving Credit Facility, in accordance with the terms and conditions of the Credit Agreement, with all outstanding amounts due at maturity.

During March 2022, we prepaid $16.0 million in principal payments on the Term Loan A principal balance. For the nine months ended September 30, 2023 and 2022 total principal payments on both Term Loans were $22.3 million and $20.3 million, respectively.

Interest Payments

Interest payments on Base Rate Loans are payable quarterly in arrears on the last business day of each calendar quarter and the applicable maturity date. Interest periods on Term SOFR Loans will be determined, at our option, as either one, three or six months and will be payable on the last day of each interest period and the applicable maturity date. In the case of any interest periods of more than three months' duration, the interest payment will be payable on each day prior to the last day of such interest period that occurs at three-month intervals.

The commitment fee on the Revolving Credit Facility is payable quarterly in arrears on the third business day following the last day of each calendar quarter and at the maturity date. The commitment fee is included in interest expense in our condensed consolidated statements of operations.

Guarantors and Collateral

Our obligations under the Credit Agreement are unconditionally guaranteed, on a joint and several basis, by ICU Medical, Inc. and certain of our existing subsidiaries.

Debt Covenants

The Credit Agreement contains affirmative and negative covenants, including certain financial covenants. The negative covenants include restrictions regarding the incurrence of liens and indebtedness, certain merger and acquisition transactions, asset sales and other dispositions, other investments, dividends, share purchases and payments affecting subsidiaries, changes in nature of business, fiscal year or organizational documents, prepayments and redemptions of subordinated and other junior debt, transactions with affiliates, and other matters.

The financial covenants include the Senior Secured Leverage Ratio and the Interest Coverage Ratio, both defined below, and pertain to the Term Loan A and the Revolving Credit Facility.

The Senior Secured Leverage Ratio is defined, at any measurement date, as the ratio of: (a) all Funded Debt, as defined in the Credit Agreement, that is secured by a lien on any asset or property minus the lesser of (i) all unrestricted cash and cash equivalents and (ii) $500.0 million, to (b) Consolidated EBITDA, as defined in the Credit Agreement, for the most recently completed four fiscal quarters, calculated on a pro forma basis. The maximum Senior Secured Leverage Ratio is 4.50 to 1.00 until June 30, 2024. Thereafter, the maximum Senior Secured Leverage Ratio is 4.00 to 1.00, with limited permitted exception.

The Interest Coverage ratio is defined, at any measurement date, as the ratio of Consolidated EBITDA, as defined in the Credit Agreement, to Consolidated Interest Expense, as defined in the Credit Agreement, paid or payable in cash, for the most recently completed four fiscal quarters. The minimum Interest Coverage ratio is 3.00 to 1.00.

We were in compliance with all financial covenants as of September 30, 2023.

The Credit Agreement contains customary events of default, including, among others: non-payments of principal and interest; breach of representations and warranties; covenant defaults; cross-defaults and cross-acceleration to certain other material indebtedness; the existence of bankruptcy or insolvency proceedings; certain events under ERISA; material judgments; and a change of control. If an event of default occurs and is not cured within any applicable grace period or is not waived, the administrative agent and the Lenders are entitled to take various actions, including, without limitation, the acceleration of all amounts due and the termination of commitments under the Senior Secured Credit Facilities.

2017 Credit Facility

    On November 8, 2017, we entered into a five-year senior secured revolving credit facility with various lenders for $150.0 million, with Wells Fargo Bank, National Association as the administrative agent, swingline lender and issuing lender (the "Prior Credit Facility"). The Prior Credit Facility, which was set to mature on November 8, 2022, was terminated in connection with entering into the Credit Agreement on January 6, 2022.

The carrying values of our long-term debt consist of the following (in thousands):

	Effective Interest Rate		As of September 30, 2023		Effective Interest Rate		As of December 31, 2022
Senior Secured Credit Facilities:
Term Loan A — principal	7.62	%	$	818,125	3.99	%	$	834,000
Term Loan B — principal	7.96	%	837,250		4.61	%	843,625
Revolving Credit Facility — principal	—	%	—		—	%	—
Less unamortized debt issuance costs(1)			(20,443)				(24,262)
Total carrying value of long-term debt			1,634,932				1,653,363
Less current portion of long-term debt			45,688				29,688
Long-term debt, net			$	1,589,244			$	1,623,675

_______________________________

(1)    Comprised of $10.1 million and $10.3 million relating to the Term Loan A and the Term Loan B, respectively, as of September 30, 2023.

As of September 30, 2023, the aggregate amount of principal repayments of our long-term debt (including any current portion) for each of the next five years is approximately (in thousands):

Remainder of 2023	$	7,437
2024	51,000
2025	51,000
2026	72,250
2027	672,563
2028	8,500
Thereafter	792,625
Total	$	1,655,375

The following table presents the total interest expense related to our long-term debt (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Contractual interest	$	32,494	$	19,228	$	92,593	$	41,868
Amortization of debt issuance costs	1,704		1,758		5,108		5,200
Commitment fee — Revolving Credit Facility	384		334		1,135		994
Total long-term debt-related interest expense	$	34,582	$	21,320	98,836		48,062

We currently hedge against the contractual interest expense on our long-term debt (see Note 8: Derivatives and Hedging Activities).

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Commitments and Contingencies:

9 Months Ended

Sep. 30, 2023

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies [Text Block]

Commitments and Contingencies

Legal Proceedings

From time to time, we are involved in various legal proceedings, most of which are routine litigation, in the normal course of business. Our management does not believe that the resolution of the unsettled legal proceedings that we are involved with will have a material adverse impact on our financial position or results of operations.

Off-Balance Sheet Arrangements

    In the normal course of business, we have agreed to indemnify our officers and directors to the maximum extent permitted under Delaware law and to indemnify customers as to certain intellectual property matters or other matters related to sales of our products. There is no maximum limit on the indemnification that may be required under these agreements. 

Although we can provide no assurances, we have never incurred, nor do we expect to incur, any material liability for indemnification.

Contingencies

On January 6, 2022, we acquired Smiths Medical. Total consideration for the acquisition includes a potential earn-out payment of $100.0 million in cash contingent on our common stock achieving a certain volume-weighted average price from the closing date to either the third or fourth anniversary of closing. As of September 30, 2023, the estimated fair value of the contingent earn-out is $7.1 million (see Note 9: Fair Value Measurements).

Prior to being acquired, during 2021, Smiths Medical received a Warning Letter from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility. The Warning Letter cited, among other things, failures to comply with FDA's medical device reporting requirements and failures to comply with applicable portions of the Quality System Regulation. A provision for the estimated costs related to the field service corrective action was recorded on the opening acquired balance sheet of Smiths Medical in the amount of $55.1 million. The initial estimate recorded was based on a probability-weighted estimate of the costs required to settle the obligation. The actual costs to be incurred are dependent upon the scope of the work necessary to achieve regulatory clearance and could differ from the original estimate. The estimated field service corrective action recorded at September 30, 2023 is $42.8 million.

In November 2021, we acquired a small foreign infusion systems supplier. Total consideration for the acquisition included a potential earn-out payment of up to $2.5 million, consisting of (i) a cash payment of $1.0 million contingent on the achievement of certain revenue targets for the annual period ending December 31, 2022 and, separately, (ii) a cash payment of $1.5 million contingent on certain product-related regulatory certifications obtained by May 26, 2024. As of December 31, 2022, the measurement period related to (i) above ended and based on the actual revenue achieved during the measurement period we determined that the fair value of the contingent earn-out was zero as the minimum threshold for earning the earn-out was not met. As of September 30, 2023, the estimated fair value of the contingent earn-out related to certain product-related regulatory certification was estimated to be $1.5 million (see Note 9: Fair Value Measurements).

In August 2021, we entered into an agreement with one of our international distributors whereby that distributor would not compete with us in a specific territory for a three-year period that will end in September 2024. The terms of the agreement include a contingent earn-out payment. The contingent earn-out shall not exceed $6.0 million, which will be earned based on certain revenue targets over a twelve-month measurement period determined by the highest four consecutive quarters commencing over a two-year period starting on the closing date of the agreement and provided that the distributor is in compliance with its obligations under the agreement. As of September 30, 2023, the estimated fair value of the contingent earn-out is $4.3 million (see Note 9: Fair Value Measurements).

Commitments

    We have non-cancelable operating lease agreements where we are contractually obligated to pay certain lease payment amounts (see Note 6: Leases).

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Collaborative and Other Arrangements (Notes)	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Collaborative Arrangement Disclosure [Text Block]	Collaborative and Other Arrangements    On February 3, 2017, we entered into two Manufacturing and Supply Agreements ("MSAs") whereby (i) Pfizer will manufacture and supply us with certain agreed upon products for an initial five-year term with a one-time two-year option to extend and (ii) we will manufacture and supply Pfizer certain agreed upon products for a term of five or ten years depending on the product, also with a one-time two-year option to extend. The MSAs provide each party with mutually beneficial interests and both of the MSAs are to be jointly managed by both Pfizer and ICU. The initial supply price, which is subject to an annual update, is in full consideration for all costs associated with the manufacture, documentation, packaging and certification of the products. On January 1, 2021, we amended our MSA with Pfizer, whereby we manufacture and supply certain agreed upon products to Pfizer. The amendments included a change to the term of the agreement to end on December 31, 2024 with Pfizer's unilateral election to extend through December 31, 2025. Other changes to the terms of the MSA included (i) amendments to our level of supply of products to Pfizer, (ii) certain changes to our manufacturing lines, (iii) updates to our supply price with added volume price tiers for annual periods and (iv) certain minimum purchase requirements for certain products. On February 1, 2022, effective as of January 1, 2022, upon our request, Pfizer executed a Product Addendum (the "Product Addendum") to our MSA, whereby Pfizer manufactures and supplies to us certain agreed upon products. The Product Addendum includes the supply of additional product to us subject to certain time and pricing terms and conditions. The Product Addendum includes a minimum purchase obligation of $29.6 million and expired on November 30, 2022. As of November 30, 2022, we had satisfied the minimum purchase obligations under the Product Addendum.

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Equity

9 Months Ended

Sep. 30, 2023

Equity [Abstract]

Stockholders' Equity Note Disclosure

Stockholders' Equity

Shareholders Agreement

At the completion of the Smiths Medical acquisition on January 6, 2022, Smiths owned approximately 10.5% of the total outstanding shares of our common stock (see Note 3: Acquisitions). At closing, in connection with the issuance of the share consideration, we entered into a Shareholders Agreement (the “Shareholders Agreement”) with Smiths. The Shareholders Agreement imposes certain restrictions on Smiths including prohibiting certain transfers of the shares of our common stock issued (i) for 6 months following the closing of the acquisition and (ii) to certain of our competitors and certain other parties, as well as customary standstill limitations. The Shareholders Agreement also permits Smiths to designate one individual for election to our Board of Directors (the "Board") so long as Smiths beneficially owns at least 5.0% of the total outstanding shares of our common stock. On February 1, 2022, our Board appointed a new director designated by Smiths pursuant to the Shareholders Agreement who was elected to the Board at the 2022 Annual Meeting of Stockholders held in May 2022. This appointment expanded the size of our Board from eight to nine members. See our Current Report on Form 8-K filed on February 1, 2022 for additional information.

Treasury Stock

    In August 2019, our Board approved a share purchase plan to purchase up to $100.0 million of our common stock. This plan has no expiration date. During the three months ended September 30, 2023, we did not purchase any shares of our common stock under our share purchase plan. As of September 30, 2023, all of the $100.0 million available for purchase was remaining under the plan. We are currently limited on share purchases in accordance with the terms and conditions of our Credit Agreement (see Note 17: Long-Term Debt).

    For the nine months ended September 30, 2023, we withheld 58,089 shares of our common stock from employee vested restricted stock units in consideration for $9.2 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. For the nine months ended September 30, 2022, we withheld 45,370 shares of our common stock from employee vested restricted stock units in consideration for $10.5 million in payments made on the employees' behalf for their minimum statutory income tax withholding obligations. Treasury stock is used to issue shares for stock option exercises and restricted stock grants.

Accumulated Other Comprehensive (Loss) Income ("AOCI")

    The components of AOCI, net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2023	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income (loss) before reclassifications	24,983		(113)		(31)		24,839
Amounts reclassified from AOCI	—		(5,464)		—		(5,464)
Other comprehensive income (loss)	24,983		(5,577)		(31)		19,375
Balance as of March 31, 2023	$	(97,990)	$	35,202	$	1,185	$	(61,603)
Other comprehensive (loss) income before reclassifications	7,569		13,175		(34)		20,710
Amounts reclassified from AOCI	—		(7,901)		—		(7,901)
Other comprehensive income (loss)	7,569		5,274		(34)		12,809
Balance as of June 30, 2023	$	(90,421)	$	40,476	$	1,151	$	(48,794)
Other comprehensive (loss) income before reclassifications	(37,557)		10,824		(35)		(26,768)
Amounts reclassified from AOCI	—		(9,165)		—		(9,165)
Other comprehensive (loss) income	(37,557)		1,659		(35)		(35,933)
Balance as of September 30, 2023	$	(127,978)	$	42,135	$	1,116	$	(84,727)

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2022	$	(19,045)	$	(237)	$	13	$	(19,269)
Other comprehensive (loss) income before reclassifications	(4,946)		25,782		15		20,851
Amounts reclassified from AOCI	—		(2,210)		—		(2,210)
Other comprehensive (loss) income	(4,946)		23,572		15		18,641
Balance as of March 31, 2022	$	(23,991)	$	23,335	$	28	$	(628)
Other comprehensive (loss) income before reclassifications	(99,805)		10,245		14		(89,546)
Amounts reclassified from AOCI	—		(2,101)		—		(2,101)
Other comprehensive (loss) income	(99,805)		8,144		14		(91,647)
Balance as of June 30, 2022	$	(123,796)	$	31,479	$	42	$	(92,275)
Other comprehensive (loss) income before reclassifications	(90,549)		18,784		227		(71,538)
Amounts reclassified from AOCI	—		(1,869)		—		(1,869)
Other comprehensive (loss) income	(90,549)		16,915		227		(73,407)
Balance as of September 30, 2022	$	(214,345)	$	48,394	$	269	$	(165,682)

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Transfers and Servicing

9 Months Ended

Sep. 30, 2023

Transfers and Servicing [Abstract]

Transfers and Servicing of Financial Assets

Accounts Receivable Purchase Program

On January 19, 2023, we entered into a revolving $150 million uncommitted receivables purchase agreement with Bank of The West ("BOW") which provides for a less expensive form of capital. The discount rate applied to the sold receivables equals a rate per annum equal to the sum of (i) an applicable margin of 1.75%, plus (ii) Term SOFR for a period equal to the discount period which is calculated with respect to the payment terms of the specific receivable. The accounts receivable sold have payment terms ranging between 30 and 60 days, and are related to customer accounts with good credit history. The transfer of the purchased accounts receivable under the agreement is intended to be an absolute and irrevocable transfer constituting a true sale as the transferred receivables have been isolated beyond the reach of the Company and our creditors, even in bankruptcy or other receivership. We do not retain effective control over the sold receivables and BOW has the right upon purchase to pledge and/or exchange the transferred assets without restrictions. The Company acts as collection agent for BOW and collection services are undertaken by our accounts receivable personnel in their normal course of business and collected funds are remitted to BOW. We do not have any continuing involvement with the sold receivables other than the collection services which does not provide us with more than a trivial benefit. The discount rate has been negotiated net of consideration for the collection services, the cost of collection is immaterial to the Company; therefore, we did not separately record any related servicing assets or liabilities related to the sold receivables.

For the nine months ended September 30, 2023, the carrying value of trade receivables sold to BOW in connection with the purchase program was $452.6 million. In exchange for the sale of trade receivables, we received cash of $450.0 million. For the three and nine months ended September 30, 2023, the sale of the receivables resulted in a loss of $1.0 million and $2.7 million, respectively, recorded in other expense, net in our condensed consolidated statement of operations. For the nine months ended September 30, 2023, we have collected and remitted $390.2 million in cash to BOW. As of September 30, 2023, cash remaining to be collected on behalf of BOW was $62.4 million, which has been removed from our condensed consolidated balance sheet as of September 30, 2023 and is reflected as cash provided by operating activities in the condensed consolidated statement of cash flows. There were no such balances at December 31, 2022. The carrying value of the sold receivables approximated the fair value at September 30, 2023.

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Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022
Pay vs Performance Disclosure
Net Income Attributable to Parent	$ 7,238	$ (9,934)	$ (9,812)	$ (13,208)	$ (7,474)	$ (38,068)

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Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2023 shares
Virginia Sanzone [Member]
Trading Arrangements, by Individual
Name	Virginia Sanzone / CVP, General Counsel
Title	Virginia Sanzone / CVP, General Counsel
Rule 10b5-1 Arrangement Adopted	false
Adoption Date	August 14, 2023
Termination Date	August 14, 2024
Aggregate Available	2,050
Vivek Jain [Member]
Trading Arrangements, by Individual
Name	Vivek Jain, Chief Executive Officer
Title	Vivek Jain, Chief Executive Officer
Adoption Date	March 15, 2023
Rule 10b5-1 Arrangement Terminated	false
Termination Date	February 9, 2024
Aggregate Available	206,366

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Business Combinations and Asset Acquisitions (Tables)

3 Months Ended

Sep. 30, 2023

Business Combination and Asset Acquisition [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the final purchase price and the final allocation of the purchase price related to the assets acquired and liabilities assumed (in thousands):

Cash consideration for acquired assets	$	1,922,955
Fair value of contingent consideration payable to Smiths	53,520
Issuance of ICU Medical, Inc. common shares:
Number of shares issued to Smiths	2,500
Price per share (ICU's opening market price on the acquisition date)	$	230.39
Fair value of ICU shares issued to Smiths	$	575,975
Total Consideration	$	2,552,450
Purchase Price Allocation:
Cash and cash equivalents	$	78,791
Accounts receivable	106,132
Inventories	228,919
Prepaid expenses and other current assets	53,554
Property, plant and equipment	206,333
Operating lease right-of-use assets	55,161
Intangible assets(1)	945,000
Other assets	379
Accounts payable	(105,291)
Accrued liabilities(2)	(173,151)
Income tax payable	(40,312)
Other long-term liabilities	(85,490)
Deferred income taxes	(187,455)
Total identifiable net assets acquired	$	1,082,570
Goodwill - not tax deductible	1,469,880
Estimated Purchase Consideration	$	2,552,450

_______________________________

(1)    Identifiable intangible assets include $510.0 million of customer relationships, $400.0 million of developed technology, $30.0 million of internally developed software, and $5.0 million of trademark. The estimated weighted-average amortization period for the total identifiable intangible assets is approximately nine years, and, for each identifiable intangible asset is estimated as follows: eight years for customer relationships, ten years for developed technology, five years for internally developed software, and six months for the trademark.

(2)    Accrued liabilities includes, among other things, accrued warranty reserves, accrued restructuring initiatives, accrued salaries and related benefits, deferred revenue and accrued sales and use taxes.

Business Acquisition, Pro Forma Information

(In thousands)	Three months ended September 30, 2022		Nine months ended September 30, 2022
Revenues	$	597,857	$	1,722,357
Net Loss	$	(13,208)	$	(54,840)

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Restructuring, Strategic Transaction and Integration (Tables)

9 Months Ended

Sep. 30, 2023

Restructuring and Related Activities [Abstract]

Restructuring and Related Costs [Table Text Block]

The following table summarizes the activity in our restructuring-related accrual by major type of cost (in thousands):

	Severance Pay and Benefits		Retention and Facility Closure Costs		Total
Accrued balance, January 1, 2023	$	4,416	$	1,507	$	5,923
Charges incurred	2,732		—		2,732
Payments	(1,284)		—		(1,284)
Other(1)	(291)		(620)		(911)
Currency translation	70		16		86
Accrued balance, March 31, 2023	$	5,643	$	903	$	6,546
Charges incurred	1,290		20		1,310
Payments	(3,302)		(27)		(3,329)
Currency translation	227		17		244
Accrued balance, June 30, 2023	$	3,858	$	913	$	4,771
Charges incurred	583		522		1,105
Payments	(802)		(495)		(1,297)
Other(2)	—		(165)		(165)
Currency translation	(52)		(27)		(79)
Accrued balance, September 30, 2023	$	3,587	$	748	$	4,335

__________________________

(1) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended March 31, 2023. (2) Primarily relates to prior year accrued restructuring charges for estimated facility closure costs that were reversed during the three months ended September 30, 2023.

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Revenue (Tables)

9 Months Ended

Sep. 30, 2023

Revenue from Contract with Customer [Abstract]

Disaggregation of Revenue [Table Text Block]

The following table represents our revenues disaggregated by product line (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Product line	2023		2022		2023		2022
Consumables	242,010		251,572		715,108		732,756
Infusion Systems	148,981		161,555		463,836		448,426
Vital Care	162,320		184,730		492,326		520,801
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

For the three and nine months ended September 30, 2023, net sales to Medline made up approximately 18% and 16% of total revenues, respectively. For the three and nine months ended September 30, 2022, net sales to Medline made up approximately 16% and 15% of total revenues, respectively.

The following table represents our revenues disaggregated by geography (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Geography	2023		2022		2023		2022
United States	$	355,984	$	376,691	$	1,063,037	$	1,088,348
Europe, the Middle East and Africa	88,014		101,869		276,994		275,488
APAC	59,064		66,569		177,719		191,847
Other Foreign	50,249		52,728		153,520		146,300
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

Contract with Customer, Asset and Liability [Table Text Block]

The following table presents the changes in our contract balances for the nine months ended September 30, 2023 and 2022 (in thousands):

	Contract Liabilities
Beginning balance, January 1, 2023	$	(45,866)
Equipment revenue recognized	24,872
Equipment revenue deferred	(25,620)
Software revenue recognized	13,546
Software revenue deferred	(12,797)
Government grant deferred income*	(944)
Government grant recognized	3,164
Other deferred revenue	(1,674)
Other deferred revenue recognized	4,748
Ending balance, September 30, 2023	$	(40,571)
Beginning balance, January 1, 2022	$	(7,461)
Fair value of acquired deferred revenue	(51,245)
Equipment revenue recognized	22,757
Equipment revenue deferred	(13,420)
Software revenue recognized	12,761
Software revenue deferred	(12,978)
Government grant deferred income*	(3,434)
Government grant recognized	178
Other deferred revenue	(1,285)
Other deferred revenue recognized	3,488
Ending balance, September 30, 2022	$	(50,639)

Deferred Revenue, by Arrangement, Disclosure

As of September 30, 2023, revenue from remaining performance obligations is as follows:

	Recognition Timing
(in millions)	< 12 Months		> 12 Months
Equipment deferred revenue	$	(16,448)	$	(12)
Software deferred revenue	(8,261)		(707)
Government grant deferred income*	(1,451)		(10,548)
Other deferred revenue**	(2,575)		(569)
Total	$	(28,735)	$	(11,836)

_________________________________

*The government grant deferred income is amortized over the life of the related depreciable asset as a reduction to depreciation expense.

**Other deferred revenue includes pump development programs, purchased training and extended warranty.

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Leases (Tables)

9 Months Ended

Sep. 30, 2023

Leases [Abstract]

Lease, Cost [Table Text Block]

The following table presents the components of our lease cost (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Operating lease cost	$	5,968	$	5,819	$	18,162	$	16,472
Finance lease cost — interest	32		25		91		82
Finance lease cost — reduction of ROU asset	279		176		757		516
Short-term lease cost	3		1		29		7
Total lease cost	$	6,282	$	6,021	$	19,039	$	17,077

Cash Flow, Supplemental Disclosures [Text Block]

The following table presents the supplemental cash flow information related to our leases (in thousands):

	Nine months ended September 30,
	2023		2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	18,477	$	18,886
Operating cash flows from finance leases	$	91	$	25
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	14,423	$	4,771
Finance leases	$	932	$	266

Assets and Liabilities, Leases [Table Text Block]

The following table presents the supplemental balance sheet information related to our operating leases (in thousands, except lease term and discount rate):

	As of
	September 30, 2023			December 31, 2022
Operating leases
Operating lease right-of-use assets	$	73,767		$	74,864
Accrued liabilities	$	19,850		$	18,169
Other long-term liabilities	57,277			60,916
Total operating lease liabilities	$	77,127		$	79,085
Weighted-Average Remaining Lease Term
Operating leases	5.7 years			6.1 years
Weighted-Average Discount Rate
Operating leases	4.23		%	4.34		%

The following table presents the supplemental balance sheet information related to our finance leases (in thousands, except lease term and discount rate):

	As of
	September 30, 2023			December 31, 2022
Finance leases
Finance lease right-of-use assets	$	2,814		$	2,598
Accrued liabilities	$	897		$	816
Other long-term liabilities	2,018			1,855
Total finance lease liabilities	$	2,915		$	2,671
Weighted-Average Remaining Lease Term
Finance leases	4.2 years			4.8 years
Weighted-Average Discount Rate
Finance leases	4.85		%	4.23		%

Lessee, Operating Lease, Liability, Maturity [Table Text Block]

As of September 30, 2023, the maturities of our operating and finance lease liabilities for each of the next five years are approximately (in thousands):

	Operating Leases		Finance Leases
Remainder of 2023	$	5,866	$	301
2024	21,457		919
2025	16,108		711
2026	14,179		590
2027	10,316		266
2028	5,684		189
Thereafter	12,570		236
Total Lease Payments	86,180		3,212
Less imputed interest	(9,053)		(297)
Total	$	77,127	$	2,915

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Net Income Per Share (Tables)

9 Months Ended

Sep. 30, 2023

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

The following table presents the calculation of net earnings per common share (“EPS”) — basic and diluted (in thousands, except per share data): 

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Net income (loss)	$	7,238	$	(13,208)	$	(12,508)	$	(58,750)
Weighted-average number of common shares outstanding (basic)	24,132		23,908		24,075		23,828
Dilutive securities(1)	236		—		—		—
Weighted-average common and common equivalent shares outstanding (diluted)	24,368		23,908		24,075		23,828
EPS — basic	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)
EPS — diluted	$	0.30	$	(0.55)	$	(0.52)	$	(2.47)

_______________________________

(1)    Due to the net loss for the nine months ended September 30, 2023 and the three and nine months ended September 30, 2022, there are no potentially dilutive common shares included in the computation of diluted earnings per share.

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Derivative Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2023

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Cash Flow Hedging Instruments, Statements of Financial Performance and Financial Position, Location [Table Text Block]

The following table presents the fair values of our derivative instruments included within the Condensed Consolidated Balance Sheets (in thousands):

	Derivatives Designated as Cash Flow Hedging Instruments
Condensed Consolidated Balance Sheet Location	Foreign Exchange Contracts		Interest Rate Swaps		Gross Derivatives
As of September 30, 2023
Prepaid expenses and other current assets	$	8,630	$	30,447	$	39,077
Other assets	542		22,167		22,709
Total assets	$	9,172	$	52,614	$	61,786
Accrued liabilities	$	1,890	$	—	$	1,890
Other long-term liabilities	91		—		91
Total liabilities	$	1,981	$	—	$	1,981
As of December 31, 2022
Prepaid expenses and other current assets	$	4,860	$	28,431	$	33,291
Other assets	94		26,753		26,847
Total assets	$	4,954	$	55,184	$	60,138
Accrued liabilities	$	1,847	$	—	$	1,847
Other long-term liabilities	167		—		167
Total liabilities	$	2,014	$	—	$	2,014

We recognized the following gains on our derivative instruments designated as cash flow hedges in other comprehensive income before reclassifications to net loss (in thousands):

	Gain Recognized in Other Comprehensive Income
	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	$	1,757	$	3,383	$	10,260	$	11,720
Interest rate swaps	12,496		21,201		21,236		60,398
Total derivatives designated as cash flow hedging instruments	$	14,253	$	24,584	$	31,496	$	72,118

The following table presents the effects of our derivative instruments designated as cash flow hedges on the Condensed Consolidated Statements of Operations (in thousands):

Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss) [Table Text Block]

	Gain (Loss) Reclassified From Accumulated Other Comprehensive Loss into Income
			Three months ended September 30,				Nine months ended September 30,
	Location of Gain (Loss) Recognized in Income		2023		2022		2023		2022
Derivatives designated as cash flow hedging instruments:
Foreign exchange contracts	Total revenues		$	1,019	$	(1,690)	$	(429)	$	2,666
Foreign exchange contracts	Cost of goods sold		2,247		3,090		6,063		4,140
Foreign exchange contracts	Other expense, net	(1)	—		—		229		—
Foreign exchange contracts	Interest expense	(2)	—		462		13		717
Interest rate swaps	Interest expense		8,813		2,133		23,807		608
Total derivatives designated as cash flow hedging instruments			$	12,079	$	3,995	$	29,683	$	8,131

_______________________________

(1)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of ineffectiveness.

(2)    Represents location of gain reclassified from accumulated other comprehensive loss into income as a result of forecasted transactions no longer probable of occurring.

As of September 30, 2023, we expect an estimated $6.7 million in deferred gains on the outstanding foreign exchange contracts and an estimated $31.6 million in deferred gains on the interest rate swaps will be reclassified from accumulated other comprehensive loss to net income during the next 12 months concurrent with the underlying hedged transactions also being reported in net income.

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Fair Value Measures and Disclosures (Tables)

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

The following tables provide a reconciliation of the Level 3 earn-out liabilities measured at estimated fair value (in thousands):

	Earn-out Liability
Accrued balance, January 1, 2023	$	25,572
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(700)
Currency translation	33
Accrued balance, March 31, 2023	24,905
Change in fair value of earn-out (included in income from operations as a separate line item)(2)	4,016
Other	11
Currency translation	1
Accrued balance, June 30, 2023	28,933
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(15,572)
Other	58
Currency translation	(58)
Accrued balance, September 30, 2023	$	13,361

	Earn-out Liability
Accrued balance, January 1, 2022	$	2,589
Acquisition date fair value estimate of earn-out(3)	55,158
Currency translation	(46)
Accrued balance, March 31, 2022	57,701
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(27,194)
Currency translation	(98)
Accrued balance, June 30, 2022	30,409
Change in fair value of earn-out (included in income from operations as a separate line item)(1)	(4,059)
Currency translation	(108)
Accrued balance, September 30, 2022	$	26,242

_______________________________

(1) Primarily relates to the change in fair value of our Smiths Medical earn-out.

(2) Primarily relates to the change in fair value of our Smiths Medical earn-out and the earnout with one of our international distributors.

(3) $53.5 million of the change in fair value of earn-out relates to our acquisition of Smiths Medical, and $1.6 million of the change in fair value of earn-out relates to our acquisition of a small foreign infusions systems supplier in the fourth quarter of 2021 (see Note 3: Acquisitions).

Fair Value Measurement Inputs and Valuation Techniques

The following tables provide quantitative information about Level 3 inputs for fair value measurement of our earn-out liabilities related to Smiths Medical:

Smiths Medical Earn-out Liability

Simulation Input	As of September 30, 2023		As of December 31, 2022
Volatility	41.00	%	38.00	%
Risk-Free Rate	4.91	%	4.17	%

Fair Value, by Balance Sheet Grouping

Our assets and liabilities measured at fair value on a recurring basis consisted of the following Level 1, 2 and 3 inputs as defined above (in thousands):

	Fair value measurements as of September 30, 2023
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	1,306	$	—	$	1,306	$	—
Short-term government bonds	500		—		500		—
Foreign exchange contracts:
Prepaid expenses and other current assets	8,630		—		8,630		—
Other assets	542		—		542		—
Interest rate contracts:
Prepaid expenses and other current assets	30,446		—		$	30,446	—
Other assets	22,167		—		$	22,167	—
Total Assets	$	63,591	$	—	$	63,591	$	—
Liabilities:
Contingent earn-out liability - ST	$	6,300	$	—			$	6,300
Contingent earn-out liability - LT	7,061		—				$	7,061
Foreign exchange contracts:
Accrued liabilities	1,890		—		$	1,890	—
Other long-term liabilities	91		—		$	91	—
Total Liabilities	$	15,342	$	—	$	1,981	$	13,361

	Fair value measurements as of December 31, 2022
	Total carrying value		Quoted prices in active markets for identical assets (level 1)		Significant other observable inputs (level 2)		Significant unobservable inputs (level 3)
Assets:
Available-for-sale debt securities:
Short-term corporate bonds	$	2,314	$	—	$	2,314	$	—
Short-term U.S. treasury securities	1,412		1,412		—		—
Short-term government bonds	498		—		$	498	—
Long-term corporate bonds	516		—		$	516	—
Foreign exchange forwards:
Prepaid expenses and other current assets	4,860		—		$	4,860	—
Other assets	94		—		$	94	—
Interest rate contracts:
Prepaid expenses and other current assets	28,431		—		$	28,431	—
Other assets	26,753		—		$	26,753	—
Total Assets	$	64,878	$	1,412	$	63,466	$	—
Liabilities:
Contingent earn-out liability - LT	$	25,572	$	—	$	—	$	25,572
Foreign exchange contracts:
Accrued liabilities	1,847		—		1,847		—
Other long-term liabilities	167		—		167		—
Total Liabilities	$	27,586	$	—	$	2,014	$	25,572

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Investment Securities (Tables)

9 Months Ended

Sep. 30, 2023

Investments, Debt and Equity Securities [Abstract]

Schedule of Available-for-sale Securities Reconciliation [Table Text Block]

Our short-term and long-term investments in available-for-sale securities consist of the following (in thousands):

	As of September 30, 2023
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	1,306		$	—	$	1,306
Short-term government bonds	500		—		500
Total investment securities	$	1,806	$	—	$	1,806
	As of December 31, 2022
	Amortized Cost		Unrealized Holding Gains (Losses)		Fair Value
Short-term corporate bonds	$	2,314	$	—	$	2,314
Short-term U.S. treasury securities	1,412		—		1,412
Short-term government bonds	498		—		498
Long-term corporate bonds	516		—		516
Total investment securities	$	4,740	$	—	$	4,740

Equity Method Investments [Table Text Block]

Our non-marketable equity method investment consists of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Equity method investment	$	3,145	$	3,178

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Prepaids and Other Current Assets (Tables)

9 Months Ended

Sep. 30, 2023

Prepaid Expense and Other Assets [Abstract]

Prepaid Expenses and Other Current Assets [Table Text Block]

Prepaid expenses and other current assets consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Other prepaid expenses and receivables	$	21,880	$	21,635
Prepaid vendor expenses	1,657		3,052
Deferred costs	5,676		2,395
Prepaid insurance and property taxes	4,245		16,322
VAT/GST receivable	2,390		3,546
Deferred tax charge	4,935		3,830
Foreign exchange contracts	8,630		4,860
Interest rate contracts	30,446		28,431
Deposits	1,227		1,329
Other	3,326		3,532
	$	84,412	$	88,932

Schedule of Other Assets, Noncurrent[TableTextBlock]

Other assets consist of the following (in thousands):

	As of
	September 30, 2023		December 31, 2022
Pump lease receivables	$	29,070	$	27,086
Spare parts	44,076		38,498
Equity method investment	3,145		3,178
Deferred debt issuance costs	3,867		5,156
Finance lease right-of-use assets	2,814		2,598
Interest rate contracts	22,167		26,753
Other	2,586		2,193
	$	107,725	$	105,462

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Inventories (Tables)

9 Months Ended

Sep. 30, 2023

Inventory Disclosure [Abstract]

Schedule of Inventory, Current [Table Text Block]

Inventories consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Raw materials	$	298,753	$	286,964
Work in process	75,935		73,795
Finished goods	384,934		335,250
Total inventories	$	759,622	$	696,009

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Property and Equipment (Tables)

9 Months Ended

Sep. 30, 2023

Property, Plant and Equipment [Abstract]

Property, Plant and Equipment [Table Text Block]

Property, plant and equipment consists of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Machinery and equipment	$	477,444	$	414,811
Land, building and building improvements	275,997		274,063
Molds	87,757		77,203
Computer equipment and software	120,743		115,214
Furniture and fixtures	30,311		29,876
Instruments placed with customers(1)	107,673		98,481
Construction in progress	106,051		152,909
Total property, plant and equipment, cost	1,205,976		1,162,557
Accumulated depreciation	(597,214)		(526,444)
Property, plant and equipment, net	$	608,762	$	636,113

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Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill [Table Text Block]

The following table presents the changes in the carrying amount of our goodwill (in thousands):

	Total
Balance as of January 1, 2023	$	1,449,258
Currency translation	(4,802)
Balance as of September 30, 2023	$	1,444,456

Schedule of Intangible Assets and Goodwill [Table Text Block]

Intangible assets, carried at cost less accumulated amortization and amortized on a straight-lined basis, were as follows (in thousands):

	Weighted-Average Amortization Life in Years	September 30, 2023
		Cost		Accumulated Amortization		Net
Patents	10	$	32,741	$	20,107	$	12,634
Customer contracts	12	9,860		6,631		3,229
Non-contractual customer relationships	8	545,192		151,573		393,619
Trademarks	1	5,425		5,425		—
Trade name	15	18,243		6,852		11,391
Developed technology	10	583,845		152,444		431,401
Non-compete	3	9,100		6,900		2,200
Total amortized intangible assets		$	1,204,406	$	349,932	$	854,474
Internally developed software*		$	36,806			$	36,806
Total intangible assets		$	1,241,212	$	349,932	$	891,280

______________________________

* Internally developed software will be amortized when the projects are complete and the assets are ready for their intended use.

	Weighted-Average Amortization Life in Years	December 31, 2022
		Cost		Accumulated Amortization		Net
Patents	10	$	29,998	$	18,610	$	11,388
Customer contracts	12	10,026		6,443		3,583
Non-contractual customer relationships	8	546,935		101,556		445,379
Trademarks	1	5,425		5,425		—
Trade name	15	18,251		5,959		12,292
Developed technology	10	583,176		108,708		474,468
Non-compete	3	9,100		5,250		3,850
Total amortized intangible assets		$	1,202,911	$	251,951	$	950,960
Internally developed software*		$	31,806			$	31,806
Total intangible assets		$	1,234,717	$	251,951	$	982,766

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]

As of September 30, 2023 estimated annual amortization for our intangible assets for each of the next five years is approximately (in thousands):

Remainder of 2023	$	32,407
2024	131,060
2025	123,490
2026	122,832
2027	112,782
2028	112,184
Thereafter	219,719
Total	$	854,474

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Accrued Liabilities (Tables)

9 Months Ended

Sep. 30, 2023

Accrued Liabilities [Abstract]

Schedule of Accrued Liabilities [Table Text Block]

Accrued liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Salaries and benefits	$	53,763	$	44,304
Incentive compensation	25,853		30,254
Operating lease liability-ST	19,850		18,169
Accrued sales taxes	6,440		5,844
Restructuring accrual	4,335		5,923
Deferred revenue	28,768		30,838
Accrued other taxes	5,657		5,794
Accrued professional fees	3,194		5,317
Italy medical device payback provision(1)	22,754		7,900
Legal accrual	1,601		3,137
Distribution fees	12,500		17,063
Warranties and returns	3,576		3,097
Field service corrective action(2)	26,382		24,517
Accrued freight	17,544		17,988
Foreign exchange contracts	1,890		1,847
Accrued research and development	—		3,538
Accrued audit fees	6,362		6,279
Defined benefit plan	2,064		2,928
Accrued interest	1,083		1,033
Other	7,708		6,999
	$	251,324	$	242,769

___________________________

(1)     As of December 31, 2022, there was $12.1 million in payback provision recorded as a reduction to accounts receivable, net. The Company reclassified such amount to accrued liabilities as of September 30, 2023. This amount was not reclassified as of December 31, 2022 to conform to the current year presentation.

(2)    Relates to field service corrective actions associated with certain products in connection with a 2021 Warning Letter received by Smiths Medical from the FDA following an inspection of Smiths Medical’s Oakdale, Minnesota Facility, see Note 19: Commitments and Contingencies for further detail.

Other long-term liabilities consist of the following (in thousands): 

	As of
	September 30, 2023		December 31, 2022
Operating lease liability-LT	$	57,277	$	60,916
Benefits	4,999		5,314
Accrued rent	864		997
Finance lease liability-LT	2,018		1,855
Deferred revenue	11,836		16,239
Field service corrective action(1)	19,470		25,294
Other	3,541		3,489
	$	100,005	$	114,104

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Long-Term Obligations (Tables)

3 Months Ended

Sep. 30, 2023

LOng-Term Obligations Disclosure [Abstract]

Schedule of Long-term Debt Instruments

The carrying values of our long-term debt consist of the following (in thousands):

	Effective Interest Rate		As of September 30, 2023		Effective Interest Rate		As of December 31, 2022
Senior Secured Credit Facilities:
Term Loan A — principal	7.62	%	$	818,125	3.99	%	$	834,000
Term Loan B — principal	7.96	%	837,250		4.61	%	843,625
Revolving Credit Facility — principal	—	%	—		—	%	—
Less unamortized debt issuance costs(1)			(20,443)				(24,262)
Total carrying value of long-term debt			1,634,932				1,653,363
Less current portion of long-term debt			45,688				29,688
Long-term debt, net			$	1,589,244			$	1,623,675

_______________________________

(1)    Comprised of $10.1 million and $10.3 million relating to the Term Loan A and the Term Loan B, respectively, as of September 30, 2023.

Schedule of Maturities of Long-term Debt

As of September 30, 2023, the aggregate amount of principal repayments of our long-term debt (including any current portion) for each of the next five years is approximately (in thousands):

Remainder of 2023	$	7,437
2024	51,000
2025	51,000
2026	72,250
2027	672,563
2028	8,500
Thereafter	792,625
Total	$	1,655,375

Interest expense on long term debt

The following table presents the total interest expense related to our long-term debt (in thousands):

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Contractual interest	$	32,494	$	19,228	$	92,593	$	41,868
Amortization of debt issuance costs	1,704		1,758		5,108		5,200
Commitment fee — Revolving Credit Facility	384		334		1,135		994
Total long-term debt-related interest expense	$	34,582	$	21,320	98,836		48,062

Applicable Margin Based on Leverage Ratio

Effective on the first Adjustment Date, as defined in the Credit Agreement, occurring subsequent to our quarter ending June 30, 2022, the applicable margin for the Term Loan A and borrowings under the Revolving Credit Facility will be determined by reference to the leverage ratio in effect from time to time as set forth in the following table:

Leverage Ratio	Applicable Margin for Term SOFR Loans	Applicable Margin for Base Rate Loans	Commitment Fee Rate
Greater than 4.00 to 1.0	2.25%	1.25%	0.35%
Less than or equal to 4.00 to 1.0 but greater than 3.00 to 1.0	2.00%	1.00%	0.30%
Less than or equal to 3.00 to 1.0 but greater than 2.50 to 1.0	1.75%	0.75%	0.25%
Less than or equal to 2.50 to 1.0 but greater than 2.00 to 1.0	1.50%	0.50%	0.20%
Less than or equal to 2.00 to 1.0	1.25%	0.25%	0.15%

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Equity (Tables)

9 Months Ended

Sep. 30, 2023

Equity [Abstract]

Schedule of Accumulated Other Comprehensive Income (Loss)

The components of AOCI, net of tax, were as follows (in thousands):

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2023	$	(122,973)	$	40,779	$	1,216	$	(80,978)
Other comprehensive income (loss) before reclassifications	24,983		(113)		(31)		24,839
Amounts reclassified from AOCI	—		(5,464)		—		(5,464)
Other comprehensive income (loss)	24,983		(5,577)		(31)		19,375
Balance as of March 31, 2023	$	(97,990)	$	35,202	$	1,185	$	(61,603)
Other comprehensive (loss) income before reclassifications	7,569		13,175		(34)		20,710
Amounts reclassified from AOCI	—		(7,901)		—		(7,901)
Other comprehensive income (loss)	7,569		5,274		(34)		12,809
Balance as of June 30, 2023	$	(90,421)	$	40,476	$	1,151	$	(48,794)
Other comprehensive (loss) income before reclassifications	(37,557)		10,824		(35)		(26,768)
Amounts reclassified from AOCI	—		(9,165)		—		(9,165)
Other comprehensive (loss) income	(37,557)		1,659		(35)		(35,933)
Balance as of September 30, 2023	$	(127,978)	$	42,135	$	1,116	$	(84,727)

	Foreign Currency Translation Adjustments		Unrealized (Losses) Gains on Cash Flow Hedges		Other Adjustments		Total
Balance as of January 1, 2022	$	(19,045)	$	(237)	$	13	$	(19,269)
Other comprehensive (loss) income before reclassifications	(4,946)		25,782		15		20,851
Amounts reclassified from AOCI	—		(2,210)		—		(2,210)
Other comprehensive (loss) income	(4,946)		23,572		15		18,641
Balance as of March 31, 2022	$	(23,991)	$	23,335	$	28	$	(628)
Other comprehensive (loss) income before reclassifications	(99,805)		10,245		14		(89,546)
Amounts reclassified from AOCI	—		(2,101)		—		(2,101)
Other comprehensive (loss) income	(99,805)		8,144		14		(91,647)
Balance as of June 30, 2022	$	(123,796)	$	31,479	$	42	$	(92,275)
Other comprehensive (loss) income before reclassifications	(90,549)		18,784		227		(71,538)
Amounts reclassified from AOCI	—		(1,869)		—		(1,869)
Other comprehensive (loss) income	(90,549)		16,915		227		(73,407)
Balance as of September 30, 2022	$	(214,345)	$	48,394	$	269	$	(165,682)

XML

Business Combinations and Asset Acquisitions (Details) - USD ($) shares in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022	[1]
Business Acquisition [Line Items]
Contingent Earn-Out Liability	$ 7,061,000	$ 7,061,000		$ 25,572,000
Minimum Stock Price Target for Earn-out Payment	$ 300.00	$ 300.00
Required Share Holding Of Stock Issued At Acquisition	0.500	0.500
Related Party Transaction, Purchases from Related Party	$ 300,000	$ 8,300,000
related party open payables	$ 0	$ 0
SmithsMedical
Business Acquisition [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired	100.00%	100.00%
Business Combination, Consideration Transferred, Cash	$ 1,900,000,000	$ 1,900,000,000
Contingent Earn-Out Liability	$ 100,000,000	$ 100,000,000
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares		2,500	2,500

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Business Combinations and Asset Acquisitions Smiths Medical (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Acquisition [Line Items]
Payments to Acquire Businesses, Gross				$ 1,922,955
Business Combination, Consideration Transferred, Liabilities Incurred			$ 55,158
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life				9 years
Customer Relationships
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life				8 years
Technology-Based Intangible Assets
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life				10 years
Software Development
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life				5 years
Trademarks [Member]
Business Acquisition [Line Items]
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life				6 years
SmithsMedical
Business Acquisition [Line Items]
Business Combination, Consideration Transferred, Liabilities Incurred		$ 53,500		$ 53,520
Business Acquisition, Equity Interest Issued or Issuable, Number of Shares				2,500	2,500
Business Acquisition, Share Price	$ 230.39			$ 230.39
Business Acquisition, Equity Interest Issued or Issuable, Value Assigned	$ 575,975			$ 575,975
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Cash and Equivalents	78,791			78,791
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Receivables	106,132			106,132
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Inventory	228,919			228,919
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets	53,554			53,554
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment	206,333			206,333
business combination, recognized identifiable asset acquired and liability assumed,	55,161			55,161
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	945,000			945,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Other Noncurrent Assets	379			379
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Accounts Payable	105,291			105,291
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities	173,151			173,151
Business Combinations, Identified Assumed Liabilities Recognized, Income tax payable	(40,312)			(40,312)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Other	(85,490)			(85,490)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Deferred Tax Liabilities	(187,455)			(187,455)
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net	1,082,570			1,082,570
Business combination, goodwill- non deductible	1,469,880			1,469,880
Business Combination, Consideration Transferred	2,552,450			2,552,450
SmithsMedical | Customer Relationships
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	510,000			510,000
SmithsMedical | developed technology
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	400,000			400,000
SmithsMedical | Trademarks and Trade Names
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	5,000			5,000
SmithsMedical | Software and Software Development Costs
Business Acquisition [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Finite-Lived Intangibles	$ 30,000			$ 30,000

XML

Business Combinations and Asset Acquisitions Smiths Medical Pro Forma (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Business Acquisition, Pro Forma Revenue			$ 1,722,357	$ 597,857
Business Acquisition [Line Items]
Revenues	$ 553,311	$ 597,857	1,671,270	1,701,983
Net (Loss) Income	7,238	(13,208)	(12,508)	(58,750)
Pro Forma Adjustment - Amortization				1,900
Pro Forma Adjustment - Finance Costs				1,400
Pro Forma Adjustment Inventory				27,400
Business Acquisition, Pro Forma Net Income (Loss)	$ (13,208)		$ (54,840)
Pro Forma Adjustment - Amortization				1,900
Pro Forma Adjustment - Finance Costs				1,400
SmithsMedical
Business Acquisition [Line Items]
Revenues		261,400		699,100
Net (Loss) Income		$ 13,600		$ 79,000

XML

Restructuring, Strategic Transaction and Integration Restructuring (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Restructuring and Related Activities [Abstract]
Restructuring, strategic transaction and integration	$ 7,200	$ 14,400	$ 30,500	$ 61,800
Restructuring Costs	1,100	$ 2,400	$ 5,100	$ 7,300
FacilityRestructuringCostsReversal	$ 200

XML

Restructuring, Strategic Transaction and Integration Liability (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	$ 4,771	$ 6,546	$ 5,923
Restructuring Charges	1,105	1,310	2,732
Payments for Restructuring	1,297	3,329	1,284
Restructuring Reserve, Accrual Adjustment	165		911
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	79	(244)	(86)
Restructuring Reserve	4,335	4,771	6,546
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	3,858	5,643	4,416
Restructuring Charges	583	1,290	2,732
Payments for Restructuring	802	3,302	1,284
Restructuring Reserve, Accrual Adjustment	0		291
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	52	(227)	(70)
Restructuring Reserve	3,587	3,858	5,643
Facility Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring Reserve	913	903	1,507
Restructuring Charges	522	20	0
Payments for Restructuring	495	27	0
Restructuring Reserve, Accrual Adjustment	165		620
Restructuring Reserve, Foreign Currency Translation Gain (Loss)	27	(17)	(16)
Restructuring Reserve	$ 748	$ 913	$ 903

XML

Strategic Transaction and Integration (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Restructuring and Related Activities [Abstract]
Strategic Transaction and Integration	$ 6.1	$ 12.0	$ 25.4	$ 54.5

XML

Revenue (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Revenues	$ 553,311,000	$ 597,857,000	$ 1,671,270,000	$ 1,701,983,000
Customer Concentration Risk
Disaggregation of Revenue [Line Items]
Revenues	$ 0.18	$ 16	$ 16	$ 15

XML

Revenue Disaggregated Revenue by Product Line (Details) - USD ($)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2023

Sep. 30, 2022

Sep. 30, 2023

Sep. 30, 2022

Disaggregation of Revenue [Line Items]

Revenues

$ 553,311

$ 597,857

$ 1,671,270

$ 1,701,983

Disaggregation of Revenue [Table Text Block]

The following table represents our revenues disaggregated by product line (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Product line	2023		2022		2023		2022
Consumables	242,010		251,572		715,108		732,756
Infusion Systems	148,981		161,555		463,836		448,426
Vital Care	162,320		184,730		492,326		520,801
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

For the three and nine months ended September 30, 2023, net sales to Medline made up approximately 18% and 16% of total revenues, respectively. For the three and nine months ended September 30, 2022, net sales to Medline made up approximately 16% and 15% of total revenues, respectively.

The following table represents our revenues disaggregated by geography (in thousands):

	Three months ended September 30,				Nine months ended September 30,
Geography	2023		2022		2023		2022
United States	$	355,984	$	376,691	$	1,063,037	$	1,088,348
Europe, the Middle East and Africa	88,014		101,869		276,994		275,488
APAC	59,064		66,569		177,719		191,847
Other Foreign	50,249		52,728		153,520		146,300
Total Revenues	$	553,311	$	597,857	$	1,671,270	$	1,701,983

Infusion Consumables [Member]

Disaggregation of Revenue [Line Items]

Revenues

242,010

251,572

$ 715,108

732,756

Infusion Systems [Member]

Disaggregation of Revenue [Line Items]

Revenues

148,981

161,555

463,836

448,426

Vital Care

Disaggregation of Revenue [Line Items]

Revenues

$ 162,320

$ 184,730

$ 492,326

$ 520,801

XML

Revenue Disaggregated Revenue by Geography (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Revenues	$ 553,311	$ 597,857	$ 1,671,270	$ 1,701,983
UNITED STATES
Disaggregation of Revenue [Line Items]
Revenues	355,984	376,691	1,063,037	1,088,348
EMEA [Member]
Disaggregation of Revenue [Line Items]
Revenues	88,014	101,869	276,994	275,488
Asia Pacific
Disaggregation of Revenue [Line Items]
Revenues	59,064	66,569	177,719	191,847
Other foreign countries [Member]
Disaggregation of Revenue [Line Items]
Revenues	$ 50,249	$ 52,728	$ 153,520	$ 146,300

XML

Revenue Contract Liabilities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Movement in Deferred Revenue [Roll Forward]
Contract with Customer, Liability	$ (45,866)	$ (7,461)
Contract with Customer, Liability	(40,571)	(50,639)
SmithsMedical
Movement in Deferred Revenue [Roll Forward]
Contract with Customer, Liability		(51,245)
Equipment revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	24,872	22,757
Deferred Revenue, Additions	(25,620)	(13,420)
Software revenue [Member]
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	13,546	12,761
Deferred Revenue, Additions	(12,797)	(12,978)
Government Grant Revenue
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	3,164	178
Deferred Revenue, Additions	(944)	(3,434)
Other deferred revenue
Movement in Deferred Revenue [Roll Forward]
Increase (Decrease) in Deferred Revenue	4,748	3,488
Deferred Revenue, Additions	$ (1,674)	$ (1,285)

XML

Revenue Deferred Revenue by Arrangement (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Short Term
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (28,735)
Short Term | Equipment revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(16,448)
Short Term | Software revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(8,261)
Short Term | Government Grant Revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(1,451)
Short Term | Other deferred revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(2,575)
Long Term
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(11,836)
Long Term | Equipment revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(12)
Long Term | Software revenue [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(707)
Long Term | Government Grant Revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	(10,548)
Long Term | Other deferred revenue
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue, Remaining Performance Obligation, Amount	$ (569)

XML

Leases Text (Details)	9 Months Ended
	Sep. 30, 2023
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Option to Extend	5 years
Minimum [Member]
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	1 year
Maximum [Member]
Lessee, Lease, Description [Line Items]
Lessee, Operating Lease, Term of Contract	15 years

XML

Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Leases [Abstract]
Operating Lease, Cost	$ 5,968	$ 5,819	$ 18,162	$ 16,472
Finance Lease, Interest Expense	32	25	91	82
Finance Lease, Right-of-Use Asset, Amortization	279	176	757	516
Short-term Lease, Cost	3	1	29	7
Lease, Cost	$ 6,282	$ 6,021	$ 19,039	$ 17,077

XML

Leases Cash Flow, Operating Activities, Lessee (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Leases [Abstract]
Operating Lease, Payments	$ 18,477	$ 18,886
Finance Lease, Interest Payment on Liability	91	25
Right-of-Use Asset Obtained in Exchange for Operating Lease Liability	14,423	4,771
Right-of-Use Asset Obtained in Exchange for Finance Lease Liability	$ 932	$ 266

XML

Leases Assets and Liabilities, Lessee (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Leases [Abstract]
Operating Lease Right-of-Use Asset	$ 73,767	$ 74,864	[1]
Operating Lease, Liability, Current	19,850	18,169
Operating Lease, Liability, Noncurrent	57,277	60,916
Operating Lease, Liability	$ 77,127	$ 79,085
Operating Lease, Weighted Average Remaining Lease Term	5 years 8 months 12 days	6 years 1 month 6 days
Operating Lease, Weighted Average Discount Rate, Percent	4.23%	4.34%
Finance Lease, Right-of-Use Asset	$ 2,814	$ 2,598
Finance Lease, Liability, Current	897	816
Finance Lease, Liability, Noncurrent	2,018	1,855
Finance Lease, Liability	$ 2,915	$ 2,671
Finance Lease, Weighted Average Remaining Lease Term	4 years 2 months 12 days	4 years 9 months 18 days
Finance Lease, Weighted Average Discount Rate, Percent	4.85%	4.23%

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Leases Maturity (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Leases [Abstract]
Lessee, Operating Lease, Liability, Payments, Remainder of Fiscal Year	$ 5,866
Lessee, Operating Lease, Liability, Payments, Due Next Twelve Months	21,457
Lessee, Operating Lease, Liability, Payments, Due Year Two	16,108
Lessee, Operating Lease, Liability, Payments, Due Year Three	14,179
Lessee, Operating Lease, Liability, Payments, Due Year Four	10,316
Lessee, Operating Lease, Liability, Payments, Due Year Five	5,684
Lessee, Operating Lease, Liability, Payments, Due after Year Five	12,570
Lessee, Operating Lease, Liability, Payments, Due	86,180
Lessee, Operating Lease, Liability, Undiscounted Excess Amount	(9,053)
Operating Lease, Liability	77,127	$ 79,085
Finance Lease, Liability, Payments, Remainder of Fiscal Year	301
Finance Lease, Liability, Payments, Due Next Twelve Months	919
Finance Lease, Liability, Payments, Due Year Two	711
Finance Lease, Liability, Payments, Due Year Three	590
Finance Lease, Liability, Payments, Due Year Four	266
Finance Lease, Liability, Payments, Due Year Five	189
Finance Lease, Liability, Payments, Due after Year Five	236
Finance Lease, Liability, Payment, Due	3,212
Finance Lease, Liability, Undiscounted Excess Amount	(297)
Finance Lease, Liability	$ 2,915	$ 2,671

XML

Net Income Per Share (Details 1) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Net (Loss) Income	$ 7,238	$ (13,208)	$ (12,508)	$ (58,750)
Basic (in shares)	24,132,000	23,908,000	24,075,000	23,828,000
Dilutive securities	236,000	0	0	0
Diluted (in shares)	24,368,000	23,908,000	24,075,000	23,828,000
Basic (in dollars per share)	$ 0.30	$ (0.55)	$ (0.52)	$ (2.47)
Diluted (in dollars per share)	$ 0.30	$ (0.55)	$ (0.52)	$ (2.47)
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	247,530

XML

Derivative Financial Instruments Foreign Exchange Forward Contracts(Details)	Sep. 30, 2023 USD ($)
Derivative [Line Items]
Derivative, Notional Amount	$ 152,700,000
other currencies
Derivative [Line Items]
Derivative, Notional Amount	7,400,000
Mexico, Pesos
Derivative [Line Items]
Derivative, Notional Amount	44,100,000
Euro Member Countries, Euro
Derivative [Line Items]
Derivative, Notional Amount	25,500,000
Japan, Yen
Derivative [Line Items]
Derivative, Notional Amount	14,400,000
China, Yuan Renminbi
Derivative [Line Items]
Derivative, Notional Amount	6,400,000
Canada, Dollars
Derivative [Line Items]
Derivative, Notional Amount	13,800,000
Australia, Dollars
Derivative [Line Items]
Derivative, Notional Amount	10,300,000
United States of America, Dollars
Derivative [Line Items]
Derivative, Notional Amount	$ 30,800,000

XML

Derivative Financial Instruments (Details) - Hedge 2 [Member]	Sep. 30, 2023	Dec. 31, 2022 MXN ($)
Derivative [Line Items]
Derivative, Forward Exchange Rate	21.60
Derivative Asset, Notional Amount		$ 103,800,000

XML

Derivative Financial Instruments Interest Rate Swaps (Details)	Sep. 30, 2023 USD ($)
Derivative [Line Items]
Derivative, Notional Amount	$ 152,700,000
Interest Rate Swap | Term Loan A
Derivative [Line Items]
Derivative, Notional Amount	300,000,000
Interest Rate Swap Ending Notional Value	$ 150,000,000
Derivative, Fixed Interest Rate	1.32%
derivative variable rate floor	(0.0015)
Interest Rate Swap | Term Loan B
Derivative [Line Items]
Derivative, Notional Amount	$ 750,000,000
Interest Rate Swap Ending Notional Value	$ 46,900,000
Derivative, Fixed Interest Rate	1.17%
derivative variable rate floor	0.0035
Interest Rate Swap | Swap 3 - Term Loan A & B
Derivative [Line Items]
Derivative, Notional Amount	$ 300,000,000
Interest Rate Swap | Swap 3
Derivative [Line Items]
Derivative, Fixed Interest Rate	3.88%

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - FV of Derivative Instruments Included Within Consolidated Balance Sheet (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Derivatives, Fair Value [Line Items]
Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]	Prepaid expenses and other current assets	Prepaid expenses and other current assets
Derivative Asset, Current	$ 39,077	$ 33,291
Derivative Asset, Noncurrent, Statement of Financial Position [Extensible Enumeration]	OTHER ASSETS	OTHER ASSETS
Derivative Asset, Noncurrent	$ 22,709	$ 26,847
Derivative Asset	$ 61,786	$ 60,138
Derivative Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Derivative Liability, Current	$ 1,890	$ 1,847
Derivative Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities
Derivative Liability, Noncurrent	$ 91	$ 167
Derivative Liability	1,981	2,014
Foreign Exchange Contract
Derivatives, Fair Value [Line Items]
Derivative Asset, Current	8,630	4,860
Derivative Asset, Noncurrent	542	94
Derivative Asset	9,172	4,954
Derivative Liability, Current	1,890	1,847
Derivative Liability, Noncurrent	91	167
Derivative Liability	1,981	2,014
Interest Rate Swap
Derivatives, Fair Value [Line Items]
Derivative Asset, Current	30,447	28,431
Derivative Asset, Noncurrent	22,167	26,753
Derivative Asset	52,614	55,184
Derivative Liability, Current	0	0
Derivative Liability, Noncurrent	0	0
Derivative Liability	$ 0	$ 0

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Cash Flow Hedge Activity Included in Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 14,253	$ 24,584	$ 31,496	$ 72,118
Foreign Exchange Contract
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	1,757	3,383	10,260	11,720
Interest Rate Swap
Derivative Instruments and Hedging Activities Disclosures [Line Items]
Other Comprehensive Income (Loss), before Tax	$ 12,496	$ 21,201	$ 21,236	$ 60,398

XML

Derivative Financial Instruments Derivative Instruments and Hedging Activities - Amounts Affecting Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Derivative Instruments, Gain (Loss) [Line Items]
Derivative, Net Hedge Ineffectiveness Gain (Loss)	$ 0		$ 229	$ 0
Foreign Currency Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months	6,700		6,700
Interest Rate Cash Flow Hedge Gain (Loss) to be Reclassified During Next 12 Months, Net	31,600		31,600
Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instruments, Gain Reclassified from Accumulated OCI into Income, Effective Portion	12,079	$ 3,995	$ 29,683	8,131
Foreign Exchange Contract | Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			TOTAL REVENUES
Gain on Discontinuation of Cash Flow Hedge Due to Forecasted Transaction Probable of Not Occurring	0	462	$ 13	717
Foreign Exchange Contract | Trading Revenue | Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(1,019)	1,690	$ (429)	2,666
Foreign Exchange Contract | Cost of Sales [Member] | Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			Cost of goods sold
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	(2,247)	(3,090)	$ 6,063	4,140
Interest Rate Swap | Cash Flow Hedging [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]			Interest Expense
Derivative Instruments, Gain (Loss) Reclassified from Accumulated OCI into Income, Effective Portion, Net	$ (8,813)	$ 2,133	$ 23,807	$ 608

XML

Fair Value Measures and Disclosures (Details) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Sep. 30, 2022 USD ($)	Jan. 06, 2022 USD ($)	Dec. 31, 2021 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 13,361	$ 13,361	$ 28,933	$ 24,905	$ 25,572	$ 26,242
Contingent Consideration, Gross ST	1,000
Contingent Consideration, Gross LT	$ 1,500
Ownership requirement for Earnout Payment	0.500	0.500
Liability
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross		$ 6,000
CONTINGENT EARN-OUT LIABILITY	$ 4,300	4,300
SmithsMedical
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	100,000
Business Combination, Contingent Consideration, Liability	7,100	7,100					$ 53,500
Foreign Infusion System Supplier
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
contingent consideration gross	2,500
CONTINGENT EARN-OUT LIABILITY								$ 2,589
Business Combination, Contingent Consideration, Liability	$ 1,500	$ 1,500

XML

Fair Value Measures and Disclosures Liabilities Recurring Basis Unobservable Input Reconciliation Roll Forward (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY	$ 13,361	$ 28,933	$ 24,905	$ 26,242			$ 13,361	$ 25,572
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)			(700)
Business Combination, Contingent Consideration, Other change in amount	58	11
Business Combination, Consideration Transferred, Liabilities Incurred						$ 55,158
Currency translation on earn-out	(58)	1	$ 33	(108)	$ (98)	(46)
International Distributor
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY				$ (4,059)
Foreign Infusion System Supplier
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY									$ 2,589
Business Combination, Consideration Transferred, Liabilities Incurred					1,600
SmithsMedical
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)	$ (15,572)				(27,194)
Business Combination, Consideration Transferred, Liabilities Incurred					53,500		$ 53,520
Smiths Medical & Foreign Infusion Systems Supplier
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
CONTINGENT EARN-OUT LIABILITY					$ 30,409	$ 57,701
Fair Value, Liability, Recurring Basis, Still Held, Unrealized Gain (Loss)		$ 4,016

XML

Fair Value Measures and Disclosures Liability Measurement Inputs (Details) - SmithsMedical	Sep. 30, 2023	Jan. 06, 2022
Measurement Input, Risk Free Interest Rate [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.0491	0.0417
Measurement Input, Price Volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.4100	0.3800

XML

Fair Value Measures and Disclosures Assets and Liabilities by Balance Sheet Grouping (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022		Sep. 30, 2022
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	$ 1,806	$ 4,224	[1]
Long-term investment securities	0	516
Assets, Fair Value Disclosure	$ 63,591	$ 64,878
Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]	Prepaid expenses and other current assets	Prepaid expenses and other current assets
Derivative Asset, Noncurrent, Statement of Financial Position [Extensible Enumeration]	OTHER ASSETS	OTHER ASSETS
Derivative Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued liabilities	Accrued liabilities
Derivative Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities
current
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	$ 8,630	$ 4,860
Interest Rate Derivative Assets, at Fair Value	30,446			$ 28,431
Foreign Currency Contracts, Liability, Fair Value Disclosure	1,890	1,847
noncurrent
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	542			94
Interest Rate Derivative Assets, at Fair Value	22,167			26,753
Foreign Currency Contracts, Liability, Fair Value Disclosure	91	167
Corporate Bond Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	1,306	2,314
US Treasury Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities		1,412
US Government Debt Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	500	498		498
Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	7,061	25,572
Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure		27,586
Financial Liabilities Fair Value Disclosure	15,342
Earn-out liability ST
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	6,300
Prepaid Expenses and Other Current Assets [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	8,630	4,860
Interest Rate Derivative Assets, at Fair Value	30,446	28,431
Fair Value, Inputs, Level 1 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term investment securities		0
Assets, Fair Value Disclosure	0	1,412
Fair Value, Inputs, Level 1 [Member] | current
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Interest Rate Derivative Assets, at Fair Value	0			0
Foreign Currency Contracts, Liability, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 1 [Member] | noncurrent
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0			0
Interest Rate Derivative Assets, at Fair Value	0			0
Foreign Currency Contracts, Liability, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 1 [Member] | Corporate Bond Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0	0
Fair Value, Inputs, Level 1 [Member] | US Treasury Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities		1,412
Fair Value, Inputs, Level 1 [Member] | US Government Debt Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0			0
Fair Value, Inputs, Level 1 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0
Fair Value, Inputs, Level 1 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure		0
Financial Liabilities Fair Value Disclosure	0
Fair Value, Inputs, Level 1 [Member] | ST Earnout Liability
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	0
Fair Value, Inputs, Level 2 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term investment securities		516
Assets, Fair Value Disclosure	63,591	63,466
Fair Value, Inputs, Level 2 [Member] | current
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	8,630	4,860
Interest Rate Derivative Assets, at Fair Value	30,446			28,431
Foreign Currency Contracts, Liability, Fair Value Disclosure	1,890	1,847
Fair Value, Inputs, Level 2 [Member] | noncurrent
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	542			94
Interest Rate Derivative Assets, at Fair Value	22,167			26,753
Foreign Currency Contracts, Liability, Fair Value Disclosure	91	167
Fair Value, Inputs, Level 2 [Member] | Corporate Bond Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	1,306	2,314
Fair Value, Inputs, Level 2 [Member] | US Treasury Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities		0
Fair Value, Inputs, Level 2 [Member] | US Government Debt Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	500			498
Fair Value, Inputs, Level 2 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure		0
Fair Value, Inputs, Level 2 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure		2,014
Financial Liabilities Fair Value Disclosure	1,981
Fair Value, Inputs, Level 2 [Member] | ST Earnout Liability
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure
Fair Value, Inputs, Level 3 [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term investment securities		0
Assets, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 3 [Member] | current
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0	0
Interest Rate Derivative Assets, at Fair Value	0			0
Foreign Currency Contracts, Liability, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 3 [Member] | noncurrent
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	0			0
Interest Rate Derivative Assets, at Fair Value	0			0
Foreign Currency Contracts, Liability, Fair Value Disclosure	0	0
Fair Value, Inputs, Level 3 [Member] | Corporate Bond Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0	0
Fair Value, Inputs, Level 3 [Member] | US Treasury Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities		0
Fair Value, Inputs, Level 3 [Member] | US Government Debt Securities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Short-term investment securities	0			$ 0
Fair Value, Inputs, Level 3 [Member] | Earn-out liability [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	7,061	25,572
Fair Value, Inputs, Level 3 [Member] | Liabilities, Total [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure		$ 25,572
Financial Liabilities Fair Value Disclosure	13,361
Fair Value, Inputs, Level 3 [Member] | ST Earnout Liability
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Nonfinancial Liabilities Fair Value Disclosure	$ 6,300

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Investment Securities (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($)
Investments, Debt and Equity Securities [Abstract]
Gain (Loss) on Sale of Investments	$ 0

XML

Investment Securities Table (Details) - USD ($) $ in Thousands	6 Months Ended	9 Months Ended
	Jun. 30, 2023	Sep. 30, 2023	Dec. 31, 2022		Sep. 30, 2022
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Amortized Cost		$ 1,806	$ 4,740
Debt Securities, Available-for-sale, Unrealized Loss	$ 0	0
Short-term investment securities		1,806	4,224	[1]
Long-term investment securities		0	516
Debt Securities, Available-for-sale		1,806	4,740
Corporate Debt Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Amortized Cost, Current		1,306	2,314
Debt Securities, Available-for-sale, Noncurrent			516
Debt Securities, Available-for-sale, Unrealized Loss	0	0
Short-term investment securities		1,306	2,314
Long-term investment securities			516
US Treasury Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Amortized Cost, Current			1,412
Debt Securities, Available-for-sale, Unrealized Loss	0
Short-term investment securities			1,412
US Government Debt Securities
Debt Securities, Available-for-sale [Line Items]
Debt Securities, Available-for-sale, Amortized Cost, Current		500	498
Debt Securities, Available-for-sale, Unrealized Loss	$ 0	0
Short-term investment securities		$ 500	$ 498		$ 498

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Equity Method Investments (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Equity Securities without Readily Determinable Fair Value [Line Items]
Equity Method Investment, Aggregate Cost	$ 3,300
Equity Method Investments	$ 3,145	$ 3,178
Non Public Company
Equity Securities without Readily Determinable Fair Value [Line Items]
Equity Method Investment, Ownership Percentage	20.00%

XML

Prepaids and Other Current Assets Prepaids and Other Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Prepaid Expense and Other Assets [Abstract]
Other Prepaid Expense, Current	$ 21,880	$ 21,635
Prepaid vendor expenses	1,657	3,052
Deferred Costs and Other Assets	5,676	2,395
Prepaid insurance and property taxes	4,245	16,322
Prepaid Taxes	2,390	3,546
Deferred tax charge	4,935	3,830
Deposit Assets	1,227	1,329
Other Assets, Current	3,326	3,532
Prepaid expenses and other current assets	84,412	88,932	[1]
Prepaid Expenses and Other Current Assets [Member]
Prepaid Expense and Other Assets [Abstract]
Foreign Currency Contract, Asset, Fair Value Disclosure	8,630	4,860
Interest Rate Derivative Assets, at Fair Value	30,446	28,431
Derivative [Line Items]
Foreign Currency Contract, Asset, Fair Value Disclosure	$ 8,630	$ 4,860

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Other Assets Noncurrent(Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Derivative [Line Items]
Derivative Asset, Noncurrent	$ 22,709	$ 26,847
Lessor, Operating Lease, Payments to be Received	29,070	27,086
Spare parts	44,076	38,498
Equity Method Investments	3,145	3,178
Debt Issuance Costs, Noncurrent, Net	3,867	5,156
Finance Lease, Right-of-Use Asset	2,814	2,598
Derivative Asset, Noncurrent	22,709	26,847
Other Assets, Miscellaneous, Noncurrent	2,586	2,193
OTHER ASSETS	107,725	105,462	[1]
Interest Rate Swap
Derivative [Line Items]
Derivative Asset, Noncurrent	22,167	26,753
Derivative Asset, Noncurrent	$ 22,167	$ 26,753

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Inventory, Raw Materials, Net of Reserves	$ 298,753	$ 286,964
Inventory, Work in Process, Net of Reserves	75,935	73,795
Inventory, Finished Goods, Net of Reserves	384,934	335,250
Total	$ 759,622	$ 696,009	[1]

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Machinery and Equipment, Gross	$ 477,444	$ 414,811
Total property and equipment, cost	1,205,976	1,162,557
Furniture and Fixtures, Gross	30,311	29,876
Construction in Progress, Gross	106,051	152,909
Accumulated depreciation	(597,214)	(526,444)
Net property and equipment	608,762	636,113	[1]
Land, Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	275,997	274,063
Molds [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	87,757	77,203
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	120,743	115,214
Instruments Placed with Customers [Member]
Property, Plant and Equipment [Line Items]
Total property and equipment, cost	$ 107,673	$ 98,481

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Property and Equipment Text (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Depreciation	$ 25.0	$ 23.0	$ 72.8	$ 69.4

XML

Goodwill and Intangible Assets Goodwill Table (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Dec. 31, 2022	[1]
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL	$ 1,444,456	$ 1,449,258
Goodwill, Foreign Currency Translation Gain (Loss)	$ (4,802)

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Goodwill and Intangible Assets Intangibles Table (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Assets, Gross	$ 1,204,406	$ 1,202,911
Finite-Lived Intangible Assets, Accumulated Amortization	349,932	251,951
Finite-Lived Intangible Assets, Net	854,474	950,960
Indefinite-lived Intangible Assets (Excluding Goodwill)	36,806	31,806
Intangible Assets, Gross (Excluding Goodwill)	1,241,212	1,234,717
INTANGIBLE ASSETS, net	$ 891,280	$ 982,766	[1]
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	10 years	10 years
Finite-Lived Intangible Assets, Gross	$ 32,741	$ 29,998
Finite-Lived Intangible Assets, Accumulated Amortization	20,107	18,610
Finite-Lived Intangible Assets, Net	$ 12,634	$ 11,388
Customer Contracts [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	12 years	12 years
Finite-Lived Intangible Assets, Gross	$ 9,860	$ 10,026
Finite-Lived Intangible Assets, Accumulated Amortization	6,631	6,443
Finite-Lived Intangible Assets, Net	$ 3,229	$ 3,583
Customer-Related Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	8 years	8 years
Finite-Lived Intangible Assets, Gross	$ 545,192	$ 546,935
Finite-Lived Intangible Assets, Accumulated Amortization	151,573	101,556
Finite-Lived Intangible Assets, Net	$ 393,619	$ 445,379
Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	1 year	1 year
Finite-Lived Intangible Assets, Gross	$ 5,425	$ 5,425
Finite-Lived Intangible Assets, Accumulated Amortization	5,425	5,425
Finite-Lived Intangible Assets, Net	$ 0	$ 0
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	15 years	15 years
Finite-Lived Intangible Assets, Gross	$ 18,243	$ 18,251
Finite-Lived Intangible Assets, Accumulated Amortization	6,852	5,959
Finite-Lived Intangible Assets, Net	$ 11,391	$ 12,292
Developed Technology Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	10 years	10 years
Finite-Lived Intangible Assets, Gross	$ 583,845	$ 583,176
Finite-Lived Intangible Assets, Accumulated Amortization	152,444	108,708
Finite-Lived Intangible Assets, Net	$ 431,401	$ 474,468
Noncompete Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Finite-Lived Intangible Asset, Useful Life	3 years	3 years
Finite-Lived Intangible Assets, Gross	$ 9,100	$ 9,100
Finite-Lived Intangible Assets, Accumulated Amortization	6,900	5,250
Finite-Lived Intangible Assets, Net	$ 2,200	$ 3,850

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

XML

Goodwill and Intangible Assets Text (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of Intangible Assets	$ 33,400,000	$ 35,600,000	$ 98,800,000	$ 108,900,000

XML

Goodwill and Intangible Assets 5-Year Amortization (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	$ 32,407
Finite-Lived Intangible Assets, Amortization Expense, Next Twelve Months	131,060
Finite-Lived Intangible Assets, Amortization Expense, Year Two	123,490
Finite-Lived Intangible Assets, Amortization Expense, Year Four	122,832
Finite-Lived Intangible Assets, Amortization Expense, Year Five	112,782
Finite-Lived Intangible Assets, Amortization Expense, Year Five	112,184
Finite-Lived Intangible Assets, Amortization Expense, after Year Five	219,719
Finite-Lived Intangible Assets, Net	$ 854,474	$ 950,960

XML

Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022		Jan. 06, 2022
Accrued Liabilities [Abstract]
Salaries and benefits	$ 53,763	$ 44,304
Incentive compensation	25,853	30,254
Operating Lease, Liability, Current	19,850	18,169
Sales taxes	6,440	5,844
Restructuring accrual	4,335	5,923
UnfavorablecontractliabilityST	28,768	30,838
Accrued other taxes	5,657	5,794
Accrued Professional Fees	3,194	5,317
Legal accrual	1,601	3,137
Distribution Fees	12,500	17,063
Warranties and returns	3,576	3,097
Field service corrective action	26,382	24,517
Accrued freight	17,544	17,988
Derivative Liability, Current	1,890	1,847
Other	7,708	6,999
Accrued liabilities	251,324	242,769	[1]
Liability, Defined Benefit Plan, Current	2,064	2,928
Accrued audit fees	6,362	6,279
Derivative [Line Items]
Derivative Liability, Current	1,890	1,847
Product Liability Contingency [Line Items]
Product Liability Accrual, Component Amount	42,800			$ 55,100
Interest Payable	1,083	1,033
accrued research and development	0	3,538
Accrued liability Italy payment scheme	22,754	7,900
Contra AR - Italy Payment Scheme		12,100
Foreign Exchange
Accrued Liabilities [Abstract]
Derivative Liability, Current	1,890	1,847
Derivative [Line Items]
Derivative Liability, Current	$ 1,890	$ 1,847

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

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Accrued Liabilities Long-term liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Jan. 06, 2022
Accrued Liabilities [Abstract]
Operating Lease, Liability, Noncurrent	$ 57,277	$ 60,916
Accrued Employee Benefits	4,999	5,314
Accrued Rent	864	997
Derivative Liability, Noncurrent	91	167
Finance Lease, Liability, Noncurrent	2,018	1,855
Other Accrued Liabilities, Noncurrent	3,541	3,489
OTHER LONG-TERM LIABILITIES	100,005	114,104
Product Liability Accrual, Component Amount	42,800		$ 55,100
Product Liability Contingency [Line Items]
Product Liability Accrual, Component Amount	42,800		$ 55,100
Contract with Customer, Liability, Noncurrent	11,836	16,239
Derivative [Line Items]
Derivative Liability, Noncurrent	91	167
Long Term
Accrued Liabilities [Abstract]
Product Liability Accrual, Component Amount	19,470	25,294
Product Liability Contingency [Line Items]
Product Liability Accrual, Component Amount	$ 19,470	$ 25,294

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Income Taxes Effective tax rate (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Acquisition, Contingent Consideration [Line Items]
Change in fair value of contingent earn-out	$ (15,572)	$ (4,059)	$ (12,256)	$ (31,253)
Share-based Payment Arrangement, Expense, Tax Benefit	600	$ 1,500	$ 800	4,100
contingent consideration, tax expense	0			$ 0
Return-to-Provision Tax Benefit	$ 7,500
Effective Income Tax Rate	235.00%	38.00%	70.00%	37.00%
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent			21.00%	21.00%
Share-based Payment Arrangement, Expense, Tax Benefit	$ 600	$ 1,500	$ 800	$ 4,100
contingent consideration, tax expense	0			0
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations	0		6,000
SmithsMedical
Business Acquisition, Contingent Consideration [Line Items]
Change in fair value of contingent earn-out	$ (15,600)	$ 4,100	$ 12,300	$ 31,300

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Long-Term Obligations (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
TotalSeniorSecuredCreditFacility	$ 2,200,000
Long-term Debt, Gross	1,655,375
Revolver Sub limits	50,000
Debt Issuance Costs, Gross	37,800
Leverage Ratio Calculation Ceiling Subtracted Amount	500,000
Term Loan A
Debt Instrument [Line Items]
Proceeds from Issuance of Debt	850,000
Long-term Debt, Gross	818,125	$ 834,000
Debt Issuance Costs, Gross	15,800
Long-term Debt	$ 834,200
Debt Instrument, Maturity Date	Jan. 06, 2027
Term Loan B
Debt Instrument [Line Items]
Proceeds from Issuance of Debt	$ 850,000
Long-term Debt, Gross	837,250	$ 843,625
Debt Issuance Costs, Gross	13,400
Long-term Debt	$ 836,600
Debt Instrument, Maturity Date	Jan. 06, 2029
Revolving Credit Facility
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 500,000
Debt Issuance Costs, Gross	$ 8,600

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Long-Term Obligations Interest Rate Terms (Details)	3 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Interest Percentage Added to Federal Funds Rate	0.0050
Interest Percentage Added to Base Rate	0.0100
Ter SOFR Interest Rate % Adjustment for Base Rate Loans	0.0010
Line of Credit Facility, Commitment Fee Percentage	0.25%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
Maximum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025
Applicable Margin Based on Leverage Ratio [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0025
Minimum [Member]
Debt Disclosure [Abstract]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
Applicable Margin Based on Leverage Ratio [Line Items]
Term SOFR Adjustment Interest Rate Adjustment Term SOFR Loans	0.0010
greaterthan 4to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.35%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.35%
lessthan4to1butgreaterthan3to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.30%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.30%
lessthanorequal3to1butgreaterthan2point5to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.25%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.25%
lessthanorequalto2point5to1butgreaterthan2to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.20%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.20%
lessthanorequalto2to1
Debt Disclosure [Abstract]
Line of Credit Facility, Commitment Fee Percentage	0.15%
Applicable Margin Based on Leverage Ratio [Line Items]
Line of Credit Facility, Commitment Fee Percentage	0.15%
Term Loan A
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Term Loan A | greaterthan 4to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Term Loan A | lessthan4to1butgreaterthan3to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0100
Applicable Margin Term SOFR Loans	0.0200
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0100
Applicable Margin Term SOFR Loans	0.0200
Term Loan A | lessthanorequal3to1butgreaterthan2point5to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0075
Applicable Margin Term SOFR Loans	0.0175
Term Loan A | lessthanorequalto2point5to1butgreaterthan2to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0050
Applicable Margin Term SOFR Loans	0.0150
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0050
Applicable Margin Term SOFR Loans	0.0150
Term Loan A | lessthanorequalto2to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0025
Applicable Margin Term SOFR Loans	0.0125
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0025
Applicable Margin Term SOFR Loans	0.0125
Term Loan B
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.015
Applicable Margin Term SOFR Loans	0.025
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.015
Applicable Margin Term SOFR Loans	0.025
Term Loan B | greaterthan2point75to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0150
Applicable Margin Term SOFR Loans	0.0250
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0150
Applicable Margin Term SOFR Loans	0.0250
Term Loan B | lessthan2point75to1
Debt Disclosure [Abstract]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225
Applicable Margin Based on Leverage Ratio [Line Items]
Applicable Margin Base Rate Loans	0.0125
Applicable Margin Term SOFR Loans	0.0225

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Long-Term Obligations Terminated Credit Agreement (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($)
Debt Disclosure [Abstract]
Line of Credit Facility, Maximum Borrowing Capacity	$ 150.0
Line of Credit Facility, Expiration Date	Nov. 08, 2022

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Long-Term Obligations Table (Details) - USD ($)	3 Months Ended	6 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 1,655,375,000
Line of Credit Facility, Fair Value of Amount Outstanding	0		$ 0
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	(20,443,000)		(24,262,000)
Debt, Long-term and Short-term, Combined Amount	1,634,932,000		1,653,363,000
Debt, Current	45,688,000		29,688,000
Long-term Debt	1,589,244,000		1,623,675,000
Revolving Credit Facility
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 500,000,000
Debt Instrument, Interest Rate During Period	0.00%	0.00%
Term Loan A
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 818,125,000		834,000,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 10,100,000
Debt Instrument, Interest Rate During Period	7.62%	3.99%
Term Loan B
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 837,250,000		$ 843,625,000
Debt Instrument, Unamortized Discount (Premium) and Debt Issuance Costs, Net	$ 10,300,000
Debt Instrument, Interest Rate During Period	7.96%	4.61%

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Long-Term Obligations Schedule of Maturities (Details) $ in Thousands	Sep. 30, 2023 USD ($)
LOng-Term Obligations Disclosure [Abstract]
Long-Term Debt, Maturity, Remainder of Fiscal Year	$ 7,437
Long-Term Debt, Maturity, Year One	51,000
Long-Term Debt, Maturity, Year Two	51,000
Long-Term Debt, Maturity, Year Three	72,250
Long-Term Debt, Maturity, Year Four	672,563
Long-Term Debt, Maturity, Year Five	8,500
Long-Term Debt, Maturity, after Year Five	792,625
Long-term Debt, Gross	$ 1,655,375

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Long-Term Obligations Interest Expense (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Debt Disclosure [Abstract]
Interest Expense, Debt, Excluding Amortization	$ 32,494,000	$ 19,228,000	$ 92,593,000	$ 41,868,000
Amortization of Debt Issuance Costs and Discounts	1,704,000	1,758,000	5,108,000	5,200,000
Line of Credit Facility, Commitment Fee Amount	384,000	334,000	1,135,000	994,000
Interest Expense, Debt	$ 34,582,000	$ 21,320,000	$ 98,836,000	$ 48,062,000

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Long-Term Obligations Principal Payment (Details)	3 Months Ended	9 Months Ended
	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)
Debt Disclosure [Abstract]
Term A principal payment % First 2 Years		0.0250
Term A Principal Payment % Year 3 and 4		0.0500
Term A Principal Payment % in Year 5		0.0750
Term Loan B Principal Payment %		0.0025
Debt Instrument, Periodic Payment, Principal	$ 16,000,000	$ 22,300,000	$ 20,300,000

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Commitments and Contingencies Contingency (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Jan. 06, 2022
Business Acquisition, Contingent Consideration [Line Items]
Contingent Consideration, Gross ST	$ 1,000
Contingent Consideration, Gross LT	1,500
Product Liability Accrual, Component Amount	42,800	$ 42,800	$ 55,100
SmithsMedical
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross	100,000
Business Combination, Contingent Consideration, Liability	7,100	7,100	$ 53,500
Foreign Infusion System Supplier
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross	2,500
Business Combination, Contingent Consideration, Liability	1,500	1,500
International Distributor
Business Acquisition, Contingent Consideration [Line Items]
contingent consideration gross		6,000
Business Combination, Contingent Consideration, Liability	$ 4,300	$ 4,300

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Collaborative and Other Arrangements (Details) $ in Millions	Sep. 30, 2023 USD ($)
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Purchase Commitment, Remaining Minimum Amount Committed	$ 29.6

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Equity (Details) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2023 USD ($) shares	Sep. 30, 2022 USD ($) shares
Equity [Abstract]
Treasury Stock Purchase Plan	$ 100,000	$ 100,000
Stock Repurchase Program, Remaining Authorized Repurchase Amount	$ 100,000	$ 100,000
Share-based Payment Arrangement, Shares Withheld for Tax Withholding Obligation | shares		58,089	45,370
Payment, Tax Withholding, Share-based Payment Arrangement		$ 9,221	$ 10,541
Smiths Group Ownership % Acquisition Shares Issued	0.105	0.105
Smiths Group Ownership % Required for Board Representation	0.050

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Equity Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022		Dec. 31, 2021
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	$ (84,727)	$ (48,794)	$ (61,603)	$ (165,682)	$ (92,275)	$ (628)	$ (84,727)	$ (165,682)	$ (80,978)	[1]	$ (19,269)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(26,768)	20,710	24,839	(71,538)	(89,546)	20,851
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(9,165)	(7,901)	(5,464)	(1,869)	(2,101)	(2,210)
Other Comprehensive income (loss), net of Tax	(35,933)	12,809	19,375	(73,407)	(91,647)	18,641	(3,749)	(146,413)
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	(127,978)	(90,421)	(97,990)	(214,345)	(123,796)	(23,991)	(127,978)	(214,345)	(122,973)		(19,045)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(37,557)	7,569	24,983	(90,549)	(99,805)	(4,946)
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0	0	0	0
Other Comprehensive income (loss), net of Tax	(37,557)	7,569	24,983	(90,549)	(99,805)	(4,946)
Accumulated Net Gain (Loss) from Cash Flow Hedges Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	42,135	40,476	35,202	48,394	31,479	23,335	42,135	48,394	40,779		(237)
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	10,824	13,175	(113)	18,784	10,245	25,782
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	(9,165)	(7,901)	(5,464)	(1,869)	(2,101)	(2,210)
Other Comprehensive income (loss), net of Tax	1,659	5,274	(5,577)	16,915	8,144	23,572
Accumulated Defined Benefit Plans Adjustment Attributable to Parent [Member]
Accumulated Other Comprehensive Income (Loss) [Line Items]
Accumulated other comprehensive loss	1,116	1,151	1,185	269	42	28	$ 1,116	$ 269	$ 1,216		$ 13
Other Comprehensive Income (Loss), before Reclassifications, Net of Tax	(35)	(34)	(31)	227	14	15
Reclassification from Accumulated Other Comprehensive Income, Current Period, Net of Tax	0	0	0	0	0	0
Other Comprehensive income (loss), net of Tax	$ (35)	$ (34)		$ 227	$ 14	$ 15
Other Comprehensive (Income) Loss, Defined Benefit Plan, after Tax and Reclassification Adjustment, Attributable to Parent			$ (31)

[1] December 31, 2022 balances were derived from audited consolidated financial statements.

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Transfers and Servicing (Details) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2023 USD ($)
Transfers and Servicing [Abstract]
Transfer of Financial Assets Accounted for as Sales, Cash Proceeds Received for Assets Derecognized, Amount	$ 62.4	$ 62.4
Proceeds from Sale and Collection of Receivables		450.0
Cash Remitted to Purchaser		390.2
Accounts Receivable, Sale		452.6
Gain (Loss) on Sale of Accounts Receivable	1.0	2.7
Financing Receivable, Revolving	$ 150.0	$ 150.0