Intangible Assets, Gross (Excluding Goodwill)

5,627.0

$ 5,423.6

Adjustments to goodwill

(312.6)

Finite-Lived Intangible Assets, Accumulated Amortization

1,819.2

1,688.1

Goodwill, Acquired During Period

571.3

Goodwill and Intangible Assets, Goodwill, Policy

5. GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the nine months ended September 30, 2022, are as follows:



	Dx		DD		Total

Balance as of December 31, 2021	$	4,046.2	$	3,912.7	$	7,958.9
Goodwill acquired during the period	453.5		117.8		571.3



Foreign currency impact and other adjustments to goodwill	(70.2)		(242.4)		(312.6)
Balance as of September 30, 2022	$	4,429.5	$	3,788.1	$	8,217.6

The Company assesses goodwill and indefinite-lived intangibles for impairment at least annually or whenever events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable. The Company recognizes an impairment charge for the amount by which the reporting unit's carrying amount exceeds its fair value.

Although the Company believes that the current assumptions and estimates used in its goodwill analysis are reasonable, supportable, and appropriate, the Company's business could be impacted by unfavorable changes, including those that impact the existing assumptions used in the impairment analysis. Various factors could reasonably be expected to unfavorably impact existing assumptions: primarily a worsening economic environment and protracted economic downturn and related impacts, including delays in revenue from new customers; increases in customer termination activity, or increases in operating costs. Accordingly, there can be no assurance that the estimates and assumptions made for the purposes of the goodwill impairment analysis will prove to be accurate predictions of future performance.

The Company will continue to monitor the financial performance of, and assumptions for, its reporting units. A significant increase in the discount rate, decrease in the revenue and terminal growth rates, decreased operating margin, or substantial reductions in end markets and volume assumptions, could have a negative impact on the estimated fair value of the reporting units. A future impairment charge for goodwill or intangible assets could have a material effect on the Company's consolidated financial position and results of operations.

The components of identifiable intangible assets are as follows:


	September 30, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net		Gross Carrying Amount		Accumulated Amortization		Net
Customer relationships	$	4,413.0	$	(1,466.1)	$	2,946.9	$	4,336.0	$	(1,362.1)	$	2,973.9
Patents, licenses and technology	582.8		(293.7)		289.1		484.6		(267.4)		217.2
Non-compete agreements	114.3		(45.0)		69.3		70.2		(35.5)		34.7
Trade name	24.2		(1.2)		23.0		19.8		(15.5)		4.3
Land use right	10.3		(8.4)		1.9		10.4		(7.6)		2.8
Canadian licenses	468.1		—		468.1		493.5		—		493.5
Other	14.3		(4.8)		9.5		9.1		—		9.1
	5,627.0		(1,819.2)		3,807.8		5,423.6		(1,688.1)		3,735.5

Amortization of intangible assets for the three and nine months ended September 30, 2022, and 2021, was $65.2 and $92.2 and $198.7 and $276.7, respectively. The amortization expense for the net carrying amount of intangible assets is estimated to be $58.6 for the remainder of fiscal 2022, $264.4 in fiscal 2023, $258.9 in fiscal 2024, $244.2 in fiscal 2025, $234.5 in fiscal 2026, and $2,194.2 thereafter.