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GOODWILL AND OTHER INTANGIBLE ASSETS
9 Months Ended
Sep. 30, 2019
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets
GOODWILL AND OTHER INTANGIBLE ASSETS

Changes in the carrying amount of goodwill consists of the following activity for the three and nine months ended September 30, 2019 (in thousands):
Three Months Ended September 30, 2019
June 30, 2019 - net book value
 
$
632,469

Acquisitions
 
786,904

September 30, 2019 - net book value
 
$
1,419,373

 
 
 
Nine Months Ended September 30, 2019
December 31, 2018 - net book value
 
$
632,469

Acquisitions
 
786,904

September 30, 2019 - net book value
 
$
1,419,373


Changes in the carrying amount of goodwill consists of the following activity for the three and nine months ended September 30, 2018 (in thousands):
Three Months Ended September 30, 2018
June 30, 2018 - net book value
 
$
627,392

Acquisitions
 
4,492

September 30, 2018 - net book value
 
$
631,884

 
 
 
Nine Months Ended September 30, 2018
December 31, 2017 - net book value
 
$
627,392

Acquisitions
 
4,492

September 30, 2018 - net book value
 
$
631,884



The carrying amount and accumulated amortization of intangible assets consists of the following as of September 30, 2019 and December 31, 2018 (in thousands):
 
 
September 30, 2019
 
December 31, 2018
Gross intangible assets:
 
 
 
 
Referral sources
 
$
438,445

 
$
257,792

Trademarks/names
 
44,702

 
32,000

Other amortizable intangible assets
 
379

 
4,151

Total gross intangible assets
 
483,526

 
293,943

 
 
 
 
 
Accumulated amortization:
 
 
 
 
Referral sources
 
(77,749
)
 
(63,353
)
Trademarks/names
 
(10,657
)
 
(8,000
)
Other amortizable intangible assets
 
(42
)
 
(2,877
)
Total accumulated amortization
 
(88,448
)
 
(74,230
)
Total intangible assets, net
 
$
395,078

 
$
219,713



Amortization expense for intangible assets was $7.5 million and $17.3 million for the three and nine months ended September 30, 2019, respectively. Amortization expense for intangible assets was $4.9 million and $14.7 million for the three and nine months ended September 30, 2018, respectively.
The weighted average amortization period of intangible assets by class and in total as of September 30, 2019 are as follows: 17.1 years for referral sources, 4.1 years for trademarks/names, 1.5 years for other amortizable intangible assets, and 15.9 years for total intangible assets.