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GOODWILL AND OTHER INTANGIBLE ASSETS
 12 Months Ended
Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets GOODWILL AND OTHER INTANGIBLE ASSETS
Goodwill is not amortized, but is evaluated for impairment annually in the fourth quarter of the fiscal year, or more frequently if an event occurs or circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying value.
Circumstances that could trigger an interim impairment test include: a significant adverse change in the business climate or legal factors; an adverse action or assessment by a regulator; unanticipated competition; the loss of key personnel; a change in reporting units; the likelihood that a reporting unit or significant portion of a reporting unit will be sold or otherwise disposed of; and the results of testing for recoverability of a significant asset group within a reporting unit.
A qualitative impairment analysis was performed in the fourth quarter of 2022, 2021 and 2020, to assess whether it is more likely than not that the fair value of the Company’s reporting unit is less than its carrying value. The Company assessed relevant events and circumstances including macroeconomic conditions, industry and market considerations, overall financial performance, entity-specific events, and changes in the Company’s stock price. The Company determined that there was no goodwill impairment in 2022, 2021 or 2020.
The determination of fair value for acquisitions and the allocation of that value to individual assets and liabilities within the reporting unit requires the Company to make significant estimates and assumptions. These estimates and assumptions primarily include, but are not limited to, the selection of appropriate peer group companies; control premiums appropriate for acquisitions in the industries in which the Company competes; the discount rate; terminal growth rates; and forecasts of revenue, operating income, depreciation and amortization, and capital expenditures. Actual financial results could differ from those estimates due to the inherent uncertainty involved in making such estimates. Changes in assumptions concerning future financial results or other underlying assumptions could have a significant impact on either the fair value of the reporting unit, the amount of the goodwill impairment charge, or both. The Company did not recognize any accumulated impairment losses at the beginning of the period.
Changes in the carrying amount of goodwill consist of the following activity for the years ended December 31, 2022, 2021 and 2020 (in thousands):
Balance at December 31, 2019$1,425,542 
Purchase accounting adjustments3,068 
Balance at December 31, 2020$1,428,610 
Acquisitions48,954 
Balance at December 31, 2021$1,477,564 
Acquisitions54,543 
Purchase accounting adjustments1,317 
Balance at December 31, 2022$1,533,424 
    
The carrying amount and accumulated amortization of intangible assets consists of the following as of December 31, 2022 and 2021 (in thousands):
December 31, 2022December 31, 2021
Gross intangible assets:
Referral sources$509,646 $482,200 
Trademarks/names38,508 47,718 
Other amortizable intangible assets912 1,037 
Total gross intangible assets549,066 530,955 
Accumulated amortization:
Referral sources(167,902)(137,613)
Trademarks/names(16,901)(26,936)
Other amortizable intangible assets(148)(386)
Total accumulated amortization(184,951)(164,935)
Total intangible assets, net$364,115 $366,020 
Amortization expense for intangible assets was $32.9 million, $32.9 million and $35.1 million for the years ended December 31, 2022, 2021 and 2020, respectively.
Expected future amortization expense for intangible assets recorded at December 31, 2022, is as follows (in thousands):
Amount
2023$33,747 
202433,738 
202533,737 
202633,737 
202733,597 
2028 and beyond195,559 
Total$364,115